Sarcoidosis is a rare multi-system, auto immune disease that is known for its long remissions and wide variety of symptoms. Sarcoidosis symptoms vary from person to person - no two are exactly alike. It is a granulomatous disease in which inflammation may occur in lymph nodes, lungs, liver, eyes, skin, joints, kidneys, liver and spleen, and other tissues. Some patients (60%) have Sarcoid for a period of 2-3 years and never have it again, but others have it chronically, some with periods of remission.

CAUSES, INCIDENCE AND RISK FACTORS

The cause of Sarcoidosis is considered unknown, but some areas of exploration on its etiology are:

1) A viral or bacterial infection (Sarcoidosis is not contagious, but resembles tuberculosis)
2) A defect in the body's immune system
3) An unidentified toxic substance
4) An unknown environmental cause
5) An inherited or genetic cause.

Over 90% of cases involve the lungs and may also involve any other area of the body. Some cases will involve some portion of the nervous system. The disorder involves an abnormal immune system response resulting in deposits of white blood cells and abnormal tissue cells in the affected organs. Sarcoidosis occurs in highly variable groups. The disorder is slightly more common in people 25 to 50 years old, particularly women, but can occur at any age and to either sex.

In early 2002, a group of Swedish scientists published pictures of bacteria from a tick-borne disease that were living and replicating in the granuloma of 30 Sarcoidosis patients. The organisms were from the genus "Rickettsia". In the USA, these organisms give rise to "Rocky Mountains spotted fever," while in Asia they cause "scrub typhus". Other scientists have since found other types of bacteria, which also seem to be involved in sarcoid inflammation.

But granulomatous inflammation does not form in everybody. It seems as though there is a genetic pre-disposition, a tendency running within families that causes this special reaction to the bacteria by forming granuloma. Some scientists recently summarized sarcoidosis in the following sentence: "One or more microbes behaving in a non-infectious fashion in a genetically predisposed individual, trigger the sarcoidosis granulomatous response".

If somebody is attacked by 'microbes' they typically suffer from fever and intense pain, usually for several weeks. The actual sarcoid inflammation is usually not discovered until years afterwards. During the initial attack, the fever is treated with antibiotics. When the fever subsides it is then assumed that the body's immune system has rejected the microbe, and the patient has been 'cured'. Unfortunately, in that fraction of the population with the genetic pre-disposition to form sarcoid granuloma, the bacteria continue to live in the granuloma, and the body's immune system continues to try and reject them. Sometimes the immune system is successful, and the patient goes into "remission". But sometimes the inflammation continues for the remainder of the patient's lifetime.

The symptoms of sarcoidosis are highly variable. Any part of the nervous system may become involved. Involvement may be a single nerve, multiple nerves, or generalized. It is often difficult to diagnose Sarcoidosis as signs may mimic diabetes, hypopituitarism, optic neuritis, meningitis, tumors, or other neurologic disorders.

In most cases of sarcoidosis that have no symptoms, the disease "burns itself out," disappearing with little or no notice to the patient or physician.

TREATMENT

In a majority of patients, the disease spontaneously disappears, and no treatment is necessary. When therapy is recommended, the main goal is to keep the lungs and other affected body organs working, and to relieve symptoms. Drugs called corticosteroids are the most common treatment used in fighting sarcoidosis. Some physicians prescribe steroids when there are no symptoms but just abnormalities seen on the chest x-ray and in lung function measurements.

Treatment has consisted of reducing and relieving symptoms, some cases resolve themselves in time and never experience further symptoms. Corticosteroids such as Prednisone and/or other anti inflammation medications can be prescribed to reduce inflammation. Other medications, particularly those that suppress the immune system, are recommended. Patients with lung involvement may benefit from inhalers, and each symptom can usually be relieved by treating with appropriate medications. Weak areas due to arthritis may require physical therapy and/or appliances to aid mobility and ability to function.

Your doctor may suggest that you take an angiotensin receptor blocker. It turns out that Angiotensin II is not only important to cardiac health and blood pressure, but it's also an important part of the inflammatory cycle in the granuloma. ARBs are a relatively safe family of drugs that can dramatically ease any discomfort that remains once a sarcoid patient has gotten their Vitamin D under control.