What are the symptoms of sarcoidosis?
Symptoms of sarcoidosis depend on the site of involvement and may be absent, slight, or severe. Sarcoidosis is most often manifested as a restrictive disease of the lungs, causing a decrease in lung volume and decreased compliance (the ability to stretch). The vital capacity (full breath in, to full breath out) is decreased, and most of this air can be blown out in the first second. This means the FEV1/FVC ratio is increased from the normal of about 80%, to 90%.
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However, it can have systemic effects, including skin lesions, renal, liver and heart involvement, neuropathy (damage to the nerves or brain, in particular damage to the peripheral nerves causing numbness). It may also cause uveitis and retinal inflammation which incurs loss of visual acuity. Some people with sarcoidosis do not have any symptoms. Others simply feel tired and weak. Still others have nonspecific symptoms, such as fever, poor appetite, night sweats, joint pain or aching muscles. Symptoms vary widely because the disease affects different parts of the body in different people. Among those who see their doctors for more specific symptoms, more than 90 percent have problems involving the lungs. The first signs are usually a dry cough and shortness of breath. Later, there may also be wheezing, chest pain and, rarely, a cough that brings up bloody mucus. Rarely, in severe cases, lung function may become so poor that the person cannot perform even the simple, routine tasks of daily life.
Skin lesions (plaques, papules, subcutaneous nodules) are frequently present in patients with chronic sarcoidosis, and nasal and conjunctival mucosal granulomas may occur. Hepatic granulomas are found on percutaneous biopsy in 70% of patients, who may be asymptomatic with normal liver function tests. Myocardial involvement, noted in 5 to 10% of patients, may cause angina, heart failure, or fatal conduction abnormalities. Acute polyarthritis may be prominent; chronic periarticular swelling and tenderness may be due to osseous changes in the phalanges. CNS involvement is of almost any type, but cranial nerve palsies (especially facial paralysis) are most common, affecting 5% of patients. Diabetes insipidus may occur. Hypercalcemia and hypercalciuria may cause renal calculi or nephrocalcinosis with consequent renal failure, but prednisone has reduced the frequency of disordered Ca metabolism. |
