Caused by inflammation in the lungs, sarcoidosis can cause an array of symptoms.
Learn more about the causes and symptoms, along with treatment options, from Dr. Andrew Vranic, a UVA specialist in pulmonology.
Selected Podcast
How Can Sarcoidosis Be Treated?
Featured Speaker:
Learn more about Dr. Andrew Vranic
Learn more about UVA Pulmonary & Respiratory Care
Andrew Vranic, MD
Dr. Andrew Vranic is a board-certified physician in pulmonary medicine and critical care medicine whose specialties include sarcoidosis.Learn more about Dr. Andrew Vranic
Learn more about UVA Pulmonary & Respiratory Care
Transcription:
How Can Sarcoidosis Be Treated?
Bill Claproth (Host): Hi. This is Bill Claproth in for Melanie Cole. Sarcoidosis is caused by inflammation in the lungs and can cause an array of symptoms. What are the causes and symptoms along with treatment options? Joining us is Dr. Andrew Vranic, a UVA specialist in pulmonology, board certified physician in pulmonary medicine and critical care medicine whose specialties include sarcoidosis. Dr. Vranic, thank you so much for being on with us today. Let’s start right at the beginning. What is sarcoidosis?
Dr. Andrew Vranic (Guest): Thank you for having me today, Bill. Sarcoid is actually an idiopathic disease which means that we actually don’t know what causes it. We assume that in certain susceptible individuals something in their environment triggers it for them to develop this type of inflammation in their body called “granuloma inflammation”. This inflammation usually affects the lungs but it can actually affect any part of the body. Again, it most commonly affects the lungs which is why it is treated by lung doctors like myself. Outside of the lungs, it can affect almost anything. More commonly after the lungs, things like the skin, the eyes, other lymph nodes in the body and even sometimes, in rare cases, the heart and the brain. So, it can go pretty much anywhere.
Bill: Does it always start in the lungs?
Dr. Vranic: The symptoms that bring it to light don’t always necessarily have to do with pulmonary symptoms but almost everybody with sarcoid will have some lung involvement.
Bill: What are the common symptoms associated with sarcoidosis?
Dr. Vranic: Interestingly many patients won’t have any symptoms at all with sarcoidosis. They may come to light incidentally, such as when they get an x-ray for some other reason. Maybe their primary care doctor orders an x-ray for bronchitis or pneumonia but the x-ray ends up showing some findings suggestive of sarcoid and then they are sent to us. If they are going to have symptoms, usually the symptoms are lung related because, again, the lungs are the most commonly involved organ. They may have symptoms like shortness of breath, chronic cough, occasionally chest pains. Many of them will have non-specific symptoms such as fatigue. Like I said earlier, because sarcoid can involve any other part of the body besides the lungs, you need to look out for the heart, the skin, things like that as well. It can actually present in a myriad of ways but most often with pulmonary symptoms.
Bill: If someone comes to visit you, how is it traditionally diagnosed then?
Dr. Vranic: Usually by the time they get to see me we have a pretty good suspicion already based on the x-ray and they probably had a CT scan of their lungs as well. Once you suspect it, you almost always want to do a biopsy to see if they actually have that type of inflammation that I mentioned earlier – that granuloma inflammation. You want to biopsy the easiest thing to get at. So, if they have a rash that is usually a good place to start because the skin biopsy is pretty easy; it’s fairly non-invasive. In general, though, most of these patients, because most of them have some pulmonary involvement, most of them will get a lung biopsy which is done via a procedure called a bronchoscopy. Most of the time people with sarcoid will actually have enlarged lymph nodes or glands around their airway. We actually do a very cool procedure these days called an EBUS which stands for “endobronchial ultrasound”. That actually allows us to get inside their airways. Through, this very small ultrasound on the end of our scope we can actually look through the airway, outside of the airway, visualize the lymph nodes sitting outside the airway, and actually visualize our needle going through their airway into that lymph node. The cool thing, too, is we usually have a pathologist in the room with us when we do this, so they can tell us almost instantly whether or not we’ve gotten the diagnosis.
Bill: Is sarcoidosis confused with other diseases? It seems like this is kind of like an unknown disease. It sounds like you are getting to the point now where you can easily diagnose this, where you know right away instead of “you may have this; you may have that”. Is that correct?
