Sarcoidosis - Causes, Symptoms and Treatment .MF .
Sarcoidosis - a disease in which may affect many organ systems, characterized by the formation of granulomas in affected organs, which can be seen at the microscopic level.The most commonly affected lymph nodes, lungs and spleen.It is not a contagious disease and is not transmitted to others.Previously, sarcoidosis was considered a rare disease, but at the present improved diagnostic capabilities, a fresh look at the pathology of the doctors he had ceased to be a rarity.
Most sarcoidosis diagnosed in younger groups of 20 to 40 years.A certain predominance of women.This disease is known for more than 100 years, but its reason has not yet been known.There is speculation that sarcoidosis cause different viruses, such as the herpes virus.As there is a possibility that this disease is hereditary or caused by various mycobacteriosis (so before doing phthisiatricians sarcoidosis, sarcoidosis was considered a form of tuberculosis).There may be a number of factors, which together lead to c
In accordance with the International Classification of Diseases release:
1. Sarcoidosis Lung
2. Sarcoidosis lymph nodes
3. Sarcoidosis of lung with sarcoidosis of lymph nodes
4. Sarcoidosis and other specified locations combined
5. Sarcoidosis, unspecified symptoms of sarcoidosis
disease onset may be either acute or gradual and asymptomatic.Asymptomatic disease is more common in sarcoidosis intrathoracic lymph nodes , without involvement of other organs.In such cases, the identification of the disease occurs when the prophylactic fluorography.
Most disease occurs gradually with such common symptoms as lethargy, fatigue, which are typical for a variety of diseases.If involvement of the lungs, patients complain of shortness of breath, cough, pain in the back.After 2-3 weeks, these symptoms may disappear entirely.When protracted course of these symptoms may persist for a long time.Characterized by a dry cough with difficult expectoration.In the future, with the development of fibrosis (hardening of lung tissue) developed respiratory and pulmonary heart disease.
There is keen for sarcoidosis - syndrome Lefgrena .Rarely observed in 10% of cases.It is characterized by raising the temperature to 38-39 ° C, the appearance of erythema nodosum (inflammation sites, towering above the skin, most often occurs in the lower legs, forearms, face less), swelling and joint pain, as well as bilateral lesion of intrathoracic lymph nodes.These symptoms may not appear in full, and the disease will occur in this case more than erased.
Erythema nodosum sarcoidosis
addition, there is more Heerfordt syndrome characterized by lesions of the salivary glands and the eyes.
Among extrapulmonary localization process, most often isolated loss of peripheral lymph nodes, skin and subcutaneous tissue .Cervical and subclavian nodes, rarely axillary and inguinal enlarged plotnoelasticheskoy, mobile, the skin over them is not changed, not complicated by fistulas.The same may be affected and lymph nodes of the abdomen.In 5% of cases spleen and liver enlarged .The increased blood bilirubin, aminotransferases. defeat bones is rare, characterized by a typical X-ray picture.Typically, the development of multiple centers of discharge bone phalanges of fingers and toes associated with leaching of calcium and is accompanied by an increase in its content in the blood and urine tests. Central nervous system very rare, runs hard.
In 20-30% of cases of sarcoidosis occurs heart who are asymptomatic.Defects can be detected by ECG, ultrasound of the heart.Reduces the volume and size of the left heart, the right ventricle increases, arrhythmia.
If you have the above symptoms, the patient should start to apply to the general health services, where the therapist will appoint the necessary tests and other methods of research.And in cases of suspected sarcoidosis referred to a specialist - pulmonologist.Early detection and treatment of disease provides a favorable prognosis and recovery.Otherwise, there are gross changes in the lung tissue, respiratory and pulmonary heart disease, blindness and other disorders that lead to patient disability.
Most sarcoidosis its symptoms are very similar to tuberculosis, but the causes of, and thus the treatment of these diseases differ enormously.And the treatment of anti-TB drugs, and possibly self-patient, can lead to a deterioration of, and in special cases and deaths.Just in its current sarcoidosis is similar to diseases such as lymphoma, central lung cancer, toxoplasmosis, brucellosis, and a whole group of diseases, united under the name "granulomatous".Therefore, timely treatment to the doctor, diagnosis and treatment by a specialist can prevent undesirable consequences.
