Sarcoidosis is more prevalent in African Americans than Caucasians, and often African Americans experience more severe symptoms. Affected individuals are usually over the age of 20. Women are more likely to develop sarcoidosis versus men.

The highest prevalence is seen in Northern European countries, 5 to 40 cases per 100,000 people. In Japan, it is 1 to 2 cases per 100,000 people. In the United States, the incidence among African Americans is approximately 35.5 cases per 100,000 and approximately 10.9 per 100,000 for Caucasians.

The underlying cause of sarcoidosis is unknown. Inherited genes and environmental triggers can cause the immune system to have an inflammatory response. There are no specific gene mutations that can cause sarcoidosis. It can sometimes run in the family; there is a genetic tendency to develop the disease. Environmental triggers such as, bacteria, viruses, or chemicals can cause the immune system to activate, leading to inflammation, and leading to granuloma formation in the organs.

There are some risk factors that can increase a person’s chance of developing sarcoidosis. Risk factors include age, family history or genetics, environment or occupation, race or ethnicity, gender, and other medical conditions.

Sarcoidosis often occurs in women, ages 20 to 40, in certain ethnic groups. Sarcoidosis is highest in African Americans and Northern Europeans, specifically Scandinavians.

Many affected individuals with sarcoidosis are asymptomatic; meaning they have no signs or symptoms and feel fine. Some affected individuals may have flu-like symptoms, such as a fever, night sweats, wheezing, cough, congestion, and fatigue. Other affected individuals with experience symptoms depending on the affected organ that the granulomas are clustered at. If inflammation continues on an area or an organ, many individuals develop permanent scarring. Permanent scarring can be life threatening if it affects the heart or the lungs.

Sarcoidosis can affect any organ, but it primarily affects the lungs. The most common symptom is flu-like symptoms. Other symptoms include, depression, weight loss, chest pain, skin rashes or bumps on the skin, joint pain and stiffness, eye irritation and dryness, increased heart rate or palpitations, lightheadedness, kidney stones, increased calcium in the blood, and abnormal liver function.

Other symptoms related to specific organs are abdominal pain, enlarged spleen, anemia, muscle weakness, enlarged liver accompanied by nausea/vomiting and jaundice, issues with the nervous system, skin changes, swollen salivary glands, and swollen or tender lymph nodes.

There are many complications of sarcoidosis, especially if it is left untreated or treatment does not work. The inflammation can continue and cause scarring. Life threatening scarring on organs can cause blindness, blood and bone marrow problems, endocrine system issues (high calcium in blood, diabetes insipidus, and amenorrhea), heart complications, kidney dysfunction, cirrhosis or liver disease, lung diseases, or head complications, such as brain tumors, meningitis, and psychiatric problems.

In diagnosing an individual with sarcoidosis, the physician has to rule out any other causes or diseases. To rule out other diseases, a blood tests, a bronchoscopy, environmental questionnaire, and a urinalysis are performed. The diagnose sarcoidosis, the physician observes symptoms present and performs a physical exam, imaging tests, and/or a biopsy of an affected organ.

There are five different stages of sarcoidosis. These stages indicate where the granulomas are located. Stage 0 to III can range from mild to severe. Stage IV is most severe.

• Stage 0 is no pulmonary sarcoidosis; there is no sign of granulomas in the lungs or lymph nodes.
• Stage I is lymphadenopathy; there are granulomas in the lymph nodes only.
• Stage II is lymphadenopathy and pulmonary infiltrates; there are granulomas in both the lymph nodes and the lungs.
• Stage III is pulmonary infiltrates; there are granulomas in the lungs only.
• Stage IV is pulmonary fibrosis; there is permanent scarring of the lung tissue and is life-threatening.

There are many common tests that is used to diagnose sarcoidosis.

• Chest X-ray – an x-ray of the lungs can show sarcoidosis and/or scarring of the lung tissues
• CT scans – CT scans the cross-section of the body and requires contrast dies. It can show images of the lungs and the lymph nodes
• Pulmonary function tests – PFTs measure the amount and speed of air that the person blows out. It gives data on how well the lungs are working.
• Lung biopsy – if pulmonary fibrosis is suspected, the physician can order a lung biopsy to get a small sample of the lung tissue. The tissue is analyzed in a laboratory for signs of sarcoidosis and scarring.
• Echocardiogram – EKG is an ultrasound of the heart. It checks how the heart is working and pumping blood.
• Eye exam – examines the eyes to see if sarcoidosis has affected the eyes
• Blood test – these laboratory tests check to see if there are signs of inflammation, high calcium in the blood, kidney function, and liver function

Not all affected individuals that are diagnosed with sarcoidosis need treatment. For others, the condition can go away on its own as well. Sarcoidosis cannot be completely cured or eliminated, but many affected individuals can achieve remission. Remission is a state of the condition where it is not causing problems or manifesting symptoms. Some selected individuals may not respond well to treatment or not at all.  

All treatment depends on the affected individuals’ symptoms, which organs are affected, and which organ are working well.  Since sarcoidosis is a condition where the immune system is overactive and forming granulomas, medications used to treat sarcoidosis turns down or slows down the immune system’s activity.

The most common type of medicine used is steroids. Steroids turn off the immune system, reduces inflammation, controls cough and shortness of breath, alleviates skin rashes, and helps with joint pain. Prednisone is the most common steroid used. Prednisone can be taken as a pill, injected, inhaled, or as an eyedrop. There can be long-term side effects when using steroids long-term. Some primary side effects of steroids are weight gain, insomnia, bone loss, vision changes, high blood pressure, and high blood sugar/diabetes. Once the affected individual starts a steroid, the steroid cannot be suddenly stopped. The steroid must be slowly tapered off over a period of time.

Another type of medicine used is called disease-modifying antirheumatic drugs (DMARDs). DMARDs treat and slow down an overactive immune system. Some examples of DMARDs are methotrexate, azathioprine, and leflunomide. Side effects include liver damage or liver dysfunction.

Antimalarial are originally used to treat malaria. Hydroxychloroqine and chloroquine has shown to affect the immune system’s function. It is the most effective for individuals with sarcoidosis that have skin symptoms and/or high levels of calcium in the blood. Side effects include stomachs irritation and eye problems.

Other medications that can treat sarcoidosis include, anti-TNF monoclonal antibodies, colchicine, corticotropin, and pentoxifylline. All medications have many side effects. They all require close monitoring and adjusting by a specialist or healthcare provider.

Affected individuals with severe or advanced lung sarcoidosis may need oxygen therapy or lung transplant.

In over half of the affected patient population, granulomas disappear over a period of two to five years. If the patient achieves remission, it can be life-long remission or temporary remission. If the patient has a severe and aggressive case, then on-going treatment and transplantation may be necessary.

It is important to follow up with the specialist and healthcare providers. Make appointments for routine checkups, diagnostic exams, and blood test. Adopt a healthier lifestyle by being active, having a healthy weight, eating heart-healthy, managing stress, and quitting smoking.

American Lung Association, Learn About Sarcoidosis, https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/sarcoidosis/learn-about-sarcoidosis.html

Foundation for Sarcoidosis Research, What is Sarcoidosis? https://www.stopsarcoidosis.org/what-is-sarcoidosis/

National Heart, Lung, and Blood Institute of the U.S. Department of Health & Human Services, https://www.nhlbi.nih.gov/health-topics/sarcoidosis

Sarcoidosis News, Stages of Sarcoidosis, https://sarcoidosisnews.com/stages-of-sarcoidosis/