Sarcoidosis
Definition
Sarcoidosis is a chronic condition in which clusters of inflammatory cells, known as granulomas, form in one or more organs. It most commonly affects the lungs, skin and eyes. These granulomas can interfere with normal organ function.
Aetiology
The exact cause is unknown. It may be linked to genetic factors, environmental exposures, infections or an abnormal immune response.
Pathophysiology
Exposure to an unknown trigger sets off an overactive immune reaction which leads to the formation of granulomas. This inflammation can affect various organs and cause tissue damage.
Risk factor
A family history of sarcoidosis, certain ethnic backgrounds and exposure to specific environmental factors or occupations can increase the risk.
Sign and Symptoms
Patients may experience a persistent cough, shortness of breath, chest discomfort, skin changes, eye issues and general fatigue or weight loss. Some individuals may have no symptoms at all and the condition is discovered by chance.
Investigations
- Arrange a chest x-ray (CXR) to check for bilateral hilar adenopathy
- Order relevant bloods such as FBC, LFT and electrolytes (UE) which may show raised alkaline phosphatase or hypercalcaemia
- If heart involvement is suspected, perform an ECG
- A CT scan may be arranged if more detail is required
Management
- If you suspect sarcoidosis, refer the patient to secondary care for a specialist assessment, especially when more than one organ is involved
- Arrange an urgent referral if there are signs of cardiac or eye involvement
- In primary care, provide supportive management such as pain relief, lifestyle advice and regular monitoring while waiting for specialist review
- For confirmed cases, keep the patient under secondary care management while offering ongoing support in primary care and re-referring if the condition worsens