Necessary tests for suspected sarcoidosis
to the analysis, which should be submitted include: complete blood count, blood biochemistry, Mantoux, Diaskintest, a general analysis of sputum, sputum for mycobacteria, bronchoscopy with biopsy, spirography, radiography (CTMRI).
in the blood can be detected anemia, leukopenia, lymphopenia, monocytosis, increased erythrocyte sedimentation rate (often with acute course).At the same time, in many patients, especially in sarcoidosis intrathoracic lymph nodes, changes in the blood are insignificant or non-existent.When biochemical analysis can reveal an increase of fibrinogen, lipoprotein cholesterol, C-reactive protein, some patients have Dysproteinemia.In 15% - 20% of patients have increasing levels of calcium in the blood and urine.Both of these analyzes tell us about the extent of organ involvement in sarcoidosis, a process of gravity.
Most patients with sarcoidosis marked tuberculin anergy reflecting disorders of cellular immunity.A negative tuberculin skin test and Diaskintest more common in sarcoidosis with pulmonary involvement.
General sputum analysis and the analysis of sputum for mycobacteria will help us to make a differential diagnosis with other lung diseases, such as such as aspergillosis, tuberculosis.In rare cases, the analysis of sputum revealed mycobacterium tuberculosis (1% of the combined pathology of sarcoidosis and tuberculosis).
When fibreoptic sarcoidosis patients may reveal various changes.In connection with the compression of the bronchial tubes enlarged lymph nodes occurs bronchoconstriction.The deformation of their walls, bulging into the lumen of the bronchi wall, "sarkoidoznye ectasia" - extension, crimp, thickening of blood vessels in the form of a network or individual plexus "spiders."The majority of patients found endobronchitis nonspecific, usually reversible.Rarely identifies multiple bumps.Plaques granulation.
biopsy in these areas with the help of cytological and histological methods can detect elements of sarcoid granulomas.A morphological study of the bronchi revealed various granuloma: typical sarcoid and numerous lymphoid cell clusters.The most commonly used today: intrapulmonary transbronchial biopsy, mediastinoscopy, transbronchial biopsy of intrathoracic lymph nodes, videotorokoskopiya.Furthermore held and bronchial biopsy, peripheral lymph nodes, skin, liver, spleen and other organs involved in the process.Discovered in biopsies sarkoidoznogo defeat elements allows the correct and timely diagnosis.
study of respiratory function (spirography, spirometry) to help identify violations of varying degrees in patients with respiratory sarcoidosis.The degree of disturbance of bronchial patency, increase in bronchial tubes resistance to air flow, changing the elastic properties of lung tissue shows the progression of respiratory failure.Violations obstructive nature vstechayutsya often in patients with acute course of the disease, the chronic course restriktivnogo-.
One of the main methods for diagnosis of sarcoidosis intrathoracic lymph nodes and lung X-ray is.Lymph nodes are enlarged on both sides almost always.As a rule of bronchopulmonary lymph nodes are affected.lymph nodes Shadows appear on radiographs as large konglameraty, but may be in the form of separate groups of lymph nodes.The greatest changes in the combined lesion of intrathoracic lymph nodes and lungs in the acute phase occur in the middle and lower parts of the lung lesions observed dissemination.They may be of various sizes.In some cases, the changes are more pronounced on the right than on the left.In chronic course of the process observed: increased pulmonary pattern, emphysematous lung fields, the formation of the "bulls".Against this background, there may be fresh and pockets.
Sarcoidosis intrathoracic lymph nodes in the X-ray
Isolated lung damage observed often did not.After cure sarcoidosis can be detected on X-ray residual changes in the form of pulmonary fibrosis of varying severity, abdominal formations on bullous type.
used classification of sarcoidosis stages associated with radiological signs on her distinguished: Stage 1 - an increase of intrathoracic lymph nodes, Stage 2 - the development of combined lesions of intrathoracic lymph nodes and lungs.Stage 3 - the combined loss of intrathoracic lymph nodes and lungs with the development of fibrosis and large entities.
entire set of diagnostic tests, medical history, medical history of the patient leads to a life exhibiting the exact diagnosis.
The treatment of sarcoidosis is used: corticosteroids, non-steroidal anti-inflammatory praparaty, pentoxifylline, cytostatics (methotrexate, azathioprine), immunosuppressants (cyclosporine), immunomodulating agents, physical therapy techniques, plasmapheresis.Currently used hormonal number of schemes, which reduce inflammation, improve the clinical picture of the disease.As a rule, prescribed Prednisolone, or its analogs (metipred).Just apply ingalyatsioonye corticosteroid - budesonide.Bekotid, beclomethasone dipropionate.They selectively affect the diseased bronchial mucosa.
