What not to do with pulmonary sarcoidosis. Sarcoidosis - causes, symptoms, treatment, folk remedies. Principles of creating a diet for sarcoidosis of the lungs and lymph nodes

The diet for pulmonary sarcoidosis does not have strict restrictions, but there are still certain recommendations. If you believe the words of doctors, proper nutrition for sarcoidosis can not only improve the patient’s well-being, but sometimes even eliminate the disease altogether.

Almost any disease requires the patient to follow certain rules. Usually we are talking about a way of life, namely nutrition, physical activity and daily routine. Most often, many doctors recommend a certain diet that could alleviate the course of a particular disease. In some cases it is necessary to focus on vitamin E, and in others on vitamin C.

Principles of healthy nutrition

As you know, sarcoidosis is a disease that is characterized by the appearance of small inflammatory foci. Typically, such neoplasms occur on various tissues and organs, but most often the organs of the respiratory system, namely the lungs, are affected. All the reasons for its appearance also affect the patient’s diet.

A diet diagnosed with sarcoidosis requires the patient to adhere to the following rules:

• limit the amount of foods consumed that can cause or intensify an existing inflammatory process;
• significantly reduce the intake of foods that contain calcium;
• focus on vitamin E and significantly expand the range of products containing this vitamin.

Sarcoidosis is an inflammatory process. It is known to intensify when taking simple carbohydrates, so experts recommend reducing their consumption as much as possible, since in large quantities they provoke the development of the disease. If you have pulmonary sarcoidosis, you need to limit yourself to sugar, flour and confectionery products. In addition, any inflammatory process can only be aggravated by excessive consumption of salty and oil-fried foods. It is not recommended to add a lot of spices and hot seasonings to food.

Another feature of sarcoidosis is increased calcium levels in the blood. Quite often, with pulmonary inflammation, this phenomenon is accompanied by the appearance of calcium stones, which are excreted through the urethra and kidneys. That is why many experts recommend virtually eliminating dairy products from your daily diet, except for butter, which contains virtually no calcium. But overusing this product is not very useful.

Sarcoidosis requires the patient to regularly consume vitamin E, whether in capsule form or in food form. Almost all types of nuts, seafood and sea fish, spinach, oatmeal and barley, as well as sea buckthorn are rich in vitamin E.

Foods for saroidosis

Nutrition during the treatment of this pulmonary disease should be balanced and nutritious. Experts recommend eating at least 5 times a day in small portions. This regime can normalize not only the digestive system, but also stop the development of inflammatory processes in other organs.

It is very useful for sarcoidosis to eat lean types of meat. As a rule, these are chicken, beef and diet rabbit. You should not deny yourself legumes and nuts, even though they are nutritious. Low-fat sea fish will be quite useful. All these food products contain a sufficient amount of vitamin E, which makes them especially in demand for this diagnosis. Don't forget about various cereals and fresh vegetables and fruits.

Fats of animal origin should be replaced as much as possible with plant analogues.

The diet should be based on more sunflower and olive oil than lard and other animal fats.

In addition, you should focus on consuming complex carbohydrates, but not simple ones. Fresh white bread should be replaced with coarse bread. Fruits can be consumed dried, as they contain fewer easily digestible carbohydrates. Complex carbohydrates help the body function normally without raising existing blood sugar levels.

Scientists have proven that it is especially important during illness to consume onions and garlic, which kill all harmful bacteria and infections that enter our body.

Eating absolutely all red berries will be no less beneficial. It can be currants, gooseberries, cherries, raspberries, rowan and even viburnum. From most of these berries, special tinctures are made, which, according to doctors, heal inflammatory processes and serve to prevent the appearance of new ones.

It is very important to regularly consume seaweed and other products of marine origin (fish, seafood). All these components of a normal person enrich his body with potassium, magnesium, iodine and other very useful microelements. Thanks to such proper nutrition, inflammatory wounds will soon disappear and will never bother you again.

What can become dangerous

With sarcoidosis, there are a number of restrictions that the patient must adhere to, otherwise the disease will begin to progress even more. The patient should stop smoking. As you know, in the case of sarcoidosis, it is the lungs that suffer. Smoking further irritates the mucous membranes, which only complicates the process of tissue regeneration.

Under no circumstances should you eat dairy products that contain calcium. As a rule, these are hard cheeses, milk, cottage cheese, sour cream and kefir. Sometimes you can allow yourself butter. If you do not adhere to this recommendation, there may be a risk of kidney stones, which are very difficult and painful to remove.

Under no circumstances should you consume excessive amounts of sweets: cakes, chocolate, caramel, condensed milk. Yeast dough also negatively affects the disease, so it is better to exclude baking. It is not recommended to drink carbonated drinks and sweet juices.

It is strictly forbidden to drink alcoholic beverages, as they can adversely affect not only the digestive system, but also interfere with recovery from a disease such as sarcoidosis.

Video about the causes and treatment of sarcoidosis:

Following a diet for sarcoidosis is very simple, since such a diet has few restrictions compared to other diets, and if you want your disease to go away as soon as possible, try to follow all the above recommendations.

Sarcoidosis is a pathological process that leads to the formation of granulomas - inflammatory nodules - in the patient's lungs. If the course is unfavorable, the disease has a negative effect on the entire human body: the cardiovascular system, kidneys, liver, and thyroid gland suffer. The prognosis of treatment depends on the characteristics of the case: often the tumors resolve without therapeutic intervention, and if complications occur, urgent medication is required. The probability of death is minimal - does not exceed 1%.

Main signs of the disease

Symptoms of the disease are vague. Often, at the initial stages of its development, clinical signs are completely absent. This is due to the fact that granulomas slowly increase in size without affecting the nerve endings.

Sarcoidosis of the lungs and intrathoracic lymph nodes in the initial stages gives the following characteristic symptoms:

• weakness, lethargy;
• decreased performance;
• increased sweating during night sleep;
• increase in body temperature up to 37 degrees;
• decreased appetite;
• deterioration in sleep quality;
• causeless anxiety.

As the disease progresses, the listed general symptoms are supplemented by specific ones:

• cough with sarcoidosis is dry and annoying in nature, does not bring relief;
• shortness of breath - appears even with light exertion or at rest;
• pain in the chest area - they are not localized in one place, but appear in different areas;
• enlarged lymph nodes (ULN);
• wheezing – obvious when listening to the patient.

