QuestionSBA
QuestionChoice
Oral steroids are reasonable in symptomatic sarcoid; however, intravenous pulsed steroids are rarely indicated in sarcoidosis
32699
b
Pulsed high dose intravenous steroids
QuestionChoice
For patients who cannot be treated with low-dose glucocorticoids and an antimetabolite, anti-tumour necrosis factor (TNF) monoclonal antibodies have been shown to control disease. However, anti-TNF drugs are associated with substantial toxic effects and, in some cases, are ineffective
32702
e
Intravenous infliximab
QuestionChoice
Oral steroids are often used to treat stage two and above or in symptomatic stage one sarcoidosis; however, as this patient is otherwise well and asymptomatic, it is reasonable to watch and wait in the first instance
32700
c
Oral steroids
QuestionChoice
In patients with stage one sarcoid who are otherwise asymptomatic, many will spontaneously resolve without the need for any treatment
32698
a
Watch and wait
QuestionChoice
Antimetabolites such as methotrexate, azathioprine and mycophenolate may be used to treat symptomatic sarcoidosis as an alternative to steroids; however, as this patient is otherwise well and asymptomatic, it is reasonable to watch and wait in the first instance
32701
d
Oral methotrexate
QuestionComment
Quesbook needs more detail
7635
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Dermis Cystic
QuestionComment
But shes symptomatic? 
7825
QuestionComment
You only treat w steroids if there is visual disturbance AFAIK
8790
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Supine Thermoregulator
QuestionComment
steroids in stage 2/3 disease only if organs other than just the lungs are involved (eye, heart, neuro) or if there is hypercalcaemia
21057
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Axillary Gas
QuestionComment
yh dry cough is symptomatic
38320
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Malignant Syndrome
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Monoclonal Fracture
QuestionComment
Pulmonary sarcoidosis radiographic staging

Stage 0: normal

Stage I: bilateral hilar lymphadenopathy

Stage II: bilateral hilar lymphadenopathy plus pulmonary infiltrates

Stage III: pulmonary infiltrates without hilar lymphadenopathy

Stage IV: extensive fibrosis with distortion.
8625
QuestionComment
Flexxx
9342
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Gas Womb
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Yellow Zebras
QuestionComment
She's literally symptomatic tho ???
12106
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Epidermis Biopsy
QuestionComment
indications for steroids = PUNCH
Parenchymal lung disease
Uveitis
Neuro involvement
Cardiac involvement
Hypercalcemia
25815
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Kinin Polyps
Concept
Chapter
# Epidemiology

Around 4,500 people are diagnosed with sarcoidosis in the UK each year representing an annual incidence rate of 7 people per 100,000.

# Definition

Sarcoidosis is a multi-system disease characterised by granuloma formation, resulting in widespread inflammatory changes and complications.

# Acute sarcoidosis features

Acute sarcoidosis: fever, polyarthralgia, erythema nodosum, and bilateral hilar lymphadenopathy. This is also known as **Löfgren syndrome**.

# Chronic sarcoidosis features

- Pulmonary (most common manifestation): dry cough, dyspnoea, reduced exercise tolerance. Examination may reveal crepitations.

- Constitutional: fatigue, weight loss, arthralgia, and low-grade fever. General signs include lymphadenopathy and enlarged parotid glands.

- Neurological: meningitis, peripheral neuropathy, bilateral Bell's palsy.

- Ocular: uveitis, keratoconjunctivitis sicca.

- Cardiac: arrhythmias, restrictive cardiomyopathy.

- Abdominal: hepatomegaly, splenomegaly, renal stones.

- Dermatological: erythema nodosum, lupus pernio.

# Investigation

Tissue biopsy (eg. lung, lymph nodes) is diagnostic, which typically finds non-caseating granulomas. However, other investigations can point towards a diagnosis of sarcoidosis.

- Bloods: Raised ESR, ACE (not specific or diagnostic) and calcium; reduced lymphocytes.

- Chest x-ray or CT:
  - Stage 1 - bilateral hilar lymphadenopathy (BHL)
  - Stage 2 - BHL with peripheral infiltrates
  - Stage 3 - peripheral infiltrates alone
  - Stage 4 - pulmonary fibrosis

# Management

- Bilateral hilar lymphadenopathy alone - usually self-limiting
- Acute sarcoidosis - bed rest, NSAIDs
- Steroid treatment: oral or IV, depending on severity of disease
- Immunosuppressants: in severe disease
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Sarcoidosis
Topic
20
Respiratory Physiology
6540
A 34-year-old female presents to GP with a mild persistent dry cough and rash. Observations and routine bloods are normal other than a raised erythrocyte sedimentation rate (ESR); her doctor refers her for a chest x-ray which shows bilateral hilar lymphadenopathy.

What is the most appropriate treatment?
a