Dr. Vranic: That’s, more or less, correct, yes. Most of the time, sarcoid presents fairly straightforwardly--again, usually with pulmonary symptoms or abnormal x-rays, or abnormal CT scans of the lungs. But, as you mentioned earlier, it certainly can be confused with a lot of other things, in part because it can affect so many organs of the body outside of the lungs. I’ve certainly had patients who had no problems breathing but they presented with difficulty walking, difficulty with their gait and balance and ended up having sarcoid in the brain. Patients present with palpitations and, again, their lungs were fine, but they had sarcoid involving the heart that is causing them to skip beats and have palpitations and things like that. Because it can present in so many ways, it can often be confused with many different diseases and often is quite a complicated diagnosis to make. Most of the time, that’s not true, but certainly it can be true.
Bill: What treatment options are available to patients suffering from sarcoidosis?
Dr. Vranic: The nice thing about sarcoid is that in the vast majority of patients, they are going to do just fine. About 50-75% of them are going to experience a resolution of the disease within a few years, usually without treatments. For the majority of the patients we see in clinic, it is more watchful waiting to make sure they don’t develop any manifestations of sarcoid that does need treatment. In the small subset of patients that do require treatment, they can often be quite sick. In about 5-10% of those patients, they might have very severe fibrosis in their lungs from their sarcoid or they may have heart involvement or brain involvement that requires treatment. In those patients, the disease can be quite debilitating and life limiting. For those patients, we usually put them on medicines to suppress the immune system or weaken their immune system, if you will, and thus calm down that inflammation that I alluded to earlier that’s causing all the problems. Traditionally, patients have been treated with steroids although the problem with steroids like prednisone is that when they are given long term, they can often have really terrible side effects, sometimes worse than the disease itself: things like osteoporosis, issues with their sugar, blood pressure, weight gain, fluid retention, cataracts, etc. There are other drugs sometimes referred to as “steroid-sparing agents” that can be given long term that will weaken the immune system enough to suppress the sarcoid without causing all of those terrible side effects.
Bill: You said in a high percentage of patients, it just goes away.
Dr. Vranic: It does, yes. So, again, most patients present with mild sarcoid and most of those patients – about 50-75% of them--will experience resolution of the disease without treatment at all. Their symptoms are mild, if present at all. Again, most of the time, our job is to do no harm and to monitor them should they develop things like heart involvement or worsening lung disease that would require treatment.
Bill: Is it fair to say, then, most people will live a normal life after being diagnosed?
Dr. Vranic: I think that’s a very fair statement. I think that the vast majority of patients with sarcoid can and will live a normal life with their disease. It’s just that small subset of patients that develop that very severe pulmonary fibrosis or disease outside of the lungs that can often be quite sick.
Bill: Are there certain environmental conditions that exacerbate it? I happen to have a nephew that has this and cold weather makes it worse for him. Is it true that where you live can make a difference in this?
Dr. Vranic: In general, no, environmental factors don’t play much of a role in sarcoid. Some people with sarcoid will actually have involvement of their airways as opposed to the lung tissue, the lung parenchyma itself. In those patients, they can often have what acts like asthma almost. In those patients, changes in the weather and things like that do make their symptoms worse. They have more of a cough and perhaps more shortness of breath as well.
Bill: Who is more susceptible to get this? Is it anyone or a certain type of person that would have a higher incidence to get this?
Dr. Vranic: Absolutely. That’s a great question. In general, this is a disease of younger people. Most of the time it comes to light usually between the ages of 20-40. It affects younger people, not older people. It is more common in African-Americans than in whites or Caucasians and a little bit more common in women as opposed to men.
Bill: Okay. Interesting. Dr. Vranic, thank you so much for being on with us today. Last question. Why should someone come to UVA Pulmonary and Respiratory for treatment?
Dr. Vranic: We actually have a clinic at UVA specifically tailored to patients with diseases like sarcoid called “The Interstitial Lung Disease Clinic”. Sarcoid, like so many of these lung diseases, is pretty rare and it is often complicated and it is a disease that many pulmonary physicians don’t see on a regular basis. I think there is a lot of evidence out there, the best example being something like cystic fibrosis, that when you have a really complex illness, you want to see a group of physicians that focus on just that one disease and take care of only these patients on a daily basis. By doing so day in and day out, they get to be truly experts of managing that disease. I think that they have better outcomes. There are currently three of us in the ILD clinic at UVA--Dr. Borna Mehrad, Dr. Diane Gomez and myself--that focus just on these diseases – these interstitial lung diseases like sarcoid. We really enjoy taking care of patients with those diseases. We really enjoy treating them. I think that’s my reason.
