Signs and Symptoms

Many people with sarcoidosis have no symptoms at all.

Some people with sarcoidosis in their lungs, called pulmonary sarcoidosis, may have the following signs and symptoms:

• Shortness of breath
• Fatigue and weakness
• Weight loss
• Chest pain
• Dry cough
• Enlarged lymph nodes around the lungs

When sarcoidosis affects areas of the body other than the lungs, symptoms can include:

• Enlarged lymph nodes
• Red bumps on arms, face, buttocks
• Fever
• Swelling and pain in the ankles and knees
• Infections of the eye, including pink eye (conjunctivitis)
• Enlarged or inflamed liver

Causes

Researchers do not know exactly what causes sarcoidosis. Some think it is due to an overactive immune system that responds too strongly to an invading organism. Other researchers think sarcoidosis may be:

• Inherited
• Caused by an infection
• Caused by allergens that are breathed in or toxins found in the environment

Risk Factors

Anyone can get sarcoidosis, although it is more common among the following:

• People of Scandinavian, Irish, African, or Puerto Rican descent
• People in their 30s or 40s
• Women

Diagnosis

Sarcoidosis can be hard to diagnose. You may have to see several different doctors, including a pulmonologist (lung specialist). To begin, your doctor will rule out other conditions that could be causing your symptoms, such as rheumatoid arthritis. The following tests may help diagnose the condition:

• Chest x-ray
• Lung function tests
• Biopsy
• Blood tests
• Bronchoscopy, which examines the inside of your lungs
• CT scan, MRI, or other imaging tests
• ECG (electrocardiogram)

Treatment

About half of all people with sarcoidosis get better without treatment. For others, medications, such as corticosteroids, may help reduce:

• Swelling
• Rashes
• Pain
• Fever
• Lung problems

Lifestyle changes may help control complications, such as kidney stones or other damage. While complementary therapies for sarcoidosis have not been studied very much, they may help you feel better as part of an overall treatment plan.

Lifestyle

If you smoke, quit. Quitting smoking can ease lung symptoms.

Sarcoidosis can be a long-lasting disease, so it is important to eat a healthy diet filled with fruits, vegetables, and whole grains.

Exercise regularly. Be sure to ask your doctor before starting a new exercise program, especially if sarcoidosis leaves you short of breath.

Medications

Corticosteroids, such as prednisone are considered the first-line treatment for lowering inflammation from sarcoidosis. Corticosteroid pills can have some serious side effects if taken in high doses for long periods. Side effects may include:

• High blood pressure
• Diabetes
• Stomach ulcers
• Tuberculosis
• Osteoporosis

Your doctor will likely suggest regular check ups and tests.

Other medications sometimes used for sarcoidosis include those that suppress the immune system, such as:

• Methotrexate
• Azathioprine (Imuran)
• Infliximab (Remicade)

However, there are no long-term studies on whether these medications work to treat sarcoidosis.

Other medications that may be used include:

• Antimalarial drugs: such as hydroxychloroquine, used when the skin is affected. It may be toxic to the eyes.
• Thalidomide: being studied for sarcoidosis, used to improve lung function and treat skin problems.
• Topical therapies: including steroid creams, eye drops, nasal corticosteroids, and steroid inhalers.

Surgery and Other Procedures

Only very severe cases need surgery, such as a lung or heart transplant.

Nutrition and Dietary Supplements

Researchers do not have any evidence that herbs or supplements treat sarcoidosis, but you may decide to use them as part of your overall treatment plan. Always tell your doctor about the herbs and supplements you are using or considering using, because some supplements may interfere with other medicines.

These nutritional tips will help your overall health:

• Eat antioxidant foods, including fruits (blueberries, cherries, and tomatoes), and vegetables (squash and bell peppers).
• Include foods rich in magnesium and low in calcium, such as barley, bran, corn, rye, oats, soy, brown rice, avocado, banana, and potato.
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Use healthy oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially-baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid caffeine, alcohol, and tobacco.
• Drink 6 to 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week. Ask your doctor before starting a new exercise routine.

The following supplements may also help overall health:

• A daily multivitamin: containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids: such as fish oil, 1 to 2 capsules or 1 to 3 tbsp of oil, 1 to 3 times daily. Fish oil seems to help reduce inflammation throughout the body. Cold-water fish, such as salmon or halibut, are good choices to eat. If you take supplements, check with your doctor because they may increase the risk of bleeding, especially if you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Eating fish does not cause the same risk.
• Bromelain: a mixture of enzymes derived from pineapple, 500 mg per day. Bromelain may also help reduce inflammation in the body. Ask your doctor before taking it, because it can increase the risk of bleeding and may interact with other medications. Bromelain is often combined with turmeric.
• Probiotic supplement (containing Lactobacillus acidophilus): 5 to 10 billion CFUs (colony forming units) a day. These "friendly" bacteria help maintain gastrointestinal health. If you are taking immunosuppressive drugs, or you have a suppressed immune system, speak with your physician before taking probiotics. You should refrigerate your probiotic supplements for best results.

Herbs

Herbs may strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment.

Studies have not found any herbs that specifically treat sarcoidosis. However, the following herbs may help overall health. Talk to your doctor before taking any herb or supplement if you have sarcoidosis.

• Turmeric (Curcuma longa) standardized extract: 300 mg, 3times a day, may help reduce inflammation. Turmeric may increase the risk of bleeding and interact with other medications, so ask your doctor before taking it.
• Cat's claw (Uncaria tomentosa) standardized extract: 20 mg, 3 times a day, may help reduce inflammation. People with leukemia should not take cat's claw. People with autoimmune diseases, such as rheumatoid arthritis or lupus, should not take it, either. Cat's claw interacts with some medications, so ask your doctor before taking it.

