Mortality in Sarcoidosis: Changing Pattern of the Causes of Death

Sarcoidosis is a potentially serious illness that rarely results in death.

Sarcoidosis is a rare condition in which small patches of red and swollen tissues (granulomas) develop in organs in the body. It usually affects the lungs and skin. This condition may change the normal structure and possibly the function of an affected organ. Many people with sarcoidosis do not have any symptoms. Others have only vague symptoms which include

• Weight loss
• Fever
• Loss of appetite
• Depression
• Night sweats 
• Sleep problems

Organ-specific symptoms include

• Lungs: Shortness of breath, wheezing or dry cough that may disappear over time
• Lymph nodes: Enlarged and sometimes tender lymph nodes, most often in the neck and chest, but sometimes under the chin, arm pits or groin
• Eyes: Burning, itching, tearing, redness, sensitivity to light, dryness, seeing black spots, blurred vision, reduced color vision and, in rare cases, blindness
• Skin: Bumps, ulcers or rarely flat areas of discolored skin that appear mostly near the nose or eyes or on the back, arms, legs and scalp; painful and tender bumps can also appear on the ankles and shins.
• Bones and joints: Nodules (bone growths) causing pain in the hands and feet and sometimes pain and swelling in the ankles or other joints
• Spleen and liver: Fever, fatigue or itching; there can be pain in the upper right part of the abdomen under the ribs.
• Heart: Shortness of breath, swelling in the legs, wheezing, coughing and chest pain. One may have a feeling of an irregular or fast heartbeat at times or even pass out without warning.
• Salivary glands: Swelling (which may make the cheeks look puffy) and an overly dry mouth and throat
• Nervous system: Headaches, vision problems, weakness or numbness of an arm or a leg, drooping of one side of the face, loss of movement in the arms or legs, weakness, pain or a “pins and needles” feeling

• The exact cause of sarcoidosis is unknown; however, research shows that having certain inherited genes makes it more likely for a person to develop sarcoidosis. 
• A person with a close blood relative who has sarcoidosis is nearly five times as likely to develop the condition.
• Sarcoidosis may be the result of an abnormal immune system, where the body starts to attack its own tissues and organs. The resulting swelling causes granulomas to develop in the organs. 

Some possible triggers include:

Environmental factor or allergies

• Exposure to viruses, fungi or bacteria
• Exposure to chemicals
• Recent organ transplantation
• Age between 20 and 40 years old
• Female gender: The disease is slightly more common in women than in men.

The disease is 10 to 17 times more common in African Americans than in Caucasians. People of Scandinavian, German, Irish or Puerto Rican origin are also more prone to the disease.

The condition is not infectious, so it cannot be passed from person to person.

There is no cure for sarcoidosis, but the disease may get better on its own over time. Sarcoidosis symptoms will often get better without treatment. Treatment is aimed at maintaining good lung function, reducing symptoms and preventing organ damage. Corticosteroids such as prednisone may reduce inflammation and slow the growth of the granulomas. Patients may be advised to follow lifestyle modifications

• Eating a well-balanced diet with various fresh fruits and vegetables
• Drinking enough fluids every day
• Getting six to eight hours of sleep each night
• Exercising regularly and managing your weight
• Quitting smoking
• Avoiding exposure to dust, chemicals, fumes, gases, toxic inhalants and other substances that can harm your lungs
• Avoiding excessive amounts of calcium-rich foods (such as dairy products, oranges and canned salmon with bones), vitamin D and sunlight

Approximately 1% to 5% of patients with sarcoidosis die from its complications. Recent population studies have indicated that the mortality rate may be increasing over the past decade. The most prevalent lesion leading to death was advanced lung involvement (22/28 patients or 78%) with various late complications such as cardiorespiratory failure, gram-negative pneumonias and fungal infections. Patients who died of central nervous system and cardiac sarcoidosis were younger and their clinical course was shorter. Sarcoidosis is associated with autoimmune diseases, pulmonary embolism and cancer; however, the underlying mechanisms linking the diseases continues to be debated.