Sarcoidosis – Diagnosis and Treatment

Diagnosis

Sarcoidosis is a disease that can affect many parts of the body. It often goes undetected early on because its signs can be mild or look like other illnesses.

Health care professionals use a detailed approach to find out if someone has sarcoidosis.

They start by asking about symptoms such as cough, joint pain, or skin changes. The doctor checks for signs, including swollen lymph nodes, skin lesions like erythema nodosum, or problems in the lungs, liver, spleen, and heart.

A chest X-ray is often the first test because many cases show enlarged lymph nodes near the lungs. A CT scan of the chest gives a closer look at lung or lymph node problems.

Other tests include:

• Blood Tests: Check for inflammation or organ problems, especially liver and kidney function.
• Pulmonary Function Tests: Measure lung strength and how well the lungs deliver oxygen.
• Heart Exams: An EKG or ultrasound checks heart rhythm and structure.
• Eye Exams: Detect if the eyes are affected, as sarcoidosis may cause vision issues.

Doctors look for signs of granulomatous disease in organ systems such as the lungs, skin, joints, spleen, and nervous system (neurosarcoidosis).

They also rule out other inflammatory diseases and conditions that look similar (differential diagnosis), such as tuberculosis or chronic infections.

Tissue Sampling to Confirm Sarcoidosis

Doctors often perform a tissue sample test to diagnose sarcoidosis. They take a small piece of tissue (biopsy) from an organ or area where the disease may be active, such as the lungs, skin, or swollen lymph nodes.

A specialist examines the sample under a microscope for small collections of inflammatory cells, called granulomas, which are a key sign of sarcoidosis.

When doctors find granulomas in a biopsy and rule out other causes, they can support the diagnosis. Biopsies help confirm sarcoidosis when a person has signs in more than one organ system or when the clinical presentation is not clear.

Treatment

Types of Medication

Doctors select medicines for sarcoidosis based on symptoms and which body systems are affected. The main group of medicines used to manage this disease is corticosteroids.

These drugs reduce inflammation, which can improve problems such as shortness of breath, chest pain, and joint discomfort. Corticosteroids come in different forms—tablets, injections, inhalers for the lungs, creams for skin rashes, and eye drops for uveitis or eye inflammation.

If corticosteroids alone do not control symptoms or cause negative side effects, doctors may add other medicines that suppress the immune system.

Doctors may prescribe immunosuppressive medications when people experience ongoing symptoms such as fatigue, joint pain, or vision changes. These drugs are often considered when vital organs like the eyes or lungs are affected.

For issues like skin rashes or elevated blood calcium levels, antimalarial agents may be used. In more severe cases or when there’s a risk of relapse, tumor necrosis factor-alpha (TNF-alpha) inhibitors might be recommended if standard therapies are ineffective.

Additional Options and Supportive Care

Some people need treatments outside of medicine to manage symptoms like malaise, joint problems, or pulmonary hypertension. Physical therapy helps fight muscle weakness and tiredness.

Pulmonary rehabilitation benefits patients with breathing problems or limited endurance due to lung involvement, even if a person develops cor pulmonale.

If the heart is affected—such as with arrhythmias—a pacemaker or defibrillator may be necessary.

For those whose lungs or other organs are badly damaged by sarcoidosis, doctors may consider a lung transplant or other organ transplant, especially for advanced cases or if there is severe lupus pernio.

Regular Checkups and Life-Long Monitoring

People with sarcoidosis need ongoing medical follow-up, whether they are on treatment or in spontaneous remission. Symptoms can come and go, and possible relapses may occur even after years without trouble.

Regular appointments help doctors spot new problems early, such as blurred vision, kidney function decline, or inflammation returning.

Follow-up can involve:

• Blood and urine analysis
• Eye checks for uveitis and vision problems
• Chest X-rays to see if lung issues have improved or worsened
• Tests for heart rhythm issues
• Examinations of the liver, skin, and other organs

Keeping up with these checkups enables healthcare teams to catch and treat complications quickly, improve quality of life, and watch for rare problems like pulmonary hypertension or fever.

Practical Steps for Self-Care

Following a healthcare provider’s instructions can make a big difference. Taking medications as directed and attending regular check-ups helps in managing symptoms better.

Reporting any new or worsening issues is important for timely care. Healthy daily choices matter. Eating balanced meals, dealing with stress, reaching or keeping a healthy weight, and getting enough rest all help with overall well-being.

Physical activity boosts energy and helps maintain muscle strength. Exercise can reduce feelings of tiredness.

Avoid substances that may irritate the lungs, such as smoke, dust, or chemicals. Those who smoke should ask their healthcare provider about support for quitting. Making these changes supports daily comfort and health.

Ways to Manage and Find Support

Living with sarcoidosis can cause daily changes or even disability. People can benefit from talking with a mental health professional when feeling overwhelmed.

Connecting with a support group helps many adjust and share advice.

Getting Ready for Your Visit

Steps to Take Before Your Appointment

Preparing ahead for a healthcare provider visit is helpful. Many people with sarcoidosis see a specialist in lung care, known as a pulmonologist, but some may also meet with heart doctors (cardiologists) or other types of specialists.

Use the tips below to make the most of your visit:

• Write Down Your Symptoms: Track when each symptom started, how they have changed, and if anything makes them better or worse.
• List Your Medications and Supplements: Write down everything you take, including medicine, vitamins, and herbal products. Be sure to include the dosage of each one.
• Gather Important Health Details: Make a note of other health issues or conditions you have had.
• Prepare Questions for Your Specialist: Answers to your questions can help you feel prepared.
  • What is the possible cause of my health issues?
  • What tests do I need and how should I get ready for them?
  • Could you explain the treatment options?
  • Are there side effects I should watch for?
  • How long will I need this treatment?
  • How can I manage my other medical problems together with this condition?
• Bring Someone With You: Consider asking a family member or friend to join you. They can help remember what is said.

A sample checklist:

To-Do Item	Example
List symptoms	Shortness of breath, cough, fatigue
Bring medicine list	Prednisone 20 mg, Vitamin D, etc.
Note other conditions	Diabetes, high blood pressure
Write questions	“What will my treatment options be?”
Ask for printed resources	Pamphlets or reliable websites
Support person	Friend or family member

What Your Healthcare Provider May Ask

During the appointment, specialists like pulmonologists or cardiologists usually ask questions to better understand your health. Being ready with answers helps you focus your visit on the most important topics. Some questions they might ask:

• What symptoms do you have, and when did they start?
• Do certain activities, jobs, or substances make your symptoms worse?
• What other health conditions do you have now or did you have before?
• Has anyone in your family had sarcoidosis?
• What medicines or supplements do you use?
• Have you ever worked with or been exposed to chemicals, dust, or fumes?
• Have you had any recent illnesses or infections?