Complications of pulmonary sarcoidosis. Pulmonary sarcoidosis: symptoms, degrees and treatment of the disease

Systemic granulomatosis is a chronic disease in which inflammatory granulomas form in the patient’s body. In 97% of cases, such lesions are observed in the lung tissues. But sometimes in pathological process lymph nodes are involved. That is why experts call the disease systemic.

The disease is mainly diagnosed in women of younger and middle age. age category. In the initial period, the process is asymptomatic and characterized by a protracted course. Diagnosis usually occurs during an annual preventive x-ray examination organs of the chest cavity.

What are the causes of the disease?

To date, the exact cause of the pathology remains unknown. Some experts believe that the development of such a disease is associated with a genetic predisposition. This theory is confirmed by the presence of granulomatous lesions of regional lymph nodes several members of the same family.

Recent medical research identified the significant role of the abnormal immune response in the development of the disease. In such patients sarcoidosis of lymph nodes occurs in the primary chronic form. Their lymphocytes begin to actively produce biologically active substances, serving as the basis for a future granuloma.

Why is sarcoidosis of the lymph nodes dangerous?

The disease itself has a favorable course. The main danger lies in the complications of the disease, which can be in the following forms:

Lung collapse:

The gradual growth of the granuloma causes rupture of the pleura and collapse of the lung tissue.

Bleeding:

Inflammatory enlargement of a regional lymph node can damage a nearby one blood vessel, which is clinically manifested by spontaneous bleeding.

Chronic pneumonia:

In the later stages of systemic granulomatosis, periodic inflammation of the lung tissue is often observed.

Formation of kidney stones:

According to statistics, most patients with sarcoidal lymph node disease are diagnosed with urolithiasis disease. This may be due to an increased concentration of calcium ions in the blood.

Disruption of cardio-vascular system:

As a result, it leads to oxygen starvation central nervous system.

Decreased visual acuity:

Sarcoidosis of the lymph nodes ultimately causes irreversible changes in the eye area and blindness.

Disorders of the central nervous system:

After drug therapy, patients often complain of persistent depression, insomnia, apathy and a feeling of "". Correction of the patient's behavior is carried out by a psychologist by prescribing periodic interviews and taking antidepressants.

How to recognize the disease at the initial stage?

The disease is accompanied by damage to the thoracic lymph nodes, which gradually increase in volume. In the initial stages, patients have predominantly general complaints:

General malaise and fatigue.
Enlarged and painful lymph nodes and joints.
Decreased visual acuity.
There are signs of erythematous inflammation on the skin skin.
Night sweats.
A sharp increase in temperature or chronic hyperthermia at 37 degrees.
Dry cough and progressive shortness of breath.

Tests and examinations that need to be completed

The patient is examined according to the following scheme:

Collecting anamnesis of pathology and identifying family predisposition.
Physical examination of the patient, percussion and listening to the lungs. At this time, the doctor determines the size, location and consistency of the affected regional lymph nodes.
General blood analysis. Sarcoidosis of the lymph nodes manifests itself: increase in ESR, a reduced number of leukocytes and a jump in the level of calcium ions. There is no tuberculin test.
X-ray examination of organs respiratory system. In the photographs, the specialist notes a sharp increase in regional lymph nodes.
Biopsy. Puncture sampling of the contents of an atypically changed lymph node allows a final diagnosis to be made. In this case, the biopsy sample passes histological analysis in a specialized laboratory.
Computed and magnetic resonance imaging. Using digital processing of X-ray examination, the specialist determines the exact localization and distribution of the pathology. He can study the tissue structure of the pathological node.

Modern methods of treatment

At the current stage of development medical science, it is not possible to stop the progression of the disease. Therapeutic measures at the same time aimed at achieving stable remission.

Modern delivery standards medical care include:

Drug treatment carried out in a medical hospital. The main treatment drug is a corticosteroid. It can be given in the form of an injection, a tablet course, or an ointment rub. During conservative therapy, specialists constantly monitor the functional state of the lungs and heart.
Local medicinal effect. The disease is subject to local treatment when superficial lymph nodes are affected.
Surgery. Radical intervention is considered a last resort, since excision of damaged thoracic nodes stimulates the formation of granulomas in other parts of the body.
Radiation therapy. According to American scientists, the persistent form of the disease is well exposed to dosed radiation. As a result, the pathology enters the stage.
Diet therapy. Doctors recommend that patients enrich their daily diet with foods containing increased content protein, vitamins and microelements. Some scientists point to the positive effect of therapeutic fasting.

Is traditional treatment effective?

Systemic granulomatosis is dangerous disease, which should be treated in a specialized manner medical institution. The patient must be under constant