Clinical Immunology focuses on the immune system’s health. Learn about the diagnosis and treatment of allergies, autoimmune diseases, and immunodeficiencies.
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Sarcoidosis is a disease that causes inflammation and the formation of immune cell clusters, called granulomas, in different organs. Most often, it affects the lungs and lymph nodes, but it can also show up in the skin, eyes, heart, or nervous system. The immune system overreacts to an unknown trigger, causing T-cells and macrophages to build up. For many people, the disease goes away on its own, but some develop a long-lasting form that can cause scarring and permanent organ damage. Sarcoidosis can range from having no symptoms to causing serious health problems.
The defining feature of sarcoidosis is the non-caseating granuloma. Unlike the granulomas found in tuberculosis, these do not show central necrosis (decay).
Cellular Composition
These tiny clusters are made up of inflammatory cells, mainly epithelioid histiocytes and multinucleated giant cells, with lymphocytes around them. If granulomas stay in the body, they can damage the normal structure and function of the organ, sometimes causing scarring.
Even though the lungs are affected in most cases, sarcoidosis is a disease that can involve the whole body.
Multisystem Involvement
The definition of the disease encompasses its potential to affect multiple systems simultaneously or sequentially. It is not merely a lung disease but an immunological disorder that manifests prominently in the thorax.
Sarcoidosis is found all over the world and can affect anyone, regardless of age or race. However, some groups have higher rates or more severe forms of the disease.
Incidence Peaks
Sarcoidosis usually appears in young adults between 20 and 40 years old. There is also a second increase in cases among women over 50.
Genetic Susceptibility
Certain ethnic groups, particularly African Americans and Scandinavians, show higher prevalence rates and often more severe disease phenotypes. This suggests a strong genetic component influencing susceptibility and disease course.
The exact cause of sarcoidosis is still unknown. Most experts believe it happens when the immune system overreacts in people who are genetically more likely to develop the disease.
Environmental Factors
Studies show that certain environmental exposures, like insecticides, mold, bacteria, or dust, may trigger sarcoidosis. The immune system tries to block off these substances by forming granulomas.
Sarcoidosis is clinically categorized based on its onset and duration.
Acute Sarcoidosis
Acute sarcoidosis usually starts suddenly with clear symptoms, but the outlook is good. Many people recover without treatment within two years.
Chronic Sarcoidosis
Defined by disease activity persisting for more than two to five years, this form is more likely to require long-term treatment and carries a higher risk of permanent organ dysfunction.
A key part of sarcoidosis is the buildup of CD4+ T-helper cells, a type of immune cell, in the affected areas.
Cytokine Release
These immune cells release chemicals called cytokines, like Interferon-gamma and TNF-alpha. These chemicals attract more immune cells, keeping the granulomas in place and causing ongoing inflammation.
Lofgren’s syndrome is a specific, acute presentation of sarcoidosis that is clinically distinct and often diagnostic on its own.
Triad of Symptoms
It is characterized by erythema nodosum (painful red nodules on the shins), bilateral hilar lymphadenopathy (enlarged lymph nodes in the chest), and arthritis or joint pain. It is usually self-limiting and has an excellent prognosis for complete recovery.
In long-term cases, ongoing inflammation can lead to fibrosis, which means permanent scarring of the tissue.
Organ Dysfunction
If scarring happens in the lungs, it makes it harder for the body to get oxygen. In the heart, it can affect the heart’s electrical system. How much scarring there is helps doctors decide how severe the sarcoidosis is.
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The exact cause is unknown. It is believed to be an immune system reaction to an unknown substance, likely something inhaled from the air, in people who are genetically susceptible.
No, sarcoidosis is not cancer. It is an inflammatory disease characterized by the formation of granulomas, whereas cancer involves the uncontrolled growth of abnormal cells.
No, you cannot catch sarcoidosis from another person. It is not an infectious disease like the flu or tuberculosis, even though it shares some symptoms with infections.
There is no medical cure, but the disease often goes away on its own. In many cases, it resolves spontaneously within a few years. For chronic cases, treatment can manage symptoms and prevent damage.
The lungs and chest lymph nodes are affected in more than 90 percent of patients. However, the skin, eyes, and liver are also frequently involved.
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