Sarcoid Flashcards
What is sarcoidosis?
A rare multisystem granulomatous disorder of unknown aetiology
What are risk factors for developing sarcoidosis?
- 20-40yrs
- Female
- African-Carribeans
- Family history
How does sarcoidosis manifest in the lungs?
- Interstitial lung disease
- Bilateral hilar lymphadenopathy
How does acute sarcoidosis present?
- Fever
- Erythema nodosum
- Polyarthralgia
How does sarcoidosis usually present?
It doesn’t - patients are usually asymptomatic.
Found incidentally on a CXR.
How does ocular sarcoidosis present?
- Uveitis (iris, ciliary body and choroid)
- Pain, redness, photophobia, floaters, visual loss
- Secondary glaucoma
How does cutaneous sarcoidosis present?
- Papular sarcoidosis - On head and neck
- Erythema nodosum
- Lupus pernio (pathognomonic)
How else can sarcoidosis present?
- Hypercalcaemia
- Renal disease (stones, interstitial nephritis)
- Bone cysts
- Hepatosplenomegaly
- Cardiac - Arrythmia, cardiomyopathy, heart failure
What pattern of spirometry will sarcoidosis show?
- Restrictive due to pulmonary infiltrates and fibrosis
What bedside tests should you do?
- Observations
- Spirometry
- Mantoux test
- ECG - Arrythmias or bundle branch block
What blood tests would you request?
- FBC - lymphopenia
- U+E
- LFT - Raised
- ESR/CRP - raised
- Bone profile - Hypercalcaemia
- Serum ACE - Raised in about 70% and levels show response to treatment. Cannot be used diagnostically.
What imaging can be used to diagnose sarcoidosis?
- CXR
- HRCT
What is needed to absolutely confirm the disease?
- Bronchoalveolar lavage - Increased lymphocytes and neutrophils
- Transbronchial biopsy - Non caseating granuloma
What staging is used in sarcoidosis?
Scadding staging - based upon CXR findings. Shows chance of spontaneous reolution.
When will patients not require active treatment?
If they only have bilateral hilar lymphadenopathy
What is the treatment for acute sarcoidosis?
NSAIDS and bed rest
What is the indication for active treatment?
- Progressive lung fibrosis
- Uveitis
- Hypercalcaemia
- Neurological or cardiac involvement
- Potential danger of fatal outcome/permanent disability/unacceptable loss of quality of life
What is the pharmacological treatment for sarcoidosis?
What is the regimen?
Prednisolone
High dose induction, dose tapering (for 1 yr) then maintenance dose
What is the prognosis for sarcoidosis?
- 60% of cases with thoracic sarcoidosis spontaneously resolve over 2years
- 20% respond to steroid therapy
