Sarcoidosis
Sarcoidosis is a multisystemic disorder of unknown aetiology which is characterised by non-caseating
granulomatous inflammation that involves the lung in about 90% of affected patients. A characteristic
feature is bilateral hilar lymphadenopathy, which is often symptomless and detected on routine CXR.
Radiological lung involvement can be associated with or occur independently of hilar lymphadenopathy.
Clinical features:
- may be asymptomatic (one-third)
- onset usually 3rd or 4th decade (but any age)
- bilateral hilar lymphadenopathy (on CXR)
- cough
- fever, malaise, arthralgia
- erythema nodosum
- ocular lesions, e.g. anterior uveitis
- other multiple organ lesions (uncommon)
- overall mortality 2-5%
Erythema nodosum with acute fever, malaise and arthralgia in a young adult female is diagnostic of
sarcoidosis.
Diagnosis
Histological evidence from biopsy specimen, usually transbronchial biopsy (essential if an alternative
diagnosis, e.g. lymphoma, cannot be excluded) or skin biopsy in cases of erythema nodosum.
Supporting evidence:
- elevated serum ACE (non-specific)
- PFTs: restrictive pattern; impaired gas transfusion in advanced cases.
- ±ve Kveim test (not recommended these days)
Treatment
Sarcoidosis may resolve spontaneously (hilar lymphadenopathy without lung involvement does not require treatment). About half of all people with sarcoidosis get better without needing treatment. For others, medications such as corticosteroids may help reduce swelling, rashes, pain, fever, and lung problems. Some lifestyle changes may help control complications, such as kidney stones or other damage. While complementary therapies for sarcoidosis have not been well studied, they may help you feel better as part of an overall treatment plan.
Indications for treatment with corticosteroids:
- no spontaneous improvement after 6 months
- symptomatic pulmonary lesions
- eye, CNS and other systems involvement
- hypercalcaemia, hypercalcuria
- erythema nodosum with arthralgia
- persistent cough
Lifestyle
If you smoke, quit. Quitting smoking can ease lung symptoms.
Sarcoidosis can be a long-lasting disease, so it’s 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
Corticosteroid treatment
Prednisolone 30 mg daily for 4-6 weeks, then reduce to lowest dose that maintains
improvement. 6 If there is no response, taper the dose to zero. If there is a response, taper the
dose to 10-15 mg (o) daily as a maintenance dose for 6-12 months. 14
Prednisolone 20-30 mg for 2 weeks for erythema nodosum of sarcoidosis.
Corticosteroids such as prednisone are considered the first-line treatment for lowering inflammation associated with sarcoidosis. Oral corticosteroids can have some serious side effects if taken in high doses for long periods. Side effects may include high blood pressure, diabetes, peptic ulcers, tuberculosis, or 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), and infliximab (Remicade). However, there are no long-term studies on whether these medication are effective for treating 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.
Surgery and Other Procedures
Surgery, such as a lung or heart transplant, is only necessary in very severe cases.
Nutrition and Dietary Supplements
Although there is no evidence that any particular herb or supplement helps treat sarcoidosis, a comprehensive treatment plan may include complementary and alternative therapies. Ask your team of doctors about the best ways to bring these therapies into your overall treatment plan. Always tell your doctor about the herbs and supplements you are using or considering using, as some supplements may interfere with conventional treatments.
These nutritional tips will help your overall health:
- Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as 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 – 8 glasses of filtered water daily.
- Exercise at least 30 minutes daily, five 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 – 2 capsules or 1 – 3 tablespoonfuls oil, one to three times daily. Fish oil seems to help reduce inflammation throughout the body. Cold-water fish, such as salmon or halibut, are good sources to add to your diet. 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) or aspirin. Eating fish doesn’ t 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.
- Probiotic supplement (containing Lactobacillus acidophilus), 5 – 10 billion CFUs (colony forming units) a day. These “friendly” bacteria help maintain gastrointestinal health. You should refrigerate your probiotic supplements for best results.
Herbs : Natural Remedies
Herbs are generally a safe way to 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. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 – 10 minutes for leaf or flowers, and 10 – 20 minutes for roots. Drink 2 – 4 cups per day. You may use tinctures alone or in combination as noted.
Studies haven’ t 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 three times 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 three times a day, may help reduce inflammation. People with leukemia should not take cat’ s claw. 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
