Sarcoidosis: Key disease aspects and update on management

Abstract

Sarcoidosis is a complex disease of unknown origin, primarily affecting the lungs but capable of involving almost any organ. Diagnosis is challenging due to the lack of specific markers and requires assessment of clinical features, careful imaging, exclusion of other conditions and, ideally, a tissue biopsy demonstrating non-necrotising granulomas. Over 90% of patients have pulmonary involvement, presenting with symptoms like dry cough and breathlessness, along with systemic signs such as fever and weight loss. Extrapulmonary manifestations occur in about 30% of cases and can affect any organ, including the heart, nervous system and eyes. Management involves a multidisciplinary approach with some patients requiring immunosuppressive and antifibrotic therapies. Despite generally good outcomes, sarcoidosis can lead to significant morbidity and mortality, particularly from pulmonary and cardiac complications. Emerging treatments like infliximab and nintedanib offer hope for refractory cases, although they carry risks of serious infections and other side effects.

Keywords: Antifibrotic; Arrhythmia; Granuloma; Hypercalcaemia; Uveitis.

Fig. 1

Multisystem manifestations of sarcoidosis. Sarcoidosis can present to any specialty with a range of pulmonary and/or extrapulmonary manifestations.

Fig. 2

Radiographic appearance of sarcoidosis affecting bone. Typical radiographic appearance of bone involvement by sarcoidosis: lace-like honeycomb appearance of sarcoidosis involving first metatarsal (arrowed) on plain radiograph.

Fig. 3

Typical appearances on HRCT. Typical appearances of thoracic sarcoidosis on HRCT: calcified hilar and mediastinal nodes (red arrows), and parenchymal nodularity (white arrow).