If the disease occurs in an acute form, the listed symptoms are supplemented by aching joints, rashes on the skin, in the eye area, and enlarged lymph nodes.

How to diagnose the disease?

Diagnosis of sarcoidosis is difficult due to the fact that its clinical picture is “masked” as manifestations of other ailments. It is carried out in a hospital setting.

The following manipulations are indicated for the patient:

• X-ray, which allows you to see whether the lung is affected by an inflammatory process;
• computed tomography of the lungs;
• blood test: general, biochemistry;
• analysis of fluid from the bronchi obtained using a bronchoscope;
• lung biopsy - study of material obtained from the affected organ;
• Ultrasound of organs affected by the disease (heart, liver, thyroid);
• ECG and others.

For pulmonary sarcoidosis, treatment is determined based on test results. Refuse to attempt self-therapy: they may seem not only useless, but dangerous.

Methods of treating the disease

How to treat pulmonary sarcoidosis? How long will therapy take? This depends on the degree of damage to the respiratory organ, which is demonstrated by a lung biopsy and other tests.

The disease can regress on its own (resorption of granuloma nodules is observed), so therapy begins with monitoring the patient with a pulmonologist for 6 months. During this time interval, it is possible to determine how the disease develops. If respiratory failure and cardiovascular complications are absent, immediate treatment is not necessary. The prognosis for recovery without medication is favorable.

Indications for immediate prescription of drug therapy are:

• long-term inflammatory process;
• spread of the disease to other organs (heart, liver, kidneys, thyroid gland).

The doctor prescribes to the patient:

• angioprotectors – substances that improve blood circulation (Pentoxifylline, Trental);
• adrenal hormones (Prednisolone);
• procedures for purifying blood plasma - plasmapheresis;
• anti-inflammatory drugs (Nimesulide);
• vitamin E;
• potassium preparations.

Doctors may use combination treatment tactics, for example, combining prednisolone with anti-inflammatory drugs. The results of this therapy are continuously monitored using tests.

The choice of therapeutic measures is influenced by the severity of the disease, the duration of the inflammatory process, and the characteristics of the pathology.

The progress of treatment is monitored by a TB doctor. How long to register depends on the course of the disease. If the outcome is favorable, the duration of therapy is 1.5-2 years, in the presence of complications - up to five years.

For speedy rehabilitation after an illness, you should visit a physiotherapist. He will prescribe methods such as magnetic therapy, laser or ultrasound exposure, manual therapy, and therapeutic exercises.

Prognosis for treatment of the disease

With pulmonary sarcoidosis, the prognosis for life depends on the form of the disease, the timeliness of treatment, and the individual characteristics of the patient’s body. The disease can develop asymptomatically for many years, without causing any inconvenience to the citizen. The opposite scenario is possible: the signs appear clearly, preventing the patient from living and working fully.

How dangerous is sarcoidosis? The main risk lies in the state of the cardiovascular system. Dangerous complications are possible - rhythm disturbances, ventricular tachycardia, which require emergency care in a hospital setting. Such complications can cause loss of ability to work.

How long do people live with sarcoidosis of the lungs or lymphoid system? According to statistics, in 60% of cases, symptoms disappear without drug treatment within the first three years after diagnosis. Death occurs in less than 1% of cases and is associated with complications of the cardiovascular system.

Video

Video - how to defeat sarcoidosis

What do you need to know about this dangerous disease?

Is it possible to work with a diagnosis of pulmonary sarcoidosis?
The disease is not transmitted through contact with other people, and therefore is not a direct contraindication for continuing to work. The decision depends on the condition of the patient himself. Many people hardly notice the signs of the disease, others suffer for years. The decision to continue working is made individually based on the state of the body.

If the patient’s work is a factor in the development of the disease (chemical production, flour-grinding industry, welding, etc.), to prevent the progression of the disease, the field of activity should be changed to a “safe” one.

Can you get sarcoidosis from a sick family member?
No, the disease is not contagious. Transmission of the disease by airborne droplets or other means is impossible, therefore persons suffering from pathology are not dangerous to society. N Don’t be afraid to “catch an infection” from a colleague, relative or minibus driver.

On the other hand, there is a hereditary predisposition to the disease. It is provoked by certain living conditions. Therefore, the spread of the disease to several people from the same family occurs. This is due to more global factors than using a shared towel. There is no need to fear that neighbors or relatives will become infected with this disease.

Can sarcoidosis affect pregnancy?
No, the presence of the disease is not a strict contraindication to childbirth. The disease cannot be transmitted from mother to baby. The only question is whether the woman herself, taking into account the state of her cardiovascular and respiratory systems, is capable of bearing a baby, and whether this will not be a fatal blow for her. The answer is individual in each case and depends on the degree of damage to the heart and lungs.

In practice, relief of the disease is often observed during pregnancy: symptoms practically disappear. After childbirth, the disease returns with renewed vigor, and an exacerbation occurs.

Features of the diet for patients with sarcoidosis

There is no special diet for pulmonary sarcoidosis. Patients do not need to strictly limit themselves in their desires, but to speed up recovery and prevent relapses, they must follow the advice of doctors. Since the disease is inflammatory in nature, you should avoid eating too many carbohydrates.

Contraindications apply to the following foods in the diet:

• chocolate;
• buns, confectionery;
• soda;
• fried foods;
• spicy food;
• dishes with lots of spices.

Sarcoidosis promotes an increase in calcium above normal, which leads to the formation of calcium stones in the intestines, kidneys, and bladder area. To prevent complications, on the recommendation of your doctor, minimize the consumption of milk and its derivatives, cheeses.

To cure the disease as quickly as possible, care must be taken to ensure that the diet for pulmonary sarcoidosis is balanced and varied. It is recommended to replace heavy and high-calorie foods with light and healthy dishes with an abundance of vitamins and minerals, steamed, stewed, boiled. Give up the habit of eating heavily 1-2 times a day. Eat food in small portions, but often: 4-5 times a day.

Focus on the abundance of the following components of the daily menu:

• lean meat;
• fish of “white” varieties;
• fresh fruits and vegetables;
• croup;
• berries;
• nuts

There is no need to give up onions and garlic: these products are traditionally recognized as helping the human immune system in the fight against disease. They will help the body recover from the inflammatory process.

Doctors recommend drinking plenty of fluids. It is necessary to focus on freshly squeezed juices and decoctions of medicinal herbs. Such drinks are rich in vitamins, which will help the body cope with the manifestations of the disease.

