Ask the Expert: Dr. Arthur Yee, Rheumatologist, Answers Your Questions on Sarcoidosis
Q1. What causes sarcoidosis?
The ultimate cause of sarcoidosis is not known, but integral in its development are changes in the immune system which leads to unrestrained inflammation. The manifestations of sarcoidosis in a given individual depend on which areas of the body become targeted by this inflammation and how severe the inflammation is.
Q2. Does sarcoidosis cause pain?
Sarcoidosis does not necessarily cause pain but can if it affects particular areas. For example, bone involvement could cause pain, but skin involvement would generally not.
Q3. How do you treat sarcoidosis?
First and foremost, the management of sarcoidosis should involve a clinician with particular knowledge in the area because the disorder can be so different from patient to patient. Often, no medicinal intervention is necessary, but in all cases, vigilant monitoring is essential. This involves not only an observant physician but more importantly an educated patient. When medicines are necessary, they should be targeted to the specific issues at hand, with the appropriate degree of aggressiveness. Arthritis can be treated with simple non-steroidal anti-inflammatory drugs (NSAIDs). Skin problems can be treated with topical agents. When prompt treatment is necessary (e.g., internal organ disease), corticosteroids such as prednisone are usually first-line choices to quickly quell the inflammation. However, because of concerns for the side effects of corticosteroids with prolonged use, most clinicians will opt to transition over to more specialized immune system-directed medications to attain long-term control over the disease. These other medicines are thought to be safer over the long haul but typically take longer to start working.
Q4. Who typically gets sarcoidosis? Does sarcoidosis last a lifetime?
Anybody can get sarcoidosis, although there may be racial tendencies for certain organ systems to be affected. Once diagnosed, sarcoidosis should be considered to be always in the background. However, as indicated above, it may not always require medicinal treatment.
Q5. What’s the best way to manage the rash and legions caused by sarcoidosis?
Treatment of dermatological problems depends on the extent and type of rashes; there are many different skin manifestations associated with sarcoidosis. Topical medications like corticosteroid creams are typically used first. For discrete lesions, dermatologists will sometimes inject them with steroids directly. For more widespread or difficult cases, systemic treatments as indicated above are sometimes necessary. It is best to be evaluated by a physician to determine the treatment.
Q6. I have sarcoidosis in my lung and am very arthritic in the joints. Do people exercise under these conditions?
I encourage my patients to be as active as possible, as limited by their specific circumstances. Inactivity can beget new problems. However, I do not believe in “no pain, no gain”, and exercise should definitely be done under the supervision of their physicians.
Dr. Arthur Yee is a rheumatologist at Hospital for Special Surgery.