Dr Martin Scurr has been treating patients for more than 30 years and is a leading GP in the UK. The following is an extract from his Daily Mail column, in which he gives an informative answer to a particular question about sarcoidosis and treatment.
Question: My sister is 79 and has been diagnosed with sarcoidosis, which she has been told is incurable with no treatment. In the past five years she has had operations to remove a lump on her neck, and two lumps behind her knees. She has lost a lot of weight and still has problems walking any distance. Can you tell me anything about the condition?
Mrs B. R. Timson Basildon, Essex.
Answer: Sarcoidosis is a disease that can affect any organ in the body, and is characterised by the formation of tiny patches of inflammation — known as granulomas — in the organs. These are thought to be the result of the immune system malfunctioning and attacking the body’s own tissues, and are identified by doctors when one of the swellings, such as the lump your sister had in her neck, is taken for examination.
The condition has a wide spectrum of severity. Many cases go unnoticed and are only discovered by chance when a chest X-ray is obtained for some other reason — the lung is the most common part of the body to be involved.
Despite much research, no cause for the disease has ever been found.
Most patients who have this disorder, which affects about one in 10,000, have a mild form of the disease, with little in the way of symptoms, and requiring no treatment. In many of those cases the condition abates after a year or two.
But in others the patches of inflammation become widespread in the body, and may be found in the eyes, joints, skin, liver and spleen.
This causes symptoms such as a cough, breathlessness, fatigue, and weight loss, and treatment to suppress the damaging inflammation becomes necessary.
The standard approach is to prescribe steroids in the form of tablets of prednisolone, but it must be stressed that the decision to start treatment must be taken by a specialist, as the side effects of the medicine must be weighed against the symptoms and damage caused by the disease.
The side effects of steroids include weight gain, indigestion, muscle weakness and osteoporosis, which is why a long period of watchful waiting before making the decision to start treatment may be necessary.
The length of therapy is variable but will be at least three to six months, and relapses may occur when the steroid tablets are gradually tapered off.
Further, for patients who have unacceptable side effects, or those who have evidence of the condition becoming worse despite the steroids, the addition of pills to reduce the inflammation may be helpful.
Generally these are drugs that suppress the immune system such as azathioprine.
The most important advice for your sister is she should be monitored periodically on a specialised unit so that her progress, and hopefully her remission, is identified — as well as any complications observed and treated accordingly
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