Sarcoidosis Flashcards
What is sarcoidosis?
Multisystem disorder characterised by non-caseating granulomas
Common in young adults and African ethnicity
What is the pathophysiology of sarcoidosis?
Exaggerated immune response leading to formation of non-caseating granulomas
Non-caseating granulomas do not contain necrotic tissue, only immune cells
What can non-caseating granulomas progress to?
Fibrosis and organ dysfunction
What are the acute symptoms of sarcoidosis?
Erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
What are the insidious symptoms of sarcoidosis?
Dyspnoea, non-productive cough, malaise, weight loss
What ocular symptom is associated with sarcoidosis?
Uveitis
What skin symptom is associated with sarcoidosis?
Lupus pernio
What metabolic abnormality can occur in sarcoidosis?
Hypercalcaemia
What causes hypercalcaemia in sarcoidosis?
Macrophages inside the granulomas increase conversion of Vitamin D to active Vitamin D. More Vitmain D leads to increased bone reabsopption….Increases Ca2+ in serum.
What is Lofgren’s syndrome?
ACUTE form of sarcoidosis with good prognosis characterised by BHL, erythema nodosum, fever, polyarthralgia
What is Mikulicz syndrome?
Types of sarcoidosis where you also get enlargement of parotid and lacrimal glands
What is Heerfordt’s syndrome?
Sarcopidosis subtype with parotid enlargement, fever, uveitis (red eye)
What is a common finding in sarcoidosis investigations?
- High serum ACE levels in granulomatous-inflammatory disease
- Hypercalcaemia (U&Es)
- ESR raised
What imaging is commonly used in sarcoidosis?
Chest X-ray (CXR)
What spirometry pattern is associated with sarcoidosis?
Restrictive pattern with normal or increased FEV1/FVC ratio
What is the first-line management for symptomatic/progressive sarcoidosis?
Prednisolone (20-40mg daily + taper with response)
What are the second-line treatments for sarcoidosis?
Immunosuppressive drugs: Methotrexate, Azathioprine, Mycophenolate mofetil
What is the third-line treatment for multi/severe organ involvement in sarcoidosis?
TNF-alpha inhibitors: Infliximab, Adalimumab
What factors are associated with poor prognosis in sarcoidosis?
Insidious onset, symptoms > 6 months, absence of erythema nodosum, extrapulmonary manifestations, CXR stage III-IV features, black African or African-Caribbean ethnicity
Fill in the blank: Sarcoidosis is characterised by _______.
non-caseating granulomas
