Paging Dr. Frischer - Sarcoidosis

Congress has declared April to be National Sarcoidosis Awareness Month. Is this a disease you're familiar with?Sarcoidosis is an abnormal response by the immune system. The result is inflammation in the lymph nodes, liver, eyes, skin, and other tissues throughout the body, but most often in the lungs. Immune cells clump together to form granulomas, and as granulomas build up in an organ, the function of that organ suffers. Because sarcoidosis is difficult to diagnose and can be mistaken for several other diseases, we can only guess at how many people are affected. Statistics indicate, however, that in the United States, sarcoidosis is most common among African Americans, who have an annual incidence of 35.5/100,000. This is over three times the rate for Caucasians. It is interesting that it is found throughout the world among all races, and that it is actually most prevalent in Northern European countries. In fact, the highest incidence of 60/100,000 is found in Sweden and Iceland. It is found more often in women. Sarcoidosis is one of the few lung diseases that is actually more common among non-smokers! Its exact cause is unknown, but it is likely that it is inherited. If a close relative has sarcoidosis, you are five times more likely to get it. Symptoms of sarcoidosis range from none at all, to involving almost any body part or organ. Caucasian patients are more likely to develop a milder form of the disease, while African American patients may develop a chronic and severe form. If there are symptoms, they will include the lungs: chest pain, dry cough, and shortness of breath. Additional general symptoms include fatigue, fever, joint pains, weight loss, and a vague overall feeling of discomfort, illness, or lack of well-being. The skin may show hair loss, rashes, or raised, red, firm sores. Central nervous system symptoms include headaches, seizures, or weakness on one side of the face. Eye symptoms include burning, discharge, dry eyes, itching, pain, and loss of vision. In addition, dry mouth, fainting spells, nosebleed, and swelling of the abdomen are possible. The most remarkable thing about this disease is that it affects everyone in different ways. It is due to the presence of so many seemingly disconnected symptoms that it is not an easy disease to detect. The physical exam may show congestion in the lungs, enlarged liver, palpable lymph nodes, an enlarged spleen, or rash. The most common way that I make the diagnosis is by chest x-ray, which shows remarkably large lymph nodes. Lung involvement is by far the most common finding in individuals with sarcoidosis, with 90% having an abnormal chest x-ray at some time during the disease. A chest CT scan will show even more detail. A biopsy of one of these large lymph nodes and blood tests are often conducted to confirm the diagnosis. Treatment for sarcoidosis is only necessary if there are symptoms. This disease can go away with no intervention at all, or come and go through the years. If there are symptoms, corticosteroids are used, often for as long as two years, and even for life. Patients who have a severe form of the disease may be given immune suppression medication as well. There is no cure for sarcoidosis; treatment simply helps to manage the symptoms. While sarcoidosis often goes away by itself within three years, the disease forever alters lives. Roughly 20% of those whose lungs are involved will develop lung damage, and about 10% become seriously disabled. Counseling and support groups can help. The Sarcoidosis Center, for example, is a non-profit organization that helps to deal with the problems that face sarcoidosis patients and their caregivers. For those of you whose lives have been touched by sarcoidosis, I urge you to become knowledgeable, get proper medical care, and build a support network! Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

********** Published: March 22, 2012 - Volume 10 - Issue 49