Sarcoidosis Is a Granulomatous Disease

Sarcoidosis is a granulomatous disease that primarily affects the lung and lymphatic organs Although progress has been made in understanding the immunological, clinical, and pathological features of the disease, appropriate therapy and intervention still has not been discovered as well as the fact that certain other areas of the disease remain unresolved. Sarcoidosis is a disease that has a predictably adverse impact on patient's quality of life but how much and to what extent remains indefinite. Part of the problem is the fact that sole research studies have included cross sectional methods. Still to be investigated is progression of disease and correlation effect on QOL as part of follow up studies and this involves longitudinal experimentation.

What Sarcoidosis is

Sarcoidosis, first discovered in 1877, is a granulomatous disease that primarily affects the lung and lymphatic organs but may, particularly in patients with progressive Sarcoidosis, involve various organs (Wiegand & Brutsche, 2006). It involves the central nervous system in approximately 5% of the cases (Bona et al., 1998), but the disease is, in most cases, limited although others may become excessively ill and even die from unmitigated progression of the disease. Although progress has been made in understanding the immunological, clinical, and pathological features of the disease, appropriate therapy and intervention still has not been discovered. For all these reasons and since the cause of Sarcoidosis is still unknown, the disease continues to intrigue clinicians and researchers.

Sarcoidosis may affect all ages but most commonly the young and middle-aged. Symptoms are bilateral hilar lymphadenophy, pulmonary infection, and ocular and skin lesions. Other organs such as the heart, liver, spleen, lymph nodes, salivary glands, muscles, bones, and nervous system may be affected too.

Immunological features most associated with the disease are degrading of cutaneous-delayed- hypersensitivity and the conspicuousness of a T cell type 1 immune response at localizations of the disease. Indications of B cell hyperactivity may also be witnessed.

Sarcoidosis is a global disease affecting both sexes and all ages. There is no consistent case definition, neither is there any homogenous manner of disease appearance. For that reason, clinicians and scientists have found it hard to tag a definition to the disease. Similarly, reliable and decisive diagnostic tests still have to be created, resulting, in the meantime, in misdiagnosis and, in too many quarters, ignorance of the disease. There is insufficient research, too, on epidemiological causes of Sarcoidosis.

The disease seems to peak in adults who are 20 to 29 years old and seems to subside before 20 and in ages older than 40, although in Japan and in Scandinavian countries women older than 50 seem to evidence peeks in the disease, too. Women seem to be more susceptible than men to the disease, whilst in the U.S. The rate of Sarcoidosis for White is 0.85% compared to that of Blacks (2.4%). Sarcoidosis is approximately 1 out of 40 cases, with Swedes, Danes, and U.S. Blacks having the highest incidence. It is possible too, although not conclusively proves that Sarcoidosis is hereditary, infectious, and environmental-driven.

Genetic predisposition seems to be almost certainly a given. Environmental agents seem to be involved, and several have been suggested as implicators, but none have been conclusively resolved.

Similarly, too, medical treatments remain controversial with disease that involves mild disease such as cough or skin lesions simply needing topical steroid therapy. For more severe and systemic disease, such as cardiac disease, neurological disease or ocular disease, oral cortiscosteroids are often employed with radiation employed in some cases (American Thoracic Society, (1999).

Given the trauma involved with the disease, particularly the uncertainty of how to treat it and frequency of misdiagnosing or ignoring it as well as predictable side effects of medication (Wiegand & Brutsche, 2006), Sarcoidosis is a disease that has a predictably adverse impact on patient's quality of life. The symptoms that it is associated with - such as coughing, chest pain, wheezing, fever, weight loss, and general weakness -- aggravate stress and may contribute to the challenge. Small wonder than that mental disease, such as schizophrenia, dementia, psychosis, delirium, personality changes, and clinical depressions are often found in patients with Sarcoidosis (Bona et al., 1998). It is hard to know where the boundary stops between psychological and physical illness, since the two are, often intimately combined with one affecting the other.

QOL, as De Vries and Drent (2008) point out is often confounded with state of physical health but actually it reflects one's emotional and psychological welfare. Nonetheless, the two are intimately related in that each affects the other.

Conducting a through review on the subject with key words involving 'Sarcoidosis and health status', Sarcoidosis and quality of life" or Sarcoidosis and fatigue" De Vries and Drent (2008) ended up with 15 studies that they considered relevant to their subject.

Counter-intuitively, they discovered that the greatest challenge on QOL as effected by was the patient's fatigue caused by the disease. Breathlessness, reduced exercise, and impaired working and physical activities were the most frequent reported hindrances. The instrument used was the World Health Organization Quality of Life Assessment Instrument -- 100, the standard QOL tool that is exclusively used with Sarcoidosis, and women consistently scored lower on the items of Physical health, Psychological health, Social relationships and Environment, as well as on the general facet Overall QOL. Fatigue correlated negatively with Physical Health, Independence, and psychological health. Compared with healthy controls, patients with Sarcoidosis scored lower all around, cognitive aspects notwithstanding, and they also indicated greater tendency towards clinical depression.

QOL of life in connection with Sarcoidosis, however, indicates the same problem as is indicative in the physical aspects of the illness: there are some areas that are debatable and much research still has to be done. Inclusive in this is the fact that as yet, sole research studies on the subject have included cross sectional studies. Still to be investigated is progression of disease and correlation effect on QOL: in other words does the individual's QOL, for instance, worsen as symptoms progressively increase. To assess that, follow up studies need to be conducted and this involves longitudinal experimentation.

Bona et al. (1998) suggest that mental health professionals become acquainted with the disease in order to refrain from misdiagnosing psychiatric symptoms as outcome of another disease. Conducting follow-up or longitudinal studies may reveal hitherto concealed or misinterpreted aspects of the disease helping both scientists and psychologists better understand and deal with psychological outcomes. Assessing the progression of the disease on QOL can also help therapists devise appropriate interventions -- and, although psychotherapy with or without application of antidepressant medication is occasionally employed (Wiegand & Brutsche, 2006), physicians sometimes, believing symptoms to be the flue or negative mood, fail to recommend it and patients initially fail to see its significance. For this reason, Wiegand and Brutsche (2006) recommend open discussion on the effects of the disease on daily life especially as effecting both patient and family's (or caregiver's) moods.