Sarcoidosis and lifestyle

To treat sarcoidosis, the doctor will prescribe medications - Trental, Prednisolone, Pentoxifylline, procedures - plasmapheresis, etc. To help your body cope with the disease, take the initiative and adjust your lifestyle.

1. walk more in the fresh air;
2. quit smoking;
3. establish a rest and sleep schedule;
4. Avoid sunbathing – this promotes the production of vitamin D, which retains calcium, which is needed even without
5. that in excess in the patient’s body;
6. do daily morning exercises;
7. Avoid contact with toxic volatile substances.

To get rid of the disease forever as soon as possible, find time every day to perform special exercises. How are breathing exercises done? Lower your head, look at the floor, relax your neck muscles and fold your hands on your stomach so that they “circle” your navel. Cough while pressing on the abdominal area. You will feel that the mucus comes out easier and faster.

Is it possible to drink alcohol if you have pulmonary sarcoidosis? No, this way you will increase the load on the body, which is already suffering from an inflammatory process. Many medications, such as Trental, Pentoxifylline, prednisolone, have adverse effects on the liver. Alcohol increases harm, increasing the likelihood of dangerous complications.

Folk remedies to combat sarcoidosis

If you were treated with medications prescribed by a doctor and achieved improvements, you can add traditional methods to your therapy for a speedy recovery. Remember that any recipe for healers “for plow” must first be agreed upon with a specialist, otherwise, instead of the expected benefit, you can cause harm to the body.

Traditional recipes require the active use of absorbable and anti-inflammatory drugs, which prevent the spread of granulomas and have a restorative effect on the patient’s body.

The following methods have been proven to be effective:

• Propolis tincture
  Buy it at the pharmacy and use it twice a day before meals, 20 drops, pre-dissolved in a glass of cool water. The duration of use of the prescription is three weeks. The first results will be noticeable after just seven days.
• Unrefined sunflower seed
  Combine 1 tbsp. l. of the original component with the same volume of vodka, take before meals. The procedure is repeated three times a day for ten days. There should be a five-day break between courses.
• Grape cuttings
  Place 220 g of the herbal component and pour a liter of boiling water. Cover with a lid and bring to a boil. Simmer over low heat for another 10-15 minutes. Cool the broth and strain through cheesecloth. Drink a glass of the product twice a day, after adding a spoonful of honey to it.
• Ginger
  This plant has a recognized ability to kill microorganisms and fight inflammation. Prepare a tasty and healthy decoction from it. Mix 50 g of finely chopped root, 400 g of chopped onion and sugar, and a liter of water. Add turmeric on the tip of a knife. Bring the mixture to a boil and simmer, covered, until its volume is reduced by half, then strain. Drink 1 tbsp. l. twice a day before meals.

Treatment of pulmonary sarcoidosis with folk remedies helps relieve the symptoms of the disease, ease its course, and speed up recovery. However, this is only an addition to the course of medications prescribed by a doctor, and not independent therapy. To avoid complications, be sure to coordinate the measures taken with your doctor.

How to cure pulmonary sarcoidosis? You need to see a doctor in Moscow or the city where you live. Based on the test results (lung biopsy and others), he will prescribe Prednisolone, Trental and other medications.

To speed up recovery, you will need physical therapy, correction of your diet and lifestyle. This is not a terrible disease, but an ailment that can be easily gotten rid of using modern medicine.

Sarcoidosis is a multisystem inflammatory disease of unknown origin, characterized by the appearance of small benign granuloma vesicles on organs (usually the lungs). Another name for sarcoidosis is Besnier-Beck-Schaumann disease. With sarcoidosis, the patient is worried about fever, cough, fatigue, chest pain, skin rashes, arthralgia (pain in the joints). This pathology is most often characteristic of individuals in the age range from 20 to 45 years. The vast majority of patients are women. The disease is ethnically more common among Asians, African Americans, Scandinavians, Germans, and Irish.

Pulmonary sarcoidosis is diagnosed more often (90% of cases - this includes sarcoidosis of the lymph nodes (intrathoracic and peripheral); sarcoid lesions of the skin occur with less frequency (48%, for example, erythema nodosum). Less commonly, eye problems (iridocyclitis, keratoconjunctivitis) occur with a frequency of 27%. Liver sarcoidosis occurs in 12% of cases, spleen in 10%. The nervous system accounts for 4 to 9% of cases, the parotid salivary glands up to 6%. The incidence of sarcoidosis of the joints and heart is less than -3%, and of the kidneys is only 1%.

Scientists have noticed that with sarcoidosis, almost the entire body can be affected, except for the adrenal glands. An explanation for this phenomenon has not yet been found.

The mechanisms of development of sarcoidosis are not fully understood. The disease is believed to be caused by an unknown agent that suppresses the immune system. As a result, alveolitis develops (inflammation of the vesicular alveoli of the lungs) with the further formation of granulomas (proliferation of cellular structures resembling nodules), which either resolve on their own or become fibrous tissue (overgrown connective tissue with scars). It is still unclear what influences a particular outcome of such a problem as sarcoidosis. Treatment in any case is carried out with the use of glucocorticoids (hormones produced by the adrenal cortex) or immunosuppressants (provide artificial suppression of immunity).

The latest information obtained radically changes the understanding of immunological processes in sarcoidosis: starting from generalized suppression of the immune system, ending with the recognition of a local increase in the activity of the immune system. This behavior is explained by the constant presence of difficult-to-eliminate agents.

Schematically, the mechanism of development of sarcoidosis is presented as follows: in response to the activity of an etiologically unknown agent in the vesicular pulmonary alveoli, there is a sudden increase in the activity of macrophages (phagocyte cells that absorb elements foreign to the body - the remains of dead cells, bacteria), which intensively synthesize biologically active substances. These are interleukin-1 (inflammatory mediator, activates T-lymphocytes), fibronectin (activates fibroblasts), lymphoblasts (precursors of lymphocytes), B-lymphocytes, stimulators of monocytes (large blood cells) and others. The involved T-lymphocytes secrete interleukin-2, which first provokes lymphoid-macrophage (immune) infiltration of organs (impregnation of tissue with a certain substance), then granuloma formation in them. This often happens in the intrathoracic lymph nodes or the lungs themselves. But in addition to this, the sarcoidal process can affect the peripheral, abdominal lymph nodes, liver, spleen, salivary glands, eyeballs, skin, muscles, heart, gastrointestinal tract, skeletal and nervous systems. In sarcoidosis, there is a large accumulation of activated T-lymphocytes and phagocytes (that absorb harmful particles) in a certain area of ​​​​the lung tissue.

