Sarcoidosis

Question 1

What is sarcoidosis

Answer 1

Multi-system granulomatous disorder of unknown cause associated with HLA-DRB1 and DQB1

Question 2

Sarcoidosis presentation

Answer 2

Often asymptomatic
Acute presents with:
Fever
Erythema nodosum
BHL
Polyarthralgia

Dry cough
Progressive dyspnoea/dec exercise tolerance
Chest pain

Lots of extra pulmonary signs

Question 3

Sarcoidosis investigations

Answer 3

Raised ESR, LFTs and Ca

CXR shows BHL, pulmonary infiltrates and honeycombing depending on stage
XR shows punched out lesions on terminal phalanges
Tissue biopsy diagnostic with non-caseating granulomas

Lung FTs may be normal or show reduced lung volumes and a restrictive ventilatory defect

Question 4

Sarcoidosis staging

Answer 4

CXR staging
0 - normal
1 - BHL
2 - BHL + peripheral pulmonary infiltrates
3 - peripheral pulmonary infiltrates alone
4 - progressive pulmonary fibrosis, bulla formation (honey combing), pleural involvement

Question 5

Sarcoidosis management stage 1 or 0

Answer 5

Bed rest
NSAIDs
Spontaneously recover

Question 6

Sarcoidosis management corticosteroid indications

Answer 6

Pred 40mg/d PO 4-6wks

Parenchymal lung disease
Uveitis
Hypercalcaemia
Neuro/cardio involvement

Question 7

Sarcoidosis management stage 2+ (severe illness)

Answer 7

IV methylprednisolone
Immunosuppressants
Anti-TNF-alpha
Lung transplant

Question 8

Sarcoidosis prognosis

Answer 8

60% with thoracic resolve over 2yrs
20% respond to steroids
In the rest improvement unlikely despite therapy