Wiser about Other organs A multisystem disease

Sarcoidosis is a multisystem disease and can affect every organ. In patients with sarcoidosis certain inflammatory cells cluster, forming the so-called granulomas. These can cause damage and scarring in every part of the human body. Here you can find information about sarcoidosis involving the eyes, the heart, the stomach, intestine and liver and ear, nose and throat (ENT).

Other organs

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Sarcoidosis of the eyes

Most frequently the clustered inflammatory cells (granulomas) exist in the lungs or the nearby lymph nodes. However the eyes are frequently affected in between 1 in 4 and 1 in 2 patients with sarcoidosis. Inflammation of the eyes occurs the most, a so-called 'uveitis'. This is characterised by redness and pain of the eye. Also the tear glands and the cornea can be affected. A special form of eye involvement is the inflammation of the nerve of the eye (optical neuritis). This type of involvement is considered as a variant of involvement of the nervous system (neurosamcoidosis).
How the diagnosis is made depends on the localisations of the affected tissues. The eye doctor will test the vision en look in the eye using a slit lamp. De oogarts zal in veel gevallen het zicht testen en in het oog willen kijken middels een spleetlamp. To diagnose a patient with 100% certainty the presence of granulomas in affected tissue must be determined under the microscope. Mostly, tissue is obtained from the lymph nodes or the lungs. Frequently, the total diagnostic workup include laboratory investigations, fundoscopy or slit lamp examination, and imaging of the chest.
When the diagnosis sarcoidosis is made treatment may be indicated. The specialist responsible for the organ which is affected most severely, most frequently coordinates the treatment, most frequently the neurologist, the lung doctor or the rheumatologist. Treatment of sarcoidosis consists of medication that lowers the immune response, like prednisolone. This can be administered via intravenous drip, tablets, injections or eye drops. When the disease is severe, or when prolonged treatment with corticosteroids is necessary, a second type of medication can be added that acts on the immune system differently, like methotrexate or azathioprine. These are agents that are also being used in other disorders of the immunesystem, for example rheumatoid arthritis. When sarcoidosis proves difficult to treat despite aforementioned medication, your doctors can choose to treat you with specific powerfull antibodies, like infliximab.

For more information concerning the department of ophthalmology:

Sarcoidosis of the heart

It is estimated that sarcoidosis affects the heart in approximately 1 in 20 patients, but it is thought that it affects more patients without causing any complaints. It is important to diagnose disease involvement of the heart in an early stage. To do this ancillary investigations can be performed, including electrocardiography (ECG or EKG), a MRI scan of the heart and/or an ultrasound of the heart. In the AMC patients are often referred to the cardiologist without any heart complaints, to exclude any involvement. To diagnose a patient with certainty, affected tissue should be examined under the microscope for the presence of granulomas. This tissue is most frequently collected from the lymph nodes or the lungs, and not the heart.
Treatment may be necessary when the diagnoses of sarcoidosis of the heart is made. Treatment consists of medication that lowers the immune response, like prednisolone. This can be administered via intravenous drip, tablets, injections or eye drops. When the disease is severe, or when prolonged treatment with corticosteroids is necessary, a second type of medication can be added that acts on the immune system differently, like methotrexate or azathioprine. These are agents that are also being used in other disorders of the immunesystem, for example rheumatoid arthritis. When sarcoidosis proves difficult to treat despite aforementioned medication, your doctors can choose to treat you with specific powerfull antibodies, like infliximab. In some rare cases additional treatment of the heart may be necessary. Examples include a pacemaker.

For more information concerning the department of cardiology:

Sarcoidosis of the stomach, intestine and liver

The stomach and the liver are only rarely affected in between 0.1 and 0,9% of the sarcoïdosis patients, while the liver is involved in between 5 and 15% of the sarcoidosis patients. Complaints of the stomach consist of heartburn (called 'pyrosis') or nausea. Complaints of the intestine consist of belly ache and changes in bowel habits. Liver involvement can cause jaundice or belly ache, but most patients only have abnormalities in the blood tests. The diagnosis is based on three pillars. Firstly, the presence of granulomas may be confirmed by examining liver tissue under the microscoop. To do this, in some cases a biopsy will be performed to collect liver tissue. Secondly, other possible causes of liver disease must be excluded. And lasty, Involvement of at least one other organ must be determined. This can be done with biopsy confirmation, but also with imaging. Treatment for sarcoidosis of the stomach, the intestine or the liver is not necessary in all cases. This depends on the extent of disease involvement and the severity of the involvement of other organ systems. Treatment may be necessary when the diagnoses of sarcoidosis of the heart is made. Treatment consists of medication that lowers the immune response, like prednisolone. This can be administered via intravenous drip, tablets, injections or eye drops. When the disease is severe, or when prolonged treatment with corticosteroids is necessary, a second type of medication can be added that acts on the immune system differently, like methotrexate or azathioprine. These are agents that are also being used in other disorders of the immunesystem, for example rheumatoid arthritis. When sarcoidosis proves difficult to treat despite aforementioned medication, your doctors can choose to treat you with specific powerfull antibodies, like infliximab.

For more information concerning the department of gastro-enterology:

Sarcoidosis of the ear, nose and throat

Sarcoïdosis can involve the (inner) ear, the nose, the paranasal sinuses, the throat and the salivary glands. Sarcoïdosis of the ear, nose and throat is rare. Complaints include a stuffy nose, hearing loss, changed speech, difficulty swallowing, enlarged salivary glands and impaired smell. Additionally, the organ of balance can be affected. In some cases it is difficult to distuignish involvement of the ear, nose and throat, from involvement of the nerves that lead to this area (which is called neurosarcoidosis). An example includes involvement of the auditory nerve. Because this manifestation is rare, it is not always recognized initially. To diagnose a patient with 100% certainty the presence of granulomas in affected tissue must be determined under the microscope. To obtain affected tissue a biopsy is necessary. Treatment is not always necessary and it depens on the severity of the complaints and involvement of other organs. Treatment consists of medication that lowers the immune response, like prednisolone. This can be administered via intravenous drip, tablets, injections or eye drops. When the disease is severe, or when prolonged treatment with corticosteroids is necessary, a second type of medication can be added that acts on the immune system differently, like methotrexate or azathioprine. These are agents that are also being used in other disorders of the immunesystem, for example rheumatoid arthritis. When sarcoidosis proves difficult to treat despite aforementioned medication, your doctors can choose to treat you with specific powerfull antibodies, like infliximab.

For more information concerning the department of ear, nose and throat:

 

Tertiary referral center sarcoidosis AMC

We are a tertiary referral center for patients with sarcoidosis. Healthcare for patients with sarcoidosis can be complex. Our opinion is that because the disease is relatively rare, 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 specialist outpatient clinic for sarcoidosis patients with a multidisciplinary approach. Additionally we have started various scientific researchprojects, aimed at improving the diagnostic process and treatment of this disease. Below you can find more information concerning the dermatology department, who we are, what kind of research we are conducting and how you can refer patients to us.

Scientific research   Referral to our center
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