In the granulomas themselves, biological substances such as interleukin-12 (has antitumor activity), TNF (tumor necrosis factor), angiotensin-converting enzyme otherwise known as ACE (regulates blood pressure, water-salt metabolism), 1a hydroxylase (sometimes leading to hypercalcemia (increased plasma calcium concentration) or nephrolithiasis (kidney stone disease)). The granulomatous stage does not progress to fibrosis due to the increased production of substances that inhibit the growth of fibroblast cells. This is how sarcoidosis manifests itself. Treatment is aimed at suppressing localized aggression of T-lymphocytes and eliminating the totality of pathological processes.

Classification

Considering location of granulomas, there are several variants of sarcoidosis according to the classification of A. E. Ryabukhin and co-authors:

• classic (predominance of pulmonary and intrathoracic pathologies);
• extrapulmonary (focus of inflammation in any location except the lungs);
• generalized (several organs or systems are affected).

There are several features of the course of the disease:

• acute onset: Löfgren's syndrome (manifested by erythema (atypical redness of the skin), arthritis, fever), Heerfordt-Waldenström syndrome (manifested by fever, uveitis (inflammation of the blood vessels of the eyeball), ;
• chronic course;
• relapse (return of the disease);
• sarcoidosis in children under 6 years of age;
• refractory sarcoidosis (treatment unsuccessful due to resistance to drugs).

Nature of development diseases happen:

• abortive (the process is suspended);
• delayed;
• progressive;
• chronic.

Must be indicated phase of the process- active, regression (gradual disappearance of symptoms) or stabilization.

Kinds

Several types of pathology are classified. Sarcoidosis occurs:

• lungs;
• intrathoracic or peripheral lymph nodes;
• skin;
• spleen;
• bone marrow;
• kidney;
• hearts;
• eye;
• thyroid gland;
• nervous system (neurosarcoidosis);
• digestive organs (salivary glands, liver, pancreas, stomach, esophagus, intestines);
• ENT organs;
• musculoskeletal system (bones, joints, muscles).

The most common type. Not contagious. Characterized by granulomatous lesions of lung tissue. The cause of the appearance has not been established, but theories of the occurrence of the disease due to infection with fungi, spirochetes, protozoa, and mycobacteria have been put forward. If left untreated, complications such as emphysema (pathological airiness of the lungs), broncho-obstructive syndrome (impaired air flow through the bronchi), cor pulmonale (enlarged right chambers of the heart), and respiratory failure are possible.

Sarcoidosis of the lymph nodes

Enlargement of the intrathoracic lymph nodes compresses the bronchi and bronchioles, subsequently causing shortness of breath, coughing, and painful spasms, but it is impossible to visually see any deviation without fluorography or x-rays. Enlarged peripheral lymph nodes can be palpated, as they are located in the neck, armpits, elbows, groin, and collarbones. If the peripheral lymph nodes have enlarged during the course of the disease, then this is a bad sign, indicating the recurrent nature of the disease. When the lymph nodes of the abdominal cavity are affected, pain appears in the abdomen and diarrhea is possible. The cervical and subclavian lymph nodes are most often affected.

Approximately 30% of patients with pulmonary sarcoidosis have the same problem with the skin. Specific manifestations include sarcoid plaques, nodules, maculopapular rashes, or lupus pernio (violet or purple indurated areas of skin). Rare - psoriasis-like ulcers, ichthyosis (impaired keratinization with the appearance of hard scales on the skin), alopecia (thinning of hair on the scalp), subcutaneous sarcoidosis. Symptoms make themselves felt by the appearance of granuloma on the skin, fever, erythema nodosum (Löfgren's syndrome), and other rashes, but there is no itching. Most often, skin changes affect the upper half of the body, face, and extensor surfaces of the arms.

Sarcoidosis of the spleen and bone marrow

Manifested by an enlarged spleen. It is responsible for hematopoiesis and immunity, absorbing bacteria that enter the blood, so it would be strange if the spleen were not involved in the process of immune disease. Bone marrow, responsible for hematopoiesis, is located inside the bones. Sarcoidosis of the hematopoietic system entails anemia (anemia), thrombocytopenia (increased bleeding, difficulty stopping bleeding), leukopenia (decreased number of white blood cells). Symptoms of sarcoid lesions are night sweats, pain under the ribs on the left side, fever, and weight loss.

Sarcoidosis of the kidneys

Rarely seen. It is usually asymptomatic, but may be accompanied by swelling on the face in the morning, dry mouth, pain when urinating; here it is important to differentiate independent kidney pathology from granulomatous lesions. The range of symptoms present when kidney granulomas are affected is wide - from minimal urinary syndrome to nephropathy and renal failure. 10% of patients have hypercalcemia (high concentration of calcium in the blood plasma), and 50% of patients have hypercalciuria (excretion of large amounts of calcium salts in the urine).

Sarcoidosis of the heart

Life-threatening type of disease. Most often, the myocardium (the cardiac muscle layer) undergoes an inflammatory process. Subsequently, cardiac sarcoidosis develops arrhythmia (disturbed rhythm of the heart) and heart failure. Cardiac sarcoidosis almost never begins on its own; it is accompanied by sarcoid pathology in the lymph nodes or lungs. Manifested by shortness of breath, pain in the heart area, pale skin, swelling in the legs.

Sarcoidosis, which affects the eyes, poses a danger to vision. Symptoms include redness of the eyelids, blurred vision, photophobia, itching or burning in the eyes, floating spots, black spots, lines in front of the eyes, and decreased visual acuity. However, these symptoms are not specific (inherent) to sarcoidosis; in order to exclude other visual impairments, you should consult an ophthalmologist. In children and adults, manifestations and symptoms differ, in children the structures of the eye are more often affected (uveitis (inflammation of the choroid), iridocyclitis (inflammation of the iris)), and in adults - the eyelids. Intraocular pressure often increases, leading to secondary glaucoma. Ignoring treatment risks blindness.

Sarcoidosis of the thyroid gland

The thyroid gland rarely suffers from this disease. Pathology leads to hypothyroidism (deficiency of thyroid hormones), thyroiditis (inflammation of the gland), goiter with changes in intrathoracic or peripheral lymph nodes.

