Many sarcoidosis patients do not have any symptoms. Some have only one symptom, while still others have several. General symptoms caused by the disease include fever, tiredness or fatigue, weight loss, night sweats and an overall feeling of ill health. Other symptoms typically depend on which organs the disease affects.
Some organs are affected more often than others. Sarcoidosis occurs most often in the lungs. It also commonly affects the skin, eyes, lymph nodes and liver. Less commonly, it affects the spleen, brain, nerves, heart, tear glands, salivary glands, sinuses, bones and joints. Rarely, it affects other organs, such as the kidneys, breasts and male and female reproductive organs. Often, the effects of sarcoidosis in an organ are so mild that there are no symptoms and the organ continues to function well.
The lungs are the most commonly affected organ in sarcoidosis. Ninety percent or more of people with sarcoidosis have lung involvement, whether they have symptoms or not. Common lung symptoms are dry coughing, trouble breathing, wheezing, or pain with breathing, chest pain, tightness, or discomfort and coughing up blood, which is rare, especially in the early stages of sarcoidosis.
Lymph nodes are glands found throughout the body that make and store white blood cells. When sarcoidosis inflammation targets these glands, they become enlarged. Swollen lymph nodes can be uncomfortable, but they rarely cause medical problems unless they press on organs or blood vessels. Most commonly, it’s the lymph glands in the chest that are affected. Some of the other places you might notice enlarged lymph nodes (they appear as swollen lumps) include your neck, under your chin, in your armpit and in your groin.
The spleen is a large organ on the left side of the body under the ribs that produces and filters red blood cells and some types of white blood cells. Along with the lymph nodes, the spleen is part of the lymphatic system, which regulates blood cells and plays a role in immunity. Sarcoidosis of the spleen does not usually cause symptoms. If you do notice symptoms, they might include pain or pressure on your upper left side under your ribs or feeling tired.
Sarcoidosis granulomas can cause the liver to enlarge. The disease rarely causes serious liver problems, however, and most people do not even realize it when their livers are affected. If you have liver symptoms, they might include fever, feeling tired or fatigued, itchy skin, jaundice, which causes your skin and eyes to look somewhat yellow, pain on your upper right side under your ribs.
Some people with heart involvement might notice symptoms, but many people will feel nothing, even in late-stage disease. Because heart problems can be very serious, everyone who has sarcoidosis should be screened for cardiac involvement. Sarcoidosis can cause the heart to pump weakly. This results in such symptoms as shortness of breath, swelling of the legs, wheezing and coughing - although these can be a sign of lung problems too. Sarcoidosis also can affect the heart’s electrical pacing and transmission system, which tells the heart when to beat. This can make the heart beat too fast or very slowly or skip beats. Symptoms of an electrical-system problem include palpitations (a fluttering sensation of rapid heartbeats), skipped beats and, rarely, fluid buildup in the lungs or sudden loss of consciousness.
Brain & Nervous System
The nervous system includes the brain and all the body’s nerves, and it may be affected by sarcoidosis. The disease can cause a mass of granulomas in the brain or meninges, which are the membranes that cover the brain. The disease also can affect one or more nerves anywhere in the body. Most often, it affects the nerves of the face. Symptoms of the disease in the nervous system vary. If there is a mass in the brain, symptoms can include headaches, visual problems and weakness or numbness of an arm or leg. When sarcoidosis affects a facial nerve, it can cause one side of the face to droop. This may be the first symptom that someone has sarcoidosis. When sarcoidosis affects the spinal cord, it can cause weakness or even paralysis of the arms or legs. When multiple nerves in more than one place are affected, the disease can cause weakness, pain, or a "stinging needles" sensation in those areas.
