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Sarcoidosis

• Signs and Symptoms
• Causes
• Risk Factors
• Diagnosis
• Treatment
• Other Considerations
• Supporting Research

Sarcoidosis is a condition characterized by the presence of granulomas -- small bead-like patches of inflamed cells -- that often appear in the lungs and adjacent lymph nodes. Sarcoidosis can also affect other tissues of the body, including the muscles, eyes, and skin. While most individuals with sarcoidosis have no symptoms at all, the condition can cause long-term organ damage, such as the abnormal formation of fiber-like scar tissue in the lung. This actually distorts the structure of the lungs and can interfere with breathing. Those who have a variation of the condition, called Lofgren's syndrome, may have symptoms that include swollen lymph nodes, fever, painful, reddened nodules, and joint pain. Lofgren's syndrome is found more frequently in people of Scandinavian, Irish, and Puerto Rican descent, and it generally tends to clear up on its own within 1 - 2 years. The prevalence of sarcoidosis is higher in blacks than whites in the United States. About 36 in 100,000 African-Americans and 11 in 100,000 Caucasians have the condition.

Signs and Symptoms

Many individuals with sarcoidosis have no symptoms at all.

Some individuals with pulmonary (lung) sarcoidosis may experience the following signs and symptoms:

• Fatigue and weakness
• Weight loss
• Shortness of breath or 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-purple inflamed areas on the legs
• Scaly rash
• Fever
• Swelling and pain in the ankles and knees
• Infections of the eye, including conjunctivitis
• Facial paralysis
• Enlarged or inflamed liver
• Kidney stones
• Seizures

Causes

Although the precise cause of sarcoidosis is unknown, some scientists speculate that the condition may be triggered by an exaggerated defense reaction against some event or substance that the immune system perceives to be a threat. Other researchers have proposed that the condition may be inherited, caused by an infection, or caused by inhaled allergens or toxins found in the environment.

Risk Factors

Sarcoidosis is found throughout the world within almost all races and ages and in both sexes, however it is most common among the following:

• Individuals of Scandinavian, Irish, African, or Puerto Rican descent
• Individuals in their 30s or 40s
• Females

Diagnosis

Although many individuals with sarcoidosis experience no symptoms of the condition, the following tests may help a physician diagnose the condition:

• Chest x-ray
• Biopsy
• Blood tests
• CT scan, MRI, or other imaging tests
• Eye exam
• EKG (electrocardiogram)

Treatment

About half of all people with sarcoidosis recover and do not need treatment. For those who do not recover, symptom relief and prevention of complications are often provided by medications such as corticosteroids, which reduce swelling, rashes, pain, fever and lung problems. Some lifestyle changes, including a diet low in calcium or avoidance of vitamin D and sunlight, may help control some of the complications of the condition, such as kidney stones or other damage. While complementary therapies for sarcoidosis have not been well studied, anecdotal reports suggest that melatonin and homeopathy may provide symptom relief and improve general well-being.

Lifestyle

Eating a diet low in calcium and vitamin D may relieve or help prevent two of the complications of sarcoidosis, hypercalcemia (an abormally high amount of calicium in the blood) and kidney disease. Your health care provider can provide advice on how to cut calcium out of the diet.

Avoiding sunlight, which is converted to vitamin D by the body, is also recommended.

Quitting smoking can ease lung symptoms.

Medications

Corticosteroids such as prednisone, prescribed by your health care provider, are the most effective medications for reducing inflammation associated with sarcoidosis. Oral corticosteroids can have some serious side effects if taken in high doses for long periods, including high blood pressure, diabetes, peptic ulcers, tuberculosis, or hirsutism (excessive hair growth). If an individual is at risk for these problems, your health care provider will likely advise regular check-ups and tests.

Other medications for sarcoidosis can include:

• Methotrexate -- for severe sarcoidosis. It may cause liver damage.
• Antimalarial drugs such as hydroxychloroquine -- for disfiguration of the skin. It may be toxic to the eyes.

Surgery and Other Procedures

Surgery, such as a lung or heart transplant, is only necessary in extreme cases.

Nutrition and Dietary Supplements

A comprehensive treatment plan for sarcoidosis may include a range of complementary and alternative therapies. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using, as some supplements may interfere with conventional cancer treatments.

Following these nutritional tips may help reduce symptoms:

• Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Cut down on oxalate-containing foods, such as spinach, rhubarb, beets, nuts, chocolate, black tea, wheat bran, strawberries, and beans.
• 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 especially 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 coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, five days a week.