Neurosarcoidosis

With sarcoidosis of a neurological nature, the facial nerve is often affected. The optic, vestibulocochlear, and glossopharyngeal nerves may be involved. With neurosarcoidosis, there are complaints of headaches, deterioration of hearing or vision, dizziness, staggering when walking, epileptic seizures, and eternal daytime sleepiness (if we are talking about a protracted process). Neurosarcoidosis manifests itself as neuritis (inflammation of the peripheral nerves, causing a decrease in their sensitivity), less commonly, meningitis (inflammation of the membranes of the brain), meningoencephalitis (inflammation of the brain substance; causes paralysis). Possible death.

Sarcoidosis of the digestive system

Most often, granulomas affect the stomach (granulomatous gastritis), liver (sarcoidosis of the liver provokes cirrhosis with a incidence of 1%), less often the small intestine, esophagus, pancreas (damage to the pancreas resembles cancer). Sarcoidosis of the salivary glands is accompanied by their swelling, it should be distinguished from changes in tuberculosis, chronic sialadenitis (inflammation of the salivary glands), cat scratch disease (infection resulting from cat bites or scratches), actinomycosis (infection caused by a fungus), Sjögren's syndrome (decreased function exocrine glands).

Sarcoidosis of ENT organs

The most common symptoms of sarcoidosis of the nose are rhinitis (runny nose), rhinorrhea (secretion of watery mucus), crusts formed on the mucous membrane, impaired sense of smell, and bleeding occurs. Severe forms lead to perforation of the nasal septum (through hole). Sarcoidosis of the tonsils is asymptomatic, but swelling of the tonsils is present. Sarcoidosis of the larynx is accompanied by dysphonia (nasal tone, hoarseness), cough, dysphagia (impaired swallowing), and sometimes increased breathing. Sarcoidosis of the ears is characterized by hearing loss, vestibular disorders, and deafness. Sarcoid pathology of the oral cavity and tongue is manifested by such symptoms as ulcerations on the mucous surface of the tongue, gums, lips, obstructive apnea (breathing stops during sleep for more than 10 seconds).

Sarcoidosis of the musculoskeletal system

Bone sarcoidosis is rarely diagnosed and is asymptomatic (asymptomatic osteitis cystica). If left untreated, it leads to dactylitis (inflamed small bones of the hands and feet). Painful joints are among the symptoms of Löfgren's syndrome. Arthritis occurs in the ankle joint, knees, elbows, and is accompanied by erythema nodosum (inflammatory vascular disease). Muscle sarcoidosis is characterized by granulomatous myositis (muscle weakness, pain due to granuloma formation), myopathy (muscular dystrophy).

Sarcoidosis in gynecology and urology

With sarcoidosis of the urinary tract in women, the strength of the urine stream decreases. Affected external genitalia are a rare condition, accompanied by nodular changes in the vulva. The most dangerous manifestation of uterine sarcoidosis is bleeding in the postmenopausal period. The disease is not considered a serious violation of a woman’s reproductive function.

In men, sarcoidosis of the testes and appendages occurs together with or without intrathoracic pathology. Difficult to diagnose due to similarities with cancer. Prostate sarcoidosis has many similarities to prostate cancer, so it is important to get the correct diagnosis and treatment.

Stages

At a specific stage, patients experience pathological changes in the lungs or other organs. But the classification of pulmonary sarcoidosis by stages is more often considered:

First- the x-ray shows lymphadenopathy (enlarged intrathoracic lymph nodes), but the lung parenchyma (soft lung tissue) has not undergone changes. Enlarged lymph nodes are almost always asymmetrical, less often bilateral. Diagnosed in 50% of patients.

Second- there is bilateral dissemination (spread of the lesion in both lungs), damage to the intrathoracic lymph nodes, infiltration of the parenchyma (penetration and accumulation in the tissues of a substance not characteristic of this environment). The incidence of the second stage is 30%.

Third- there is pronounced pneumosclerosis or, in other words, fibrosis (replacement of functioning tissue (parenchyma) with connective tissue devoid of functions). There is no enlargement of intrathoracic lymph nodes. The frequency of occurrence of the third stage is 20%.

The sequence of stages is not obligatory; it happens that the first immediately passes into the third.

Sarcoidosis according to ICD-10

According to the International Classification of Diseases, 10th revision, sarcoidosis is assigned code D86, and its clarifying diagnoses are as follows:

• D86.0 - pulmonary sarcoidosis;
• D86.1 - sarcoidosis of lymph nodes;
• D86.2 - sarcoidosis of the lymph nodes and lungs;
• D86.3 - cutaneous sarcoidosis;
• D86.8 - sarcoidosis of other specified and combined localizations;
• D86.9 - unspecified sarcoidosis.

This also includes sarcoidosis:

• arthropathy (M14.8*) (destruction of joints);
• myocarditis (I41.8*) (myocardial damage);
• myositis (M3*) (inflammation of skeletal muscles);
• iridocyclitis in sarcoidosis (1*).

Causes and risk factors

Sarcoidosis has no clear etiology, so there are only hypotheses about the reasons for its occurrence:

Inhalation of metal dust. It goes without saying that dust from cobalt, titanium, aluminum, gold, barium, and zirconium is harmful to health.

Smoking. Smoking itself does not cause this disease, but sarcoidosis is much more difficult in smokers. Treatment completely eliminates this bad habit.

Medicines. Sometimes the disease is associated with a side effect of specific medications (interferon, anti-HIV medications).

Genetics. There are more and more observations that it is heredity that plays a key role in the genesis of sarcoidosis, and all other factors only complement each other, increasing the likelihood of developing pathology.

The risk group includes:

• women from 20 to 45 years old;
• constantly in contact with toxic substances, metal dust;
• African Americans;
• Asians;
• Germans;
• Irish;
• Puerto Ricans;
• Scandinavians.

Since it is not completely known what sarcoidosis is and why it occurs, the patient who has been diagnosed with this is shocked and has many questions that he tries to find on the Internet: “is sarcoidosis cancer?” or “is sarcoidosis contagious?” The answer is no.

It has been noticed that the disease “selects” people from certain specialties. These are firefighters, mechanics, sailors, millers, postal workers, agricultural workers, miners, chemical workers and healthcare workers.

Symptoms

During fluorography or x-rays, sarcoidosis may be accidentally detected; symptoms may not appear for a long time, so the patient is not aware of the presence of the disease.

