Sarcoidosis affects the lungs in more than 90% of cases. The most common lung-related symptoms are cough, shortness of breath and chest pain.

• Treatment

  There are a few different drugs used to treat sarcoidosis, which often work by reducing symptoms and include:

  • Prednisolone and prednisone (steroids) - the most common drugs used for sarcoidosis.
  • Methotrexate and azathioprine are often used to help people come off prednisolone (this is known as ‘steroid-sparing’).
  • Infliximab and similar drugs can sometimes work when prednisolone or steroid sparing drugs do not work.

About 25% of patients with sarcoidosis develop at least one skin symptom. Skin conditions may include:

• Erythema nodosum: tender, red bumps or patches on the skin, usually found on the shins. Often accompanied by swollen and painful joints. This is the most common skin condition found in people with sarcoidosis.
• Lupus Pernio: purple-coloured bumps form on the face e.g. on the cheeks, nose, lips and ears.
• Other skin signs: in patients with long-term disease this may include bumps in or under the skin, rashes and scars.

• Treatment

  Erythema nodosum: this skin condition often improves by itself after 3 to 6 weeks, often without treatment.

  Lupus pernio: this skin condition rarely disappears by itself and can cause permanent damage to the skin. Referral to a dermatologist (specialist skin doctor) is required for the right medication.
  

Eye problems caused by sarcoidosis might include:

• Uveitis: this is the most common eye symptom and is caused by inflammation of the middle layer of the eye (uvea). Symptoms include blurred vision and/or seeing black spots, redness and pain to the touch, light sensitivity.
• Lacrimal gland inflammation: this is rare and occurs when the tear glands are swollen.Symptoms include dry eyes, burning or itchy eyes, overproduction of tears.
• Glaucoma, cataracts, and blindness: these are rare but serious problems that can occur if eye symptoms go untreated.

• Treatment

  Uveitis: usually requires treatment with eye drops. You may be prescribed two kinds of eye drops e.g. corticosteroids (drops to prevent inflammation) and mydriatic (drops to dilate the pupils) If the inflammation lasts a long time or recurs, corticosteroid treatment in tablet form can be effective.

  Lacrimal gland inflammation: usually requires treatment with eye drops.

  Glaucoma and cataracts: treated with eye drops and may require surgery where the cataract lens is replaced by an artificial lens.

The heart muscle can be affected by sarcoidosis. Only about 5% of patients report having any heart-related symptoms. When the heart is involved it may be called cardiac sarcoidosis.

Symptoms include:

• irregular heartbeat
• dizziness or fainting spells
• shortness of breath
• chest pain
• swelling of the legs

Many diagnostic tests can be performed in the assessment of people suspected of cardiac sarcoidosis and include ECG (electrocardiogram). Echocardiography, and MRI imaging.

• Treatment

  The main treatment for cardiac sarcoidosis is corticosteroids, for example prednisolone.

Sarcoidosis may affect any part of the nervous system, such as your brain or spinal cord (neurosarcoidosis). However, this is very rare. It can present in many different ways and resembles many other neurological disorders.

Some examples are:

• Cranial neuropathy (weakness of one side of the face)
• Leptomeningitis (inflammation of the inner lining of the brain): common symptoms are headaches, tiredness, slowness of thinking
• Pachymeningitis (inflammation of the outer lining of the brain): common symptoms are headaches, numbness down one side
• Vasculitis (inflammation of blood vessels of the brain)

Small fibre neuropathy gives a sensation of burning in the feet and is common for people with neurosaroidosis.

• Treatment

  Corticosteroids are usually used as treatment - often in a high dose.

  It is important to be monitored by a neurologist with experience of the disease.

  Treatment for small fibre neuropathy includes Gabapentin and Duloxetine (anti-neuralgia drugs).

Granulomas are present in the liver in 50% to 80% of patients with sarcoidosis. However, patients usually do not notice symptoms related to the liver.

If symptoms do occur they may include:

• Abdominal pain
• Fever
• Weight loss
• Jaundice (yellowing of the skin)

In rare cases, liver disease can progress to hypertension in the liver (called portal hypertension) or cirrhosis (a disease causing widespread disruption of liver function).

• Treatment

  Most people with sarcoidosis of the liver do not require treatment (known as asymptomatic patients).

  Some people may need treatment with corticosteroids which usually brings an improvement in liver function tests.