Sarcoidosis

Question 1

What is the epidemiology of sarcoidosis?

Answer 1

5-40 cases per 100,000

Bimodal ages peaks in the 30s and 50s

Question 2

What is the pathophysiology of sarcoidosis?

Answer 2

Sarcoidosis involves a multisystem inflammatory response that is predominantly T cell in nature (commonly CD4)

TNF and B cells also play a role

No viral, bacterial or parasitic antigen has been identified

It is not malignant or autoimmune

Question 3

What is Lofgren’s syndrome?

Answer 3

Fever

Bilateral hilar lymphadenopathy

Polyathralgias

Erythema nodosum

Question 4

How does sarcoid present?

Answer 4

It is a multisystem disease so potentially in any way, however commonly it is with:

• Pulmonary symptoms - exertional SOB, chest pain, cough
• Arthralgias
• Constitutional symptoms - Fever, malaise, weight loss
• Lofgren’s syndrome
• Cutaneous: Erythema nodosum, lower extremity panniculitis, lupus pernio
• Uveitis

Question 5

How do you Ix sarcoidosis?

Answer 5

CXR

FBE

UEC

CMP

LFTs

ECG

Serum ACE

Question 6

How is sarcoid Mx?

Answer 6

>75% patients require only symptomatic treatment with NSAIDs

Cutaneous steroids for cutaneous manifestations

Oral corticosteroids for systemic disease

Methotrexate is an alternative to steroids