Symptoms of sarcoidosis of the lungs and lymph nodes:

• dyspnea;
• chest discomfort;
• dry cough;
• fever;
• weakness;
• drowsiness;
• enlarged lymph nodes (only peripheral ones are visually visible);
• decreased appetite;
• weight loss.

Skin:

• erythema nodosum (painful hemispherical nodes spreading on the skin or subcutaneously);
• sarcoid plaques (painless, raised, purple-colored lumps located symmetrically on the skin of the body);
• lupus pernio (purple or violet colored nose, cheeks, ears, fingers due to changes in blood vessels; occurs in winter);
• hair loss;
• cicatricial changes (pain in long-healed wounds, the phenomenon of “revived scars”);
• dryness.

Spleen and bone marrow:

• enlarged spleen;
• abdominal discomfort;
• anemia (anemia);
• leukopenia (decreased white blood cell level);
• thrombocytopenia (low platelet levels);
• increased bleeding.

Kidney:

• protein content in urine;
• renal failure (rare);
• dry mouth;
• swelling of the face (in the morning);
• discomfort in the lower back;
• pain when urinating;
• elevated temperature;
• kidney stones due to high calcium levels.

Hearts:

• shortness of breath after exercise;
• heart pain;
• swelling of the legs (a manifestation of heart failure);
• pallor;
• increased sensation of your own heartbeat;
• loss of consciousness due to severe arrhythmia.

Eye:

• uveitis (inflamed choroid of the eyeball);
• iridocyclitis (inflamed iris);
• keratoconjunctivitis (inflamed cornea and conjunctiva);
• reduced visual acuity;
• secondary glaucoma (increased intraocular pressure);
• photophobia;
• redness of the eyes;
• soreness;
• black spots, spots, stripes before the eyes.

Nervous system(symptoms of damage to the brain, spinal and peripheral nervous systems are described):

• headache;
• general weakness;
• temperature increase;
• arthralgia (volatile joint pain);
• myalgia (muscle pain);
• dizziness;
• nausea or vomiting;
• impaired coordination of movements;
• hand tremors (sometimes);
• memory impairment;
• convulsions;
• changes in handwriting, impaired understanding of speech and spatial thinking (as it progresses).

With pathology of the spinal cord, radicular syndrome, hyperalgesia (hypersensitivity to pain), and paralysis appear. Severe cases are characterized by involuntary urination and defecation.

Affected peripheral nerves lead to the appearance of Bell's palsy (facial nerve paralysis), polyneuropathy (decreased sensitivity of the limbs), and increasing pain in the feet when walking.

Digestive organs:

• stomach ache;
• diarrhea;
• enlarged parotid salivary glands;
• violation of the outflow of bile;
• manifestations of gastritis, colitis, duodenitis, chronic pancreatitis;
• enlarged liver (not always);

Often the clinical picture of sarcoidosis of the digestive organs is blurred, so it often goes unnoticed.

ENT organs:

• runny nose;
• hearing loss;
• vestibular disorders;
• cough;
• dysphonia (hoarseness);
• dysphagia (impaired swallowing);
• apnea (stopping breathing during sleep).

Musculoskeletal system:

• involuntary muscle spasm;
• pain and swelling in the joints;
• erythema nodosum;
• limited joint mobility.

Who treats sarcoidosis?

For the initial appointment, the patient with complaints comes to the therapist. After a survey and examination, the doctor, if a lung disease is suspected, gives a referral to a pulmonologist; if there are sarcoid skin lesions, then to a dermatologist. Enlarged intrathoracic lymph nodes are a reason to see an immunologist or infectious disease specialist (since enlarged lymph nodes are often caused by infection). In case of sarcoid eye pathology, the patient is referred to an ophthalmologist. You may need the help of an oncologist, rheumatologist, cardiologist, gastroenterologist, endocrinologist, ENT doctor and phthisiatrician (for tuberculosis). Which doctor treats sarcoidosis depends on the nature of the disease.

Diagnostics

Until the 2000s, sarcoidosis was considered a form of tuberculosis, and patients were managed by a TB specialist. However, over time, it became clear that tuberculosis and sarcoid lesions are different diseases; now diagnosis and treatment are carried out by multidisciplinary specialists, using a variety of techniques. To make a correct diagnosis for such a difficult-to-diagnose disease, it is necessary to undergo a lot of examinations.

Laboratory diagnostics

Kveim's test consists of intradermal injection of a suspension taken from the spleen of a person suffering from sarcoidosis. Nowadays this test is practically not used due to the risk of transmitting infections.

Tuberculin test- an obligatory part of the diagnosis. Done to differentiate pulmonary tuberculosis.

Clinical blood test shows the content of copper and protein, the level of which increases in sarcoidosis.

Analysis of urine It will be necessary to see the functioning of the kidneys and determine the presence of protein in the urine.

ACE blood test(blood sampling comes from a vein) increased secretion of ACE (angiotensin-converting enzyme) indicates a sarcoid process.

C-reactive protein- an old method that detects Löfgren's syndrome given the increase in this protein.

Test for TNF-alpha(tumor necrosis factor) allows you to identify a malignant tumor and select appropriate treatment tactics.

Instrumental diagnostics

Hardware examination reveals enlargement of peripheral or intrathoracic lymph nodes, granulomatous lesions or organ enlargement. The patient will need to undergo some of the examinations:

Radiography and fluorography- traditional methods are performed at the first stage of diagnosis and are used to evaluate the effectiveness of treatment. Both methods are based on the use of X-rays; the difference between X-rays and fluorography is their radiation power and information content. Fluorography has less radiation exposure. Today they can be replaced by more accurate computed tomography.

CT(computed tomography) allows you to obtain detailed images of the smallest anatomical structure of the lung or other organs. There is X-ray radiation.

MRI(magnetic resonance imaging) is informative in the diagnosis of neurosarcoidosis, since it distinguishes soft tissue better than CT. There is no X-ray radiation.

PAT(positron emission tomography) is a relatively new method of radiation diagnostics. Distinguishes the localization of metabolic activity. PET images are obtained in color.

Electrocardiography studies the work of heart rhythm and contractions.

Electromyography detects disorders of the neuromuscular system by recording the biopotentials of skeletal muscles.

Spirometry allows you to assess the function of external respiration and lung volume.

Ultrasound(ultrasound examination) detects foci of inflammation in the liver, spleen, heart, and lungs.