Sarcoidosis of the skin can result in rashes or various types of skin lesions. If you have one of these skin problems it can be a clue to how serious your case of sarcoidosis is. One type of lesion is called erythema nodosum which causes raised, red, and tender bumps to form on the skin, usually on the front of your legs. Nearby joints are often swollen and painful. Erythema nodosum usually goes away on its own in 6 to 8 weeks, even without treatment. Having it is a good sign that you might have the type of sarcoidosis that also goes away on its own after a few months or years. Lupus pernio is an uncommon skin condition that causes hard, reddish-purplish bumps to form on your cheeks, nose, lips, and/or ears. These bumps do not go away on their own and often come back when treatment is stopped. They are usually associated with chronic sarcoidosis. In some cases, the sores are disfiguring and can damage underlying cartilage and bone. Other lesions may appear as bumps on or under the skin, rashes, sores, scaling, and/or changes in old scars or tattoos that do not go away and are rarely painful or itchy. These skin problems are also associated with chronic sarcoidosis.
Bones, Joints & Muscles
Musculoskeletal sarcoidosis (musculo=muscles, joints and bones=skeletal) can result in a number of symptoms. Early-onset arthritis, which is joint pain, stiffness, and/or swelling that usually occurs in the first 6 months of the disease, begins suddenly in one or both of the ankles and/or feet, and sometimes involves the knees, toes, fingers, wrists, and/or elbow joints. It often accompanies erythema nodosum, and it usually goes away on its own in a few weeks or months. Late-onset arthritis, which usually occurs 6 months or more after sarcoidosis develops, is less painful and affects fewer joints than early-onset arthritis (usually the knees and/or ankles, or sometimes the fingers or toes), and is often associated with chronic skin symptoms rather than erythema nodosum. This type of arthritis can last a long time or a lifetime, or it may come and go, but it usually does not go away for good without treatment like early-onset arthritis does. It can cause permanent joint damage and should be treated even when it is not painful. Sarcoidosis also can affect the bone marrow (soft, organic material that fills bone cavities), which produces blood cells. This can result in anemia, in which there are too few red blood cells, or a lowered number of white blood cells. Red blood cells are needed to deliver oxygen to the body; white blood cells help fight infections. In muscles, sarcoidosis may cause muscle aches or muscle pain (also called myalgia) or muscle weakness. The disease can also cause bone cysts, which are rare.
Common symptoms of sarcoidosis in the eyes include: burning, itching and/or pain, dryness, tearing, red eyes, vision problems such as seeing black spots (called floaters) and blurred vision, sensitivity to light and small, pale yellow bumps on the eye. A condition called uveitis, which is inflammation of the membranes (uvea) of the eye, can result in many of these symptoms. Rarely, glaucoma, cataracts and blindness can occur if uveitis goes untreated. As a precaution, a routine eye examination performed by an ophthalmologist is recommended for anyone with suspected sarcoidosis. It is a good idea to schedule them annually for several years after your diagnosis, and routinely as recommended thereafter.
Kidneys & Urinary Tract
Sarcoidosis rarely attacks the kidneys directly. However, the disease can cause the body to overproduce vitamin D, which in turn causes the body to absorb too much calcium and can lead to kidney stones. Although they are uncommon in sarcoidosis, kidney stones can be painful when they break loose from the kidney and pass into the bladder, so it is a good idea to ask your doctor to check you for excess calcium before kidney stones have the chance to develop. Symptoms of kidney stones you might notice include pain in your back or side, or an increased urge to urinate.
Inflammation in the salivary glands can sometimes cause painful dryness in the mouth. When sarcoidosis affects these glands, it can make your cheeks look swollen.
Sarcoidosis can also cause inflammation of the sinuses (called sinusitis). Symptoms include a runny nose, stuffiness, and sinus pain or headache. The sinusitis associated with sarcoidosis is often chronic and can be very troublesome, although it is rarely serious.
Research shows that more than half of people with sarcoidosis symptoms also show signs of clinical depression. Depression can affect your work, your studies, how well you sleep, and even your appetite. Persistent feelings of sadness, emptiness, and anxiety are all signs of depression that you should talk to your doctor about. Certainly if you are having suicidal thoughts you should tell your doctor. Depression is treatable. Medications and/or talk therapy are often helpful.
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