You may address nutritional deficiencies with the following supplements:

• 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, to help decrease inflammation and help with immunity. Cold-water fish, such as salmon or halibut, are good sources, but not substitutes for supplementation.
• Vitamin C, 500 - 1,000 mg, one to three times daily, as an antioxidant and for immune support.
• N-acetyl cysteine, 200 mg daily, for antioxidant effects. Higher doses may be needed, so check with your health care provider.
• Probiotic supplement (containing Lactobacillus acidophilus ), 5 - 10 billion CFUs (colony forming units) a day, when needed for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity.
• Melatonin, 2 - 6 mg at bedtime as needed, for immune support and sleep.

Herbs

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.

• Olive leaf ( Olea europaea ) standardized extract, 250 - 500 mg one to three times daily, for anticancer and immune effects.
• Turmeric ( Curcuma longa ) standardized extract, 300 mg three times a day, for pain and inflammation.
• Cat's claw ( Uncaria tomentosa ) standardized extract, 20 mg three times a day, for inflammation.
• Ashwagandha ( Withania somniferum ) standardized extract, 450 mg one to two times daily, for general health benefits and stress.

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

Sarcoidosis does not affect fertility. Symptoms may improve in up to 65% of pregnant women who once had the condition, while 5% may experience worsening of symptoms. Postpartum symptom flare-ups may also occur within the first 6 months. Pregnant women with sarcoidosis should avoid exposure to x-rays and toxic medications such as methotrexate.

Prognosis and Complications

Complications from sarcoidosis usually occur in only the most serious cases, and can include heart, kidney, and lung damage. Ulcers, diabetes, high blood pressure, and infections, such as tuberculosis, may result from long-term use of corticosteroids.

The prognosis for most individuals with sarcoidosis is good. Only 15% of those with sarcoidosis experience symptoms that progressively worsen, and 5% develop severe lung problems, which increases the risk of death. Almost half of all individuals with sarcoidosis spontaneously improve without any therapy, and treatments used today, such as corticosteroids, often help ease the inflammation associated with the condition.

Supporting Research

Antony F, Layton AM. A case of cutaneous acral sarcoidosis with response to allopurinol. Br J Dermatol . 2000;142(5):1052-1053.

Birdsall TC. The biological effects and clinical uses of the pineal hormone melatonin. Alt Med Rev. 1996; 1(2):94-102.

Cagnoni ML, Lombardi A, Cerinic MC, Dedola GL, Pignone A. Melatonin for treatment of chronic refractory sarcoidosis [letter]. Lancet . 1995;346(4):1229-1230.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine , 20th ed. Philadelphia, Pa: W.B. Saunders; 1996.

Connolly JW. Sarcoidosis. Br Homeopath J. 1987;76:202-203.

Dambro MR. Griffith's 5-Minute Clinical Consult . Baltimore, Md: Lippincott Williams & Wilkins, Inc.; 1999.

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, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine , 14th ed. New York, NY: McGraw-Hill; 1998:1922-1929.

Feldman M, ed. Sleisenger & Fordtran's Gastrointestinal and Liver Disease , 6th ed. Philadelphia, Pa: W.B. Saunders; 1998.

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

Georgiou S, Monastirli A, Pasmatzi E, Tsambaos D. Cutaneous sarcoidosis: complete remission after oral isotretinoin therapy . Acta Derm Venereol (Stockh) . 1998;78(6):457-459.

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

Goroll AH, ed. Primary Care Medicine , 3rd ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1995.

Il 'kovich MM, Novikova LN, Baranova OP. Weight-reducing diet therapy in the combined treatment of pulmonary sarcoidosis [in Russian]. Ter Arkh . 1996;68(3):83-87.

Koopman WJ, ed. Arthritis and Allied Conditions , 13th ed. Baltimore, MD: Williams & Wilkins, Inc.; 1997.

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

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide . Hudson, OH:LexiComp; 2000: 387-388.

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.

Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl J Med . 1997;336(17):1224-1234.

Paramothayan NS, Jones PW. Corticosteroids for pulmonary sarcoidosis. Cochrane Database Syst Rev . 2000;No. 2:CD001114.

Rakel RE, ed. Conn's Current Therapy , 51st ed. Philadelphia, Pa: W.B. Saunders; 1999.

Tani K, Ogushi F, Huang L, et al. CD13/aminopepetidase N, a novel chemoattractant for T lymphocytes in pulmonary sarcoidosis. Am J Respir Crit Care Med . 2000;161(5):1636-1642.

Waldinger TP, Ellis CN, Quint K, Voorhees JJ. Treatment of cutaneous sarcoidosis with isotretinoin. Arch Dermatol. 1983;119(12):1003-1005.

Weinberg I, Vasiliev L, Gotsman I. Anti-dsDNA antibodies in sarcoidosis. Semin Arthritis Rheum . 2000;29(5):328-331.

• Review Date: 10/19/2006
• Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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