Scintigraphy is important for determining impaired microcirculation of the lungs and the functioning of the intrathoracic lymph nodes.

Endoscopy carried out using an endoscope inserted into the organ cavities. The endoscope is inserted through natural routes - through the mouth, if necessary, to examine the stomach, through the larynx - the bronchi.

Biopsy- the most informative, since the examination uses a biopsy specimen (tissue or cells) taken intravitally by puncture (puncture).

Bronchoscopy provides information about the condition of the bronchi. To obtain data, diagnostic lavage is used to obtain bronchoalveolar lavages. Hyperemia of the bronchial mucosa (excessive overflow of blood vessels), its swelling, and sometimes tuberculate rashes are detected.

Videothoracoscopy- a risky invasive procedure that allows you to examine the surfaces of the chest wall, lungs, and heart using a camera at the end of a thoracoscope.

Treatment

Some cases do not require treatment, and granulomas resolve on their own irrevocably, but some types of sarcoidosis require full treatment, which can take six months or more. Treatment is aimed at eliminating symptoms, preserving organ functions, complete recovery, and maintaining a healthy state. But scar changes, if they occur, are unfortunately impossible to eliminate. It is difficult to get rid of the disease without the use of hormones, so drug therapy cannot do without these drugs.

Drug treatment

Corticosteroids (steroid hormones produced by the adrenal cortex) are the most effective drugs against any type of sarcoidosis and are always used. First, large doses are prescribed, gradually moving to small ones. Prednisolone is popular. Patients who are dose-resistant to corticosteroids are given the antitumor drug Methotrexate.

Long-term use of corticosteroids risks:

• weight gain;
• increased blood pressure;
• development of diabetes mellitus;
• swelling of soft tissues;
• frequent changes in emotional background;
• acne on the face;
• softening of bone tissue, leading to fractures.

Sarcoidosis of the lungs and hilar or peripheral lymph nodes in addition to hormones, they are treated with a group of medications:

• antibiotics. To prevent pneumonia;
• antiviral;
• analgesics (Analgin, Ketanov);
• anti-inflammatory (Ibuprofen, Diclofenac, Fanigan);
• expectorants (Ambroxol, Gerbion, Lazolvan, Pectolvan);
• diuretics. To prevent stagnation;
• immunosuppressants that suppress actively working immunity (Chloroquine, Azathioprine);
• anti-tuberculosis drugs;
• vitamin complexes, general strengthening vitamins (Alpha-Tocopherol acetate or vitamin E).

Oxygen therapy is prescribed for people with respiratory failure. For poor circulation, Pentoxifylline is prescribed.

For sarcoidosis of the skin local anti-inflammatory ointments and creams are used (Akriderm, Hydrocortisone, Uniderm). They contain corticosteroids. Immunosuppressants such as Adalimumab and Azathioprine are prescribed. Sometimes laser surgery is used when skin defects disfigure a person.

If uveitis is present, it is treated with corticosteroid eye drops. Drugs that dilate the pupils are used - Cyclopentolate, Atropine. Surgery is performed if cataracts develop.

To eliminate symptoms liver sarcoidosis give ursodeoxycholic acid, which prevents bile stagnation.

Cardiosarcoidosis requires the use of ACE inhibitors, diuretics, immunosuppressants, and antiarrhythmic drugs.

Neurosarcoidosis requires treatment with hormonal drugs (Prednisolone). They may prescribe sedatives (Corvalol, Barboval). If corticosteroids do not provide results, cytotoxic agents (Methotrexate, Azathioprine) will be prescribed.

After treatment, the patient is observed for another 2 years to avoid relapse or exacerbation, with complications - 5 years.

Diet

As such, a diet for sarcoidosis has not been developed, but there are nutritional recommendations.

Necessary:

• limit salt intake;
• give up baked goods and confectionery products. They contain large amounts of simple carbohydrates, which increase inflammation.
• Avoid spicy, fried and spicy foods as this increases the inflammatory process.
• give up alcohol;
• eat more garlic and onions, as they improve metabolism.

Since people suffering from sarcoidosis have elevated levels of calcium in the blood, they should limit foods containing large amounts of this trace element. Excess calcium leads to the formation of stones in the kidneys and bladder. That is, it is not advisable to consume dairy products, nuts, mustard, oatmeal, beans, and peas.

• seaweed;
• garlic;
• pomegranate;
• basil;
• sea ​​​​buckthorn;
• rose hip;
• chokeberry;
• black currant;
• turmeric.

Traditional treatment

Treatment of sarcoidosis at home with tinctures and herbs only relieves symptoms, but does not replace adequate medical care, in addition, the effect of such treatment can be disastrous, so before treating sarcoidosis with self-selected methods, you should consult a doctor.

Propolis tincture

Propolis has a bactericidal, regenerating, and disinfectant effect on the body. For preparation you will need propolis and pure alcohol in a ratio of 1:5. For example, if you took 20 grams of propolis, then you need to fill it with 100 milliliters of alcohol. The prepared food is infused for a whole week. Use by mixing with warm water (20 drops of tincture), three times a day, a glass.

Echinacea

The plant stimulates the immune system and has a general strengthening effect. Pharmacies sell ready-made alcohol tincture of Echinacea. It is taken three times a day 30 minutes before meals. Calculating 40 drops per 50 milliliters of water. The course of treatment is 3 weeks.

Lilac

You need to collect a third of a glass of lilac flowers. Fill a glass with floral raw materials with vodka and leave away from light for about a week. The finished product is used for rubbing the back or chest area (1 tablespoon). Sometimes the temperature rises, this means the infusion is effective.

Rhodiola rosea

The plant is useful for people with respiratory problems, has a resorption effect, normalizes hearing and vision. The finished tincture is purchased at the pharmacy. Take 15 drops twice a day before meals. The course of treatment is a month.

Birch juice

Horseradish mustard plasters

Fresh horseradish root is grated and placed in gauze bags. The bags should be placed on the bronchi area and wrapped in a warm cloth or scarf. After half an hour, remove and wipe with a damp towel. The procedure is carried out before bedtime.

Eucalyptus

Eucalyptus will improve the condition of the bronchopulmonary system. It will relieve cough, clear breathing, and help you sleep. To do this, take 50 g of plant leaves and pour a liter of boiling water. Leave overnight. In the morning and evening, drink 1 cup, adding honey.

