Sarcoidosis

• What is sarcoidosis classified as?

  It is a chronic granulomatous disorder.
• What are granulomas composed of?

  Granulomas are inflammatory nodules full of macrophages.
• What is known about the cause of granulomas in sarcoidosis?

  The cause of these granulomas is unknown.
• What symptoms are usually associated with sarcoidosis?

  It is usually associated with respiratory symptoms but has many extra-pulmonary manifestations.
• What are some extra-pulmonary manifestations of sarcoidosis?

  Examples include erythema nodosum and lymphadenopathy.
• How can the symptoms of sarcoidosis vary?

  Symptoms can vary dramatically from asymptomatic to severe or life-threatening.
• Who can be affected by sarcoidosis?

  Sarcoidosis can affect anyone.
• In which demographics is sarcoidosis slightly more common?

  It seems to be slightly more common in those aged 20-39 or around 60, women, and individuals of black ethnic origin.
• What is a typical MCQ exam patient profile for sarcoidosis?

  A 20-40 year old black female presenting with a dry cough and shortness of breath.
• What skin features are associated with sarcoidosis?

  • Less than half of patients have skin involvement.
  • Erythema nodosum: nodules of inflamed subcutaneous fat on the shins.
  • Lupus pernio: raised purple skin lesions, often on the cheeks and nose.
• How is erythema nodosum characterized?

  Erythema nodosum is characterized by raised, red, tender, painful, subcutaneous nodules across both shins.
• What happens to erythema nodosum nodules over time?

  Over time, the nodules settle and appear as bruises.
• What is panniculitis?

  Panniculitis is the inflammation of fat.
• What is lupus pernio specific to?

  Lupus pernio is specific to sarcoidosis.
• Where do lupus pernio lesions typically appear?

  Lupus pernio lesions often appear on the cheeks and nose.
• What organs can be affected by sarcoidosis?

  • Lungs: mediastinal lymphadenopathy, pulmonary fibrosis, pulmonary nodules.
  • Liver: liver nodules, cirrhosis, cholestasis.
  • Eyes: uveitis, conjunctivitis, optic neuritis.
  • Heart: bundle branch block, heart block, myocardial muscle involvement.
  • Kidneys: kidney stones, nephrocalcinosis, interstitial nephritis.
  • Central nervous system: nodules, pituitary involvement, encephalopathy.
  • Peripheral nervous system: facial nerve palsy, mononeuritis multiplex.
  • Bones: arthralgia, arthritis, myopathy.
• What is the most commonly affected organ in sarcoidosis?

  The lungs are most commonly affected in over 90% of patients.
• What are systemic symptoms of sarcoidosis?

  Systemic symptoms include fever, fatigue, and weight loss.
• What is Lofgren’s syndrome?

  Lofgren’s syndrome refers to a specific presentation of sarcoidosis with a classic triad of symptoms.
• What are the classic triad of symptoms in Lofgren’s syndrome?

  The classic triad includes erythema nodosum, bilateral hilar lymphadenopathy, and polyarthralgia.
• What are the top differential diagnoses for sarcoidosis?

  • Tuberculosis
  • Lymphoma
  • Hypersensitivity pneumonitis
  • HIV
  • Toxoplasmosis
  • Histoplasmosis
• What blood test finding is often used as a screening test for sarcoidosis?

  Raised angiotensin-converting enzyme (ACE) is often used as a screening test.
• What is another common blood test finding in sarcoidosis?

  Raised calcium (hypercalcaemia) is another common finding.
• What imaging investigations may be performed for sarcoidosis?

  • Chest x-ray: may show hilar lymphadenopathy.
  • High-resolution CT: may show hilar lymphadenopathy and pulmonary nodules.
  • MRI: can show central nervous system involvement.
  • PET scan: can show active inflammation in affected areas.
• What does histology help establish in sarcoidosis?

  Histology helps establish the diagnosis, often by bronchoscopy with an ultrasound-guided biopsy of mediastinal lymph nodes.
• What is characteristic of histology in sarcoidosis?

  Histology characteristically shows non-caseating granulomas with epithelioid cells.
• What other tests may be used to determine organ involvement in sarcoidosis?

  • U&Es for kidney involvement.
  • Urine albumin-creatinine ratio to look for proteinuria.
  • LFTs for liver involvement.
  • Ophthalmology assessment for eye involvement.
  • ECG and echocardiogram for heart involvement.
  • Ultrasound for liver and kidney involvement.
• What is the management approach for sarcoidosis?

  • Conservative management for no or mild symptoms.
  • Oral steroids (for 6-24 months) as first-line treatment.
  • Bisphosphonates to protect against osteoporosis during long-term steroid use.
  • Methotrexate as a second-line option.
  • Lung transplant is rarely required in severe pulmonary disease.
• What is the prognosis for patients with sarcoidosis?

  Sarcoidosis spontaneously resolves in around half of patients, usually within two years.
• What can happen to some patients with sarcoidosis over time?

  In some patients, it progresses to pulmonary fibrosis and pulmonary hypertension.
• What is the overall mortality rate for sarcoidosis?

  The overall mortality rate is less than 10%.
• When was the last update made to the sarcoidosis information?

  The last update was made in June 2023.
• What resources are available for testing knowledge on sarcoidosis?

  Resources include digital flashcards, short answer questions, and multiple choice questions.