Introduction:

Sarcoidosis is a condition characterized by small bead-like patches of inflamed cells -- called granulomas -- that often appear in the lungs and nearby lymph nodes. Sarcoidosis can also affect other tissues of the body, including the muscles, eyes, and skin. Many people with sarcoidosis may have no symptoms at all. But in others, the condition can cause long-term organ damage -- such as the formation of fiber-like scar tissue in the lung, which can interfere with breathing. Sarcoidosis may develop over time and cause symptoms that last for years, or it may appear and disappear quickly. People who have a variation of sarcoidosis, called Lofgren's syndrome, may have symptoms that include swollen lymph nodes, fever, painful, reddened nodules, and joint pain. Lofgren's syndrome generally tends to clear up on its own within 1 - 2 years. Sarcoidosis affects more African-Americans than Caucasians in the United States. About 36 in 100,000 African-Americans, while 11 in 100,000 Caucasians have the condition.

Signs and Symptoms:

Many people with sarcoidosis have no symptoms at all.

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

• Shortness of breath
• 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 bumps on arms, face, buttocks
• Fever
• Swelling and pain in the ankles and knees
• Infections of the eye, including conjunctivitis
• Enlarged or inflamed liver

Causes:

Researchers don't know exactly what causes sarcoidosis. Some think it's due to an overactive immune system that responds too strongly to an invading organism. Other researchers have proposed that sarcoidosis may be inherited, caused by an infection, or caused by inhaled allergens or toxins found in the environment.

Risk Factors:

Anyone can develop sarcoidosis, although it's 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 difficult to diagnose. Getting a diagnosis may involve seeing 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 -- examines the inside of your lungs
• CT scan, MRI, or other imaging tests
• ECG (electrocardiogram)

Treatment:

About half of all people with sarcoidosis recover 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 some of the complications of the condition, such as kidney stones or other damage. While complementary therapies for sarcoidosis have not been well studied, they can improve general well-being as part of an overall treatment plan.

Lifestyle

• Quitting smoking can ease lung symptoms.
• Sarcoidosis can be a chronic 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

Corticosteroids such as prednisone, prescribed by your doctor, are considered the first-line treatment 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 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 extreme 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 a range of complementary and alternative therapies. Ask your team of doctors about the best ways to incorporate 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.

Following 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 and other stimulants, 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 appears 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.
• 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

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.

No herbs have been found 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.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, may help reduce inflammation.
• Ashwagandha (Withania somniferum) standardized extract, 450 mg one to two times daily, for general health benefits.

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 become pregnant; however, if you are thinking about having a baby, talk to your doctor. Some of the medications used to treat sarcoidosis can be harmful to the fetus. Symptoms may improve in up to 65% of pregnant women, while 5% may experience worsening of symptoms. Some women may experience a flare of symptoms after giving birth. 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, osteoporosis, and infections, such as tuberculosis, may result from long-term use of corticosteroids.

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