Apricot kernels

They contain vitamin B15 (pangamic acid, which improves tissue respiration and increases endurance), oils, and toxic amygdalin, which gives apricot kernels a bitter taste. Amygdalin has an antitumor, immunosuppressive effect (suppresses the immune system). The number of cores should not be more than 7 pieces per day. You can use the kernels like this: 1 tbsp. pour a spoonful of dry elecampane with hot water (200 ml), boil over low heat for 30 minutes. There, at the end of cooking, add apricot kernels. The decoction is drunk three times a month, half an hour before meals.

Complications

If sarcoidosis progresses and adequate medical care is not provided, the patient will face severe complications. Of course, sometimes granulomas resolve on their own, then treatment is not prescribed.

Some of the most dangerous complications are (“airiness”, excessive airiness of the lungs), aspergillosis(fungal infection) tuberculosis, broncho-obstructive syndrome(disturbance in the flow of air passing through the bronchial tree). Also dangerous (sick thyroid gland), cor pulmonale(dilatation of the right atrium and ventricle due to increased blood pressure), heart failure, blindness. But the most serious complication of sarcoidosis is respiratory failure(impaired gas exchange in the lungs), leading to death.

Forecast

Sarcoidosis has a relatively favorable prognosis. The cause of death can only be ignoring treatment, as the disease progresses and complications arise. The most common causes of death are respiratory and cardiopulmonary (heart pulmonary) failure.

Most patients have no symptoms of the onset of the disease, and in 30% of cases, sarcoidosis goes into spontaneous remission (unexpected cure). Chronic forms with fibrosis occur in 10-30% of patients. The chronic course leads to severe respiratory failure. Sarcoidosis of the eye leads to blindness.

In case of sarcoidosis, a disability group is not established, but special rare cases require the registration of a group (loss of the ability to self-care, movement).

Relapse occurs with a frequency of 4% in the first 2-5 years after treatment, so patients are still under observation during this time.

Prevention

Due to the unknown causes of sarcoidosis, no specific preventive measures have been developed. But nonspecific prevention includes:

• reduction of aggressive exposure to occupational hazards;
• strengthening immunity;
• quitting smoking (since smoking worsens sarcoidosis, symptoms become more pronounced);
• avoiding infectious diseases;
• undergoing fluorography whenever possible;
• avoiding contact with metal dust of cobalt, aluminum, zirconium, copper, gold, titanium.

Sarcoidosis is an incompletely studied phenomenon, the disease is not fatal, but the sarcoid process, affecting various systems, disrupts their functioning, which greatly complicates the patient’s life, although sometimes the pathology goes away on its own and without a trace.

Question from Valentina Kirichenko from Arkhangelsk:

Good afternoon As a result of long examinations, he was diagnosed with pulmonary sarcoidosis. The doctor prescribed hormonal and anti-inflammatory drugs, and also recommended following a diet. But is there any benefit to diet for pulmonary sarcoidosis? How should you eat?

Medical specialist response:

Sarcoidosis is a systemic disease, which means it negatively affects the body's metabolism, slowing it down. Therefore, it is so important to adhere to a balanced diet during treatment and rehabilitation. It is necessary to eat fortified and easily digestible food.

There is no special diet for pulmonary sarcoidosis, but a properly organized diet will help to significantly reduce the degree of inflammation, restore normal metabolism, and provide essential nutrients.

During the diet for pulmonary sarcoidosis, it is necessary to consume foods rich in protein. These include:

• dietary meats;
• chicken eggs;
• legumes;
• nuts;
• fish.

The daily diet should include vegetable fats, complex carbohydrates and vitamins. To reduce the manifestation of inflammation, you should limit the consumption of foods containing light carbohydrates (sugar, flour products, sweet carbonated drinks, spicy, salty, fried foods).

One of the features of the disease is a disorder of calcium metabolism - an increased concentration of the substance in the blood. This phenomenon contributes to the suppression of renal activity and stone formation in the urinary tract and kidneys. Therefore, you should avoid eating foods rich in calcium:

• sour cream;
• milk;
• cottage cheese;
• fermented milk products.

Butter contains the least amount of calcium, so its consumption is not limited. But you shouldn’t abuse this product either.

It is necessary to supply the body with vitamins C and E; to do this, you should include tomatoes, citrus fruits, greens, spinach, and broccoli in your daily diet. It is recommended to consume all red berries:

• cherry;
• rowan;

Most of these berries are used to make infusions that help reduce the inflammatory process.

In order for the body to receive a sufficient amount of vitamin E, the menu should include foods such as peanuts, red fish, cod liver, steamed wheat grains, squid, and dried apricots.

During hormone therapy, special attention should be paid to nutrition, since the drugs effectively fight inflammation, but often cause side effects. A balanced diet allows you to minimize them.

Nutrition for sarcoidosis is one of the important components; the inclusion of certain foods in the daily diet can have a beneficial effect on human health, which is manifested in the regression of the disease up to complete recovery.

When talking about food, it should be understood: food that is suitable for one person may be intolerable to another. You need to be able to understand your body and adjust it to proper nutrition gradually and measuredly.

Features of the sarcoidosis diet

Which causes the formation of granulomas. Granular formations can be located in any system of the body: in the lungs, lymph nodes, skin, heart and liver.

Thus, emphasis should be placed on foods that have certain anti-inflammatory properties.

Note! “Natural” treatment in no way means giving up drug therapy! However, proper nutrition for sarcoidosis and lifestyle control can achieve better results in the fight against the disease.

Foods for sarcoidosis

Each of the products presented below is accompanied by a certain number - this is the so-called anti-inflammatory action coefficient (ACI).

A positive CPV value indicates the degree of anti-inflammatory effect of a food product (the higher the number, the better), and a negative number indicates low effectiveness in combating inflammation (such products can, on the contrary, support pathological processes in the body).

Anti-inflammatory fruits

Any of these fruits can be included in your daily diet: for example, prepare a dessert in the form of strawberries or a salad of fresh tomatoes.

Anti-inflammatory vegetables

In the realities of the post-Soviet space, the easiest (and most affordable) foods to eat are potatoes, cabbage and carrots.

Anti-inflammatory nuts and seeds

Anti-inflammatory oils and fats

Attention! Don't overdo it - the oil has a laxative effect!

Anti-inflammatory seafood and fish

Note! You should not “lean” on anti-inflammatory seafood - they are rich in calcium, the excess intake of which is extremely undesirable for patients with sarcoidosis!