Bill: Absolutely. We’ve been talking with Dr. Andrew Vranic a UVA specialist in pulmonology. Thank you so much again for your time today. Very interesting. For more information please visit UVAHealth.com. That’s UVAHealth.Com. I’m Bill Claproth in for Melanie Cole and this is UVA Health Systems Radio. Thanks for listening.
How Can Sarcoidosis Be Treated?
Bill Claproth (Host): Hi. This is Bill Claproth in for Melanie Cole. Sarcoidosis is caused by inflammation in the lungs and can cause an array of symptoms. What are the causes and symptoms along with treatment options? Joining us is Dr. Andrew Vranic, a UVA specialist in pulmonology, board certified physician in pulmonary medicine and critical care medicine whose specialties include sarcoidosis. Dr. Vranic, thank you so much for being on with us today. Let’s start right at the beginning. What is sarcoidosis?
Dr. Andrew Vranic (Guest): Thank you for having me today, Bill. Sarcoid is actually an idiopathic disease which means that we actually don’t know what causes it. We assume that in certain susceptible individuals something in their environment triggers it for them to develop this type of inflammation in their body called “granuloma inflammation”. This inflammation usually affects the lungs but it can actually affect any part of the body. Again, it most commonly affects the lungs which is why it is treated by lung doctors like myself. Outside of the lungs, it can affect almost anything. More commonly after the lungs, things like the skin, the eyes, other lymph nodes in the body and even sometimes, in rare cases, the heart and the brain. So, it can go pretty much anywhere.
Bill: Does it always start in the lungs?
Dr. Vranic: The symptoms that bring it to light don’t always necessarily have to do with pulmonary symptoms but almost everybody with sarcoid will have some lung involvement.
Bill: What are the common symptoms associated with sarcoidosis?
Dr. Vranic: Interestingly many patients won’t have any symptoms at all with sarcoidosis. They may come to light incidentally, such as when they get an x-ray for some other reason. Maybe their primary care doctor orders an x-ray for bronchitis or pneumonia but the x-ray ends up showing some findings suggestive of sarcoid and then they are sent to us. If they are going to have symptoms, usually the symptoms are lung related because, again, the lungs are the most commonly involved organ. They may have symptoms like shortness of breath, chronic cough, occasionally chest pains. Many of them will have non-specific symptoms such as fatigue. Like I said earlier, because sarcoid can involve any other part of the body besides the lungs, you need to look out for the heart, the skin, things like that as well. It can actually present in a myriad of ways but most often with pulmonary symptoms.
Bill: If someone comes to visit you, how is it traditionally diagnosed then?
Dr. Vranic: Usually by the time they get to see me we have a pretty good suspicion already based on the x-ray and they probably had a CT scan of their lungs as well. Once you suspect it, you almost always want to do a biopsy to see if they actually have that type of inflammation that I mentioned earlier – that granuloma inflammation. You want to biopsy the easiest thing to get at. So, if they have a rash that is usually a good place to start because the skin biopsy is pretty easy; it’s fairly non-invasive. In general, though, most of these patients, because most of them have some pulmonary involvement, most of them will get a lung biopsy which is done via a procedure called a bronchoscopy. Most of the time people with sarcoid will actually have enlarged lymph nodes or glands around their airway. We actually do a very cool procedure these days called an EBUS which stands for “endobronchial ultrasound”. That actually allows us to get inside their airways. Through, this very small ultrasound on the end of our scope we can actually look through the airway, outside of the airway, visualize the lymph nodes sitting outside the airway, and actually visualize our needle going through their airway into that lymph node. The cool thing, too, is we usually have a pathologist in the room with us when we do this, so they can tell us almost instantly whether or not we’ve gotten the diagnosis.
Bill: Is sarcoidosis confused with other diseases? It seems like this is kind of like an unknown disease. It sounds like you are getting to the point now where you can easily diagnose this, where you know right away instead of “you may have this; you may have that”. Is that correct?
Dr. Vranic: That’s, more or less, correct, yes. Most of the time, sarcoid presents fairly straightforwardly--again, usually with pulmonary symptoms or abnormal x-rays, or abnormal CT scans of the lungs. But, as you mentioned earlier, it certainly can be confused with a lot of other things, in part because it can affect so many organs of the body outside of the lungs. I’ve certainly had patients who had no problems breathing but they presented with difficulty walking, difficulty with their gait and balance and ended up having sarcoid in the brain. Patients present with palpitations and, again, their lungs were fine, but they had sarcoid involving the heart that is causing them to skip beats and have palpitations and things like that. Because it can present in so many ways, it can often be confused with many different diseases and often is quite a complicated diagnosis to make. Most of the time, that’s not true, but certainly it can be true.
