sarcoidosis

Sarcoidosis is a condition in which groups of cells in your immune system form small, red, and swollen (inflamed) lumps. These lumps are called granulomas. They can form in any organ in the body. But they most commonly affect the lungs and lymph nodes in the chest. Over time, sarcoidosis can cause permanent scarring of organs.

Your immune system creates inflammation to help defend you against germs and sickness. But in sarcoidosis, inflammation goes off track. It causes the cells in your immune system to form granulomas. Studies suggest that this inflammation might be triggered by infections and certain substances in the environment such as insecticides and mold. And your genes may affect how your immune system reacts to a trigger.

Anyone can develop sarcoidosis, but you are more likely to have it if you:

• Are older, especially if you are over age 55
• Live or work near insecticides, mold, or other substances that may cause inflammation
• Have a close relative who has sarcoidosis
• Take certain medicines, such as some types of HIV medicines and monoclonal antibodies
• Are of African or Scandinavian descent
• Are female

Many people who have sarcoidosis have no symptoms, or they may feel unwell but without any obvious symptoms. If you have symptoms, you may have some general symptoms. And you may have other symptoms, which will depend upon which part of the body is affected.

The general symptoms can include:

• Fatigue
• Weight loss
• Swollen lymph nodes
• Depression
• Fever
• Night sweats (heavy sweating during sleep)

The symptoms of sarcoidosis in the lungs can include:

• Wheezing
• Cough
• Shortness of breath
• Chest pain

The symptoms of sarcoidosis in other parts of the body can include:

• Larger than normal liver or spleen
• Jaundice, which can make your eyes or skin yellow
• Nervous system problems, such as:
  • Headache
  • Dizziness
  • Vision problems
  • Seizures
  • Numbness or tingling
• Heart palpitations or an irregular heartbeat (arrhythmia)
• Pain and swelling in the joints
• Skin problems such as rashes and growths under the skin

There is also a set of symptoms that are called Lofgren's syndrome. Some people have Lofgren's syndrome when they first develop sarcoidosis. It usually goes away completely within 2 years. The symptoms of Lofgren's syndrome may include:

• Swollen lymph nodes in your chest, neck, chin, armpits, or groin.
• A rash of small, itchy, or painful bumps called erythema nodosum. The rash is most often on your head, neck, or legs.
• Blurred vision, eye pain or redness, light sensitivity, or watery eyes.
• Joint pain, stiffness, or swelling.
• Fever.

If untreated, or if the treatment does not work, sarcoidosis can cause serious health problems called complications. Possible complications include:

• Lung problems
• Heart problems
• Hormone problems
• Brain, nerve, or muscle problems
• Kidney problems
• Severe organ damage

There is no single test that can diagnose sarcoidosis, and its symptoms can be similar to the symptoms of many other conditions. That makes it hard to diagnose. To find out if you have sarcoidosis, your health care provider:

• Will ask about your medical history, including your symptoms, lifestyle, and any other health conditions you may have.
• Will do a physical exam, which may include:
  • Checking your temperature
  • Checking to see if your lymph nodes, spleen, or liver are swollen
  • Listening to your chest with a stethoscope as you breathe in and out
  • Looking for rashes or sores on your body, such as scalp and lower legs
• Will likely order various tests, such as:
  • Chest x-rays
  • A biopsy of the skin, lymph nodes, lungs, or other affected organs
  • Blood tests to check your blood counts, hormone levels, and how well your kidneys are working
  • Other imaging tests

If you are diagnosed with sarcoidosis, your provider may order other tests to look at how sarcoidosis is affecting the body.

There is no cure for sarcoidosis. The goal of treatment for sarcoidosis is remission, which means you still have the condition, but it does not cause you problems.

You may not need treatment, and sometimes the condition goes away on its own. If you do need treatment, which treatment(s) you get will depend on your symptoms, which organs are affected, and whether those organs are working well. You may be given medicines to:

• Lower inflammation
• Treat an overactive immune response
• Treat joint pain
• Treat skin problems

If you have complications from sarcoidosis, you may need other treatments, such as other medicines, surgery, oxygen therapy, pulmonary rehabilitation, or an implanted cardiac pacemaker or defibrillator.

Whether or not you have symptoms from sarcoidosis, it's important to get regular follow-up care from your provider, make healthy lifestyle changes, and contact your provider if you have any new symptoms.

NIH: National Heart, Lung, and Blood Institute

Heart disease is a general term that includes many types of heart problems. It's also called cardiovascular disease, which means heart and blood vessel disease.

Heart disease is the leading cause of death in the United States, but there are ways to prevent and manage many types of heart disease.

There are many different types of heart disease. Some you may be born with, called congenital heart disease. Other types develop during your lifetime.

Coronary artery disease (also called coronary heart disease) is the most common type of heart disease. It happens slowly over time when a sticky substance called plaque builds up in the arteries that supply your heart muscle with blood. The plaque narrows or blocks blood flow to the heart muscle and can lead to other heart problems:

• Angina - chest pain from lack of blood flow
• Heart attacks - when part of the heart muscle dies from loss of blood flow
• Heart failure - when your heart can't pump enough blood to meet your body's needs
• Arrhythmia - a problem with the rate or rhythm of your heartbeat

Other types of heart diseases may affect your heart valves or heart muscle (cardiomyopathy).

