Let's learn more about this strange disease called Sarcoidosis.

Have you been feeling lethargic for a while, with a cough and a runny nose? Maybe you've also noticed small bumps on your skin. Many of these seemingly unrelated symptoms could be caused by a condition you might not even think about, called 'Sarcoidosis.' While the name may sound a little scary, let's talk simply and clearly about what it really is, why it occurs, and what you can do about it.

What is Sarcoidosis simply?

Okay, let's understand this this way. Our body has an immune system . It's like a defense army inside our body. The job of this army is to protect us from enemies like germs , bacteria , and viruses that come from outside.

What happens in sarcoidosis is that our immune system becomes a little more active than it should be. That is, even when there is no real enemy, the cells of the immune system (especially white blood cells ) gather and form small camps in various places in the body. These small camps are what we medically call lumps or granulomas .

These lumps (granulomas) can form anywhere in the body. However, they are most commonly seen in the lungs and lymph nodes . They can also form in the skin, eyes, heart , and brain.

Sometimes these nodules do not cause any symptoms. But sometimes, depending on where they form and their size, they can cause various symptoms. In the worst case, permanent scarring can form over time in the areas where these nodules were. We call this fibrosis . Just like a scar remains after a wound heals. If this happens in the lungs, it can have long-term effects on the breathing process.

Who is affected the most by this situation?

Sarcoidosis is a condition that can affect anyone. However, there are some factors that may predispose you to it:

• Age: This disease is most commonly diagnosed in people between the ages of 25 and 40.
• Gender: Women are slightly more likely than men to be affected.
• Family history: This is not a disease that is directly inherited. However, if someone in your immediate family (mother, father, brother or sister) has this disease, your risk of developing it is slightly higher than the average person.

This is considered a rare disease. So there's no need to be overly concerned about it, but it's important to be aware.

What are the symptoms of Sarcoidosis?

This is where many people get confused. Because the symptoms of sarcoidosis are very diverse. The symptoms vary completely depending on where the lumps (granulomas) form. Some people may not have any symptoms at all, and may even be diagnosed incidentally during an X-ray done for another reason.

Let's see what the main symptoms are.

Is Sarcoidosis of the lungs divided into stages?

Yes, Sarcoidosis (Pulmonary Sarcoidosis), a condition that affects the lungs, is divided into stages based on how the lungs look on a chest X-ray. But it is not a stage that progresses from one stage to the next like cancer. It only refers to the location of the granulomas. A person can move from one stage to another, return to the old stage, or the granulomas may disappear completely.

• Stage 0: No changes are seen on X-ray. Lungs and lymph nodes are normal.
• Stage 1: The tumors are only in the lymph nodes in the chest.
• Stage 2: Nodules can be seen in both the lymph nodes in the chest and the lungs.
• Stage 3: The tumors are only in the lungs. They are not in the lymph nodes.
• Stage 4: Permanent scarring of the lungs (pulmonary fibrosis) has occurred. This stage is difficult to reverse.

Why does Sarcoidosis develop? What is the cause?

Doctors are still not sure what exactly causes this, but the current accepted theory is that when people with a genetic predisposition are exposed to a specific substance in the environment (such as a bacteria, virus, or dust particle), their immune system overreacts .

Simply put, it is believed to be caused by a combination of both genetic and environmental factors. Although it is a disease involving the immune system, it is not classified as an `autoimmune` disease.

How is Sarcoidosis diagnosed?

Diagnosing sarcoidosis can be a bit complicated, as the symptoms we discussed above can also be seen in many other diseases. Therefore, your doctor will rule out other conditions before concluding that sarcoidosis is a possibility.

Several tests are used for this:

• Physical examination: The doctor will listen carefully to your symptoms and examine things like your skin, eyes, and lymph nodes.
• Imaging tests: A chest X-ray is the first thing you'll do. It can check the condition of your lungs and lymph nodes. In addition, a CT scan or MRI scan may be needed.
• Biopsy: This is the best way to confirm the disease 100%. A very small piece of tissue is taken from a suspected area (e.g. skin, lymph node) and examined under a microscope.
• Pulmonary function tests: These measure how well the lungs are working.
• Blood and urine tests: These check things like the function of organs like the liver and kidneys and the level of calcium in the blood.
• EKG (Electrocardiogram): This test is done to see if there is any effect on the heart.
• TB test: Since the symptoms of tuberculosis are sometimes similar to this, a simple skin test is done to make sure it is not the case.

What are the treatments for this?

The good news is that not everyone with sarcoidosis needs treatment. For about two-thirds of people, the condition will get better on its own within two to three years, without any treatment.

Whether or not to start treatment depends on the severity of your symptoms and where the tumors are located. For example, if the eyes, heart, or nervous system are affected, treatment will start quickly to stop organ damage.

The main goals of treatment are:

1. Controlling symptoms.

2. Reducing inflammation in the body.

3. Preventing permanent damage (fibrosis) to organs.

The main types of medications given for this are:

• Corticosteroids: This is the most commonly used type of medication (e.g., Prednisone). These work by suppressing the immune system and quickly reducing inflammation in the body. They come in the form of pills, inhalers, or creams applied to the skin.
• Immunosuppressants: In addition to corticosteroids or to reduce their dosage, other drugs that control the immune system (e.g., Methotrexate) are given.
• Anti-TNF-alpha antibodies: These are a type of intravenous (infusion) medication that targets a specific chemical in the immune system.
• NSAIDs (painkillers): These can be given to control temporary symptoms such as joint pain.

Things to know when living with sarcoidosis

A person living with sarcoidosis can do many things to manage their condition.

• Follow your doctor's instructions: take your medication as prescribed, go to the clinics on scheduled days, and inform your doctor if there are any changes in your symptoms.
• A healthy lifestyle: It is important to eat a balanced diet, completely avoid smoking (especially if it has affected the lungs), and exercise moderately as directed by your doctor.
• Diet: Some research suggests that cutting back on sugary, starchy foods and eating more vegetables, fruits, and foods rich in omega-3s (e.g., small fish) can help reduce inflammation. However, be sure to talk to your doctor before making any major dietary changes.

Most people can live a normal, happy life with sarcoidosis. It rarely shortens life expectancy (1%-5%). The most important thing is to not be afraid of the disease, but to understand it correctly and work with your doctor to develop the best management plan that works for you.