Homeopathy

A few case reports suggest that homeopathic remedies may improve the general well-being of individuals with sarcoidosis. An experienced homeopath can prescribe a regimen for treating sarcoidosis that is designed specifically for each individual. The primary remedies used by individuals who reported improvements in their symptoms include:

• Tuberculinum bovinum
• Beryllium

Other homeopathic remedies that have been used clinically for the condition are as follows:

• Carcinosin
• Euphrasia
• Graphites
• Leuticum (Syphilinum)
• Bacillinum
• Sepia
• Phosphorus
• Arsenicum album

Other Considerations

Pregnancy

Women with sarcoidosis can still get pregnant. But if you are thinking about having a baby, talk to your doctor. Some of the medications used to treat sarcoidosis, such as methotrexate, can be harmful to the baby. Up to 65% of women may see their symptoms improve during pregnancy, while 5% may find symptoms get worse. Some women may have a flare of symptoms after giving birth. Pregnant women with sarcoidosis should avoid being exposed to x-rays.

Prognosis and Complications

Sarcoidosis is associated with excessive daytime sleepiness. Complications from sarcoidosis usually happen in only the most serious cases, and can include heart, kidney, and lung damage. Long-term use of corticosteroids may cause:

• Ulcers
• Diabetes
• High blood pressure
• Osteoporosis
• Infections, such as tuberculosis.

The prognosis for most people with sarcoidosis is good. Only 15% of those with sarcoidosis have symptoms that get worse. About 5% develop severe lung problems, which increases the risk of death. Almost half of all people with sarcoidosis get better without any therapy. Treatments used today, such as corticosteroids, often help ease the inflammation associated with the condition.

Supporting Research

Boots AW, Drent M, de Boer VC, Bast A, Haenen GR. Quercetin reduces markers of oxidative stress and inflammation in sarcoidosis. Clin Nutr. 2011 Aug;30(4):506-12. doi: 10.1016/j.clnu.2011.01.010. Epub 2011 Feb 15.

Boots AW, Drent M, Swennen EL, Moonen HJ, Bast A, Haenen GR. Antioxidant status associated with inflammation in sarcoidosis: A potential role for antioxidants. Respir Med. 2009 Mar;103(3):364-72.

Cox CE, Donohue JF, Brown CD, Kataria YP, Judson MA. Health-related quality of life of persons with sarcoidosis. Chest. 2004 Mar;125(3):997-1004.

Culver D. Sarcoidosis. Immunology and Allergy Clinics of North America. Philadelphia, PA: W. B. Saunders Company; 2012; 32(4).

de Kleijn WP, Drent M, De Vries J. Nature of fatigue moderates depressive symptoms and anxiety in sarcoidosis. Br J Health Psychol. 2013; 18(2):439-52.

Doty JD, Mazur JE, Judson MA. Treatment of sarcoidosis with infliximab. Chest. 2005 Mar;127(3):1064-71.

Dryden GW Jr, Deaciuc I, Arteel G, McClain CJ. Clinical implications of oxidative stress and antioxidant therapy. Curr Gastroenterol Rep. 2005;7(4):308-16.

Fauci AS, Braunwald E, Hauser SL, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. New York, NY: McGraw-Hill. 2008.

Ferri: Ferri's Clinical Advisor 2015, 1st ed. Philadelphia, PA: Elsevier Mosby. 2014.

Funk JL, Oyarzo JN, Frye JB, et al. Turmeric extracts containing curcuminoids prevent experimental rheumatoid arthritis. J Nat Prod. 2006;69(3):351-5.

Goldman L, Ausiello DA, et al, eds. Cecil Textbook of Medicine. 23rd ed. Philadelphia, PA: W.B. Saunders. 2007.

Gonclaves C, Dinis T, Batista MT. Antioxidant properties of proanthocyanidins of Uncaria tomentosa bark decoction: a mechanism for anti-inflammatory activity. Phytochemistry. 2005;66(1):89-98.

Goroll AH, ed. Primary Care Medicine. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins Publishers. 2007.

Judson MA, Boan AD, Lackland DT. The clinical course of sarcoidosis: presentation, diagnosis, and treatment in a large white and black cohort in the United States. Sarcoidosis Vasc Diffuse Lung Dis. 2012; 29(2):119-27.

Krieg C. Role of diet in the prevention of common kidney stones. Urol Nurs. 2005;25(6):451-7.

Lichtenstein AH, Russell RM. Essential nutrients: food or supplements? Where should the emphasis be? JAMA. 2005;294(3):351-8.

Massey L. Magnesium therapy for nephrolithiasis. Magnes Res. 2005;18(2):123-6.

Nguyen YT, Dupuy A, Cordoliani F, Vignon-Pennamen MD, Lebbé C, Morel P, Rybojad M. Treatment of cutaneous sarcoidosis with thalidomide. J Am Acad Dermatol. 2004 Feb;50(2):235-41.

Patterson KC, Huang F, Oldham JM, Bhardwaj N, Hogarth DK, Mokhlesi B. Excessive daytime sleepiness and obstructive sleep apnea in patients with sarcoidosis. Chest. 2013; 143(6):1562-8.

Rakel RE, ed. Conn's Current Therapy 2008. Philadelphia, PA: W.B. Saunders. 2008.