Sarcoidosis Flashcards
What is sarcoidosis
multisystem disorder of unknown aetiology characterised by non-caseating granulomas
Population most commonly affected by sarcoidosis
More common in young adults and in people of African descent
Acute features of sarcoidosis
erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
Skin manifestation of sarcoidosis
Lupus pernio
Erythema nodosum
Granulomas develop in scar tissue
What causes hypercalcaemia in sarcoidosis
Macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)
Syndromes associated with sarcoidosis
Lofgren’s syndrome
Mikulicz syndrome
Heerfordt’s syndrome
What is lofgren’s syndrome
acute form of the disease characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia
Sarcoidosis ix
Serum ACE May show hypercalcaemia Raised ESR CXR Raised serum soluble interleukin-2 receptor
What might spirometry show in sarcoidosis
May show a restrictive defect
How does sarcoidosis affect the lungs
Mediastinal lymphadenopathy
Pulmonary fibrosis
Pulmonary nodules
How does sarcoidosis affect the liver
Liver nodules
Cirrhosis
Cholestasis
How does sarcoidosis affect the eyes
Uveitis
Conjunctivitis
Optic neuritis
What is lupus pernio
Raised purple skin lesions commonly on cheeks and nose
How does sarcoidosis affect the heart
Bundle branch block
Heart block
Myocardial muscle involvement
How does sarcoidosis affect the kidneys
Kidney stones (due to hypercalcaemia)
Nephrocalcinosis
Interstitial nephritis
How does sarcoidosis affect the CNS
Nodules
Pituitary involvement (diabetes insipidus)
Encephalopathy
How does sarcoidosis affect the PNS
Facial nerve palsy
Mononeuritis multiplex
What is mononeuritis multiplex
painful, asymmetrical, asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas.
How does sarcoidosis affect the bones
Arthralgia
Arthritis
Myopathy
Gold standard for confirming sarcoidosis
Histology from a biopsy
Treatment for sarcoidosis in patients with no or mild symptoms
No treatment is considered as first line in patients with no or mild symptoms as the condition often resolves spontaneously.
1st line treatment for sarcoidosis when required
Oral steroids are usually first line where treatment is required and are given for between 6 and 24 months. Patients should be given bisphosphonates to protect against osteoporosis whilst on such long term steroids.
Second line options are methotrexate or azathioprine
Intervention in severe pulmonary disease in sarcoidosis
Lung transplant