The causes of heart disease depend on the type of disease. Some possible causes include lifestyle, genetics, infections, medicines, and other diseases.

There are many different factors that can make you more likely to develop heart disease. Some of these factors you can change, but others you cannot.

• Age. Your risk of heart disease goes up as you get older.
• Sex. Some factors may affect heart disease risk differently in women than in men.
• Family history and genetics. A family history of early heart disease raises your risk of heart disease. And research has shown that some genes are linked to a higher risk of certain heart diseases.
• Race/ethnicity. Certain groups have higher risks than others.
• Lifestyle habits. Over time, unhealthy lifestyle habits can raise your risk heart disease:
  • Eating a diet high in saturated fats, refined carbohydrates, and salt.
  • Not getting enough physical activity.
  • Drinking too much alcohol.
  • Smoking and exposure to secondhand smoke.
  • Too much stress.
• Having other medical conditions can raise your risk of heart diseases. These conditions include:
  • High blood pressure.
  • High cholesterol levels.
  • Diabetes.
  • Obesity.
  • Autoimmune and inflammatory diseases.
  • Chronic kidney disease.
  • Metabolic syndrome.

Your symptoms will depend on the type of heart disease you have. You may not have symptoms at first. In some cases, you may not know you have heart disease until you have a complication such as a heart attack.

To find out if you have heart disease, your health care provider will:

• Ask about your medical history, including your symptoms
• Ask about your family health history, including relatives who have had heart disease
• Do a physical exam
• Likely run heart tests and blood tests

In some cases, your provider may refer you to a cardiologist (a doctor who specializes in heart diseases) for tests, diagnosis, and care.

Treatment plans for heart disease depend on the type of heart disease you have, how serious your symptoms are, and what other health conditions you have. Possible treatments may include:

• Heart-healthy lifestyle changes
• Medicines
• Procedures or surgeries
• Cardiac rehabilitation

You may be able to lower your risk of certain heart diseases by making heart-healthy lifestyle changes and managing any other medical conditions you have.

NIH: National Heart, Lung, and Blood Institute

Pulmonary rehabilitation, also known as pulmonary rehab or PR, is a program for people who have chronic (ongoing) breathing problems. It can help improve your ability to function and quality of life. PR does not replace your medical treatment. Instead, you use them together.

PR is often an outpatient program that you do in a hospital or clinic. Some people have PR in their homes. You work with a team of health care providers to find ways to lessen your symptoms, increase your ability to exercise, and make it easier to do your daily activities.

Your health care provider may recommend pulmonary rehabilitation (PR) if you have a chronic lung disease or another condition that makes it hard for you to breathe and limits your activities. For example, PR may help you if you:

• Have COPD (chronic obstructive pulmonary disease). The two main types are emphysema and chronic bronchitis. In COPD, your airways (tubes that carry air in and out of your lungs) are partially blocked. This makes it hard to get air in and out.
• Have an interstitial lung disease such as sarcoidosis and pulmonary fibrosis. These diseases cause scarring of the lungs over time. This makes it hard to get enough oxygen.
• Have cystic fibrosis (CF). CF is an inherited disease that causes thick, sticky mucus to collect in the lungs and block the airways.
• Need lung surgery. You may have PR before and after lung surgery to help you prepare for and recover from the surgery.
• Have a muscle-wasting disorder that affects the muscles used for breathing. An example is muscular dystrophy.

PR works best if you start it before your disease is severe. However, even people who have advanced lung disease can benefit from PR.

When you first start pulmonary rehabilitation (PR), your team of health care providers will want to learn more about your health. You will have lung function, exercise, and possibly blood tests. Your team will go over your medical history and current treatments. They may check on your mental health and ask about your diet. Then they will work together to create a plan that is right for you. It may include:

• Exercise training. Your team will come up with an exercise plan to improve your endurance and muscle strength. You will likely have exercises for both your arms and legs. You might use a treadmill, stationary bike, or weights. You may need to start slowly and increase your exercise as you get stronger.
• Nutritional counseling. Being either overweight or underweight can affect your breathing. A nutritious eating plan can help you work towards a healthy weight.
• Education about your disease and how to manage it. This includes learning how to avoid situations that make your symptoms worse, how to avoid infections, and how/when to take your medicines.
• Techniques you can use to save your energy. Your team may teach you easier ways to do daily tasks. For example, you may learn ways to avoid reaching, lifting, or bending. Those movements make it harder to breathe, since they use up energy and make you tighten your abdominal muscles. You may also learn how to better deal with stress, since stress can also take up energy and affect your breathing.
• Breathing strategies. You will learn techniques to improve your breathing. These techniques may increase your oxygen levels, decrease how often you take breaths, and keep your airways open longer.
• Psychological counseling and/or group support. It can feel scary to have trouble breathing. If you have a chronic lung disease, you are more likely to have depression, anxiety, or other emotional problems. Many PR programs include counseling and/or support groups. If not, your PR team may be able to refer you to an organization that offers them.

NIH: National Heart, Lung, and Blood Institute