Bill: What treatment options are available to patients suffering from sarcoidosis?
Dr. Vranic: The nice thing about sarcoid is that in the vast majority of patients, they are going to do just fine. About 50-75% of them are going to experience a resolution of the disease within a few years, usually without treatments. For the majority of the patients we see in clinic, it is more watchful waiting to make sure they don’t develop any manifestations of sarcoid that does need treatment. In the small subset of patients that do require treatment, they can often be quite sick. In about 5-10% of those patients, they might have very severe fibrosis in their lungs from their sarcoid or they may have heart involvement or brain involvement that requires treatment. In those patients, the disease can be quite debilitating and life limiting. For those patients, we usually put them on medicines to suppress the immune system or weaken their immune system, if you will, and thus calm down that inflammation that I alluded to earlier that’s causing all the problems. Traditionally, patients have been treated with steroids although the problem with steroids like prednisone is that when they are given long term, they can often have really terrible side effects, sometimes worse than the disease itself: things like osteoporosis, issues with their sugar, blood pressure, weight gain, fluid retention, cataracts, etc. There are other drugs sometimes referred to as “steroid-sparing agents” that can be given long term that will weaken the immune system enough to suppress the sarcoid without causing all of those terrible side effects.
Bill: You said in a high percentage of patients, it just goes away.
Dr. Vranic: It does, yes. So, again, most patients present with mild sarcoid and most of those patients – about 50-75% of them--will experience resolution of the disease without treatment at all. Their symptoms are mild, if present at all. Again, most of the time, our job is to do no harm and to monitor them should they develop things like heart involvement or worsening lung disease that would require treatment.
Bill: Is it fair to say, then, most people will live a normal life after being diagnosed?
Dr. Vranic: I think that’s a very fair statement. I think that the vast majority of patients with sarcoid can and will live a normal life with their disease. It’s just that small subset of patients that develop that very severe pulmonary fibrosis or disease outside of the lungs that can often be quite sick.
Bill: Are there certain environmental conditions that exacerbate it? I happen to have a nephew that has this and cold weather makes it worse for him. Is it true that where you live can make a difference in this?
Dr. Vranic: In general, no, environmental factors don’t play much of a role in sarcoid. Some people with sarcoid will actually have involvement of their airways as opposed to the lung tissue, the lung parenchyma itself. In those patients, they can often have what acts like asthma almost. In those patients, changes in the weather and things like that do make their symptoms worse. They have more of a cough and perhaps more shortness of breath as well.
Bill: Who is more susceptible to get this? Is it anyone or a certain type of person that would have a higher incidence to get this?
Dr. Vranic: Absolutely. That’s a great question. In general, this is a disease of younger people. Most of the time it comes to light usually between the ages of 20-40. It affects younger people, not older people. It is more common in African-Americans than in whites or Caucasians and a little bit more common in women as opposed to men.
Bill: Okay. Interesting. Dr. Vranic, thank you so much for being on with us today. Last question. Why should someone come to UVA Pulmonary and Respiratory for treatment?
Dr. Vranic: We actually have a clinic at UVA specifically tailored to patients with diseases like sarcoid called “The Interstitial Lung Disease Clinic”. Sarcoid, like so many of these lung diseases, is pretty rare and it is often complicated and it is a disease that many pulmonary physicians don’t see on a regular basis. I think there is a lot of evidence out there, the best example being something like cystic fibrosis, that when you have a really complex illness, you want to see a group of physicians that focus on just that one disease and take care of only these patients on a daily basis. By doing so day in and day out, they get to be truly experts of managing that disease. I think that they have better outcomes. There are currently three of us in the ILD clinic at UVA--Dr. Borna Mehrad, Dr. Diane Gomez and myself--that focus just on these diseases – these interstitial lung diseases like sarcoid. We really enjoy taking care of patients with those diseases. We really enjoy treating them. I think that’s my reason.
Bill: Absolutely. We’ve been talking with Dr. Andrew Vranic a UVA specialist in pulmonology. Thank you so much again for your time today. Very interesting. For more information please visit UVAHealth.com. That’s UVAHealth.Com. I’m Bill Claproth in for Melanie Cole and this is UVA Health Systems Radio. Thanks for listening.