Sarcoidosis Flashcards
What is sarcoidosis?
Disease which causes inflammation and granuloma formation throughout the body.
What is a granuloma?
A nodule of inflammation which is full of macrophages.
What is the cause of sarcoidosis?
Unknown
Which 2 ages are there spikes in the incidence of sarcoidosis?
young adult hood
60yrs
What are the risk factors for sarcoidosis?
Afrocaribbean ethnicity
Women
young adult (20-40)
60yrs
How many people with sarcoidosis are asymptomatic?
50%
What are the signs and symptoms in the lungs?
dry cough
reduced exercise tolerance
crepitations on examination
mediastinal lymphadenopathy
dyspnoea
pulmonary fibrosis
pulmonary nodules
What are the systemic signs and symptoms of sarcoidosis?
Weight loss
fever
lymphadenopathy
fatigue
swollen parotid glands
What are the signs and symptoms in the liver?
Cirrhosis
hepatomegaly
nodules
cholestasis
What are the signs and symptoms in the eyes?
Uveitis
Optic neuritis
conjunctivitis
Which condition is usually associated with optic neuritis?
Multiple sclerosis
What are the signs and symptoms in the heart?
Heart failure (reduced myocardial function)
Arrhythmias
bundle branch block
heart block
What are the signs and symptoms in the kidneys?
Splenomegaly
Kidney stones (due to hypercalcaemia)
Interstitial nephritis
What can be seen in the nervous system?
BILATERAL bells palsy
nodules
meningitis
diabetes insipidus
encephalopathy
What signs and symptoms can be seen in the bones?
Arthritis
Arthralgia
myopathy
What is the name for acute sarcoidosis?
Lofgrens syndrome
What 4 things are seen in lofgrens syndrome?
Fever
erythema nodosum
bilateral hilar lymphadenopathy
polyarthralgia
What signs and symptoms are seen in the skin?
Erythema nodosum - very common
Lupus pernio (purple on tips of nose and cheeks)
granulomas in scar tissue
What investigations can be done?
Serum ACE - raised
Serum calcium - raised
Soluble interlukin 2 - raised
CRP - raised
Immunoglobulins - raised
ESR - raised
Chest X ray
CT
Biopsy
What is the gold standard investigation for diagnosis?
Biopsy - for histology
Which cells are seen in histology?
Non-caseating granulomas with epitheliod cells
How is a biopsy of the chest done?
Ultrasound guided bronchoscopy
What is the 1st line treatment for those with none/mild symptoms?
no treatment
condition often resolves spontaneously
how many people with sarcoidosis resolve spontaneously?
60% within 6 months
what is the treatment for sarcoidosis with symptoms?
1st line - oral steroids 6-24 months
2nd line - immunosuppressants (methotrexate or azothiaprine)
What is prescribed alongside oral steroids?
Bisphosphonates
What is the treatment for severe pulmonary disease?
lung transplant
What is the treatment for lofgrens syndrome?
NSAIDs
bed rest
What is a common cause of death as a result of sarcoidosis?
CNS problems
Fatal heart arrhythmias