In the complex treatment regimen include sarcoidosis delagil or Plaquenil, they reduce tissue oxygen demand, inhibit the development of granulation tissue are immunomodulators.During the treatment period prescribed antioxidants: vitamin E, sodium thiosulfate, vitamin C.
patients with acute onset of the disease and impaired microcirculation appoint angioprotectors.It is necessary to avoid stress, avoid prolonged sun exposure and hypothermia.The majority of patients with Just noticeable symptoms of the disease, while moderate increase in intrathoracic lymph nodes, in the absence of lung lesions often prescribed observation for 3-6 months with the appointment of nonsteroidal anti-inflammatory agents and antioxidants: indomethacin, vitamin E, sodium thiosulfate, pentoxifylline, anti-malarial drugs (chloroquine).Often after such treatment in patients there is complete or nearly complete remission.Rarely observed the deterioration process during treatment, forcing appoint hormonal treatment.In sarcoidosis with a limited involvement of other bodies appointed by the antimalarial drug treatment minimal doses of the hormone.In generalized forms are used as methotrexate, or cyclosporine azatioprim.
Self-medication is not recommended.The entire period of rehabilitation must be strictly held under medical supervision.Rentgenkontrol held every two months.
In the first stage of treatment, especially in the acute stage of the disease, it is recommended hospital treatment for selection of an individual regimen, selection of doses of hormone therapy.The treatment will last about two months, with the transition to outpatient monitoring.With no systematic treatment of the patient's condition can deteriorate to progress.Timing of treatment depend on the improvement of the patient, analyzes, X-ray methods of research and depend on the extent of the process.Treatment for severe cases may last up to two years.
Nutrition and lifestyle in sarcoidosis
Diet is not specific for sarcoidosis, but there are some restrictions.Since the process is inflammatory in nature and beneficial carbohydrates increase inflammation, you must eliminate from your diet: sugar, sweets, cakes, products made of yeast dough, sweet carbonated drinks.Any inflammatory process also increases with the use of: sharp, salty and fried dishes.It is necessary to exclude products containing calcium, as its content increases in the blood and urine (milk and milk products, cottage cheese, sour cream).The food should be wholesome and easily digestible: steamed, cooked by boiling or quenching.Good to eat the fruit of sea buckthorn, black currants, gooseberries, cherries, pomegranates, onions, garlic, seaweed, buckwheat and oat cereals, beans, peas.When hormone therapy should limit salt intake, as there is fluid retention in the body.Strongly decomposed protein, so you need to use a protein diet.
Traditional methods of treatment
Traditional treatments include herbal therapy (marshmallow root, calendula, plantain, oregano, sage), if they do not have allergies.In principle, this treatment is permitted, it does not lead to disturbance of organs and systems.Here, for example, vodka treatment with oil, can affect the function of the liver, which may well worsen in sarcoidosis.Badger fat contributes to a deterioration in the lungs, enhance the inflammatory process, its application will only worsen the situation in sarcoidosis.Aloe immunomodulators are natural honey, so that the complex sarcoidosis can be used.
Rehabilitation after sarcoidosis
Non-pharmacological Rehabilitation interstitial electrophoresis, magnetic therapy, electrophoresis of heparin or lidazy, ultrasound, lazerolechenie, physiotherapy, manual therapy.The total duration of treatment depends on the disease and the patient's condition.
complications of sarcoidosis
The most frequent complications of sarcoidosis are: severe emphysema, respiratory failure, pulmonary heart disease, bronchial obstruction, pulmonary heart.That is, the occurrence of irreversible processes, which subsequently become chronic and accompany the patient has a lifetime, require treatment.Therefore, timely treatment to the doctor, the annual passing fluorography examination helps early detection of the disease and prevents the appearance of complications.
prognosis of sarcoidosis
Approximately 60% of patients after two years there is a spontaneous remission.25% of patients recover completely after treatment.In 10% of cases of remission can not be achieved.Treatment of extrapulmonary sarcoidosis and central nervous systems are often ineffective.Sarcoidosis is rarely a cause of permanent loss of disability, especially at the present level of medicine.The most common disability is connected with the development of pulmonary heart disease, pulmonary heart disease, as a consequence of long flowing sarkoidoznogo process.The lethal outcome occurs rarely - in 0.5-7% of cases.
Since the possible causes of the disease sarcoidosis to the end and do not know is difficult to talk about the prevention of this disease.You can talk about adherence to a healthy lifestyle: eliminate smoking and alcohol, prolonged sun exposure, avoid contact with chemicals, fumes, substances that affect the function of the liver and lungs.Held annually fluorography study.
doctor phthisiatrician Kuleshov LA