What is it?
Sarcoidosis is a disorder of the immune system. This causes an inflammatory response characterized by clustering of inflammatory cells, called granulomas. These granulomas can occur throughout the human body and can affect every organ. They can cause damage and scarring of tissues. How the disease is caused is unknown. We think that it is because of an exaggerated immune response to unknown stimuli in patients who are prone. These granulomas mainly affect the lungs, but the skin and the eyes are also frequently involved. The bones and joints are involved in approximately 1 in 10 patients with sarcoidosis. The way the disease manifests differs from person to person. Most frequently the granulomas are localized in the soft connective tissue around the joints, but the inflammation can also be localized inside the joints itself (arthritis). Most patients complain about pain and swelling of the joints. This can occure suddenly (acute), but it can be slowly progressive. Because sarcoidosis is a multisystem inflammatory disease, complaints of other organs can be present next to the rheumatic complaints.
How do I know I have it?
The diagnosis sarcoidosis of the joints can be difficult. With the use of ancillary investigations aimed at the joints itself we can find abnormalities that are not specific and can also be seen in other rheumatic diseases. Therefore, we usually also need to examine other organ systems to establish the diagnosis. Examples include a chest X-ray or laboratory tests. In some cases we may try to obtain affected tissue via a punction or biopsy, to diagnose patients with high certainty. We will examine this tissue under the microscope to evaluate the presence of granulomas. Most frequently this tissue is obtained from the lymph nodes, the lungs or the skin. At the top of this webpage in blue you can see an image of these granulomas as seen under a microscope.
Can it be treated?
When the diagnosis has been made, treatment may be necessary. However, this is not the case in all patients depending on the severity of the disease and involvement of other organs. Treatment of sarcoidosis consists of medication that suppresses the immune response, for example non-steroidal anti-inflammatory drugs (NSAIDs) prednisolone. The latter is a quickly acting hormone that results in immune suppression and can be administered as pulse therapy via an intravenous drip or in tablets. Sometimes a combination of both is necessary to quickly and effectively block signs and symptoms of the disease. When the disease cannot be brought to a halted despite treatment with prednisolone, or when prolonged treatment is necessary, a second type of medication can be added that has different effects on the immune system, so-called disease modifying anti-rheumatic drugs (DMARDs) like methotrexate or azathioprine. These are agents that are also being used in other inflammatory diseases, for example in rheumatoid arthritis. When sarcoidosis proves difficult to treat despite the aforementioned medications, your doctors can choose to treat you with anti-TNF treatment.
We are a tertiary referral center for patients with sarcoidosis. Healthcare for patients with sarcoidosis can be complex. Therefore, our opinion is that care for these patients with severe manifestations of the disease should be performed preferably in a few specialised hospitals. We want to improve Healthcare for these patients. Part of this is a specialized outpatient clinic for sarcoidosis patients with a multidisciplinary approach. Additionally, we run various scientific research projects, aimed at improving the diagnostic process and treatment of this disease. Below you can find more information on the department of Clinical Immunology and Rheumatology, who we are, what kind of research we are conducting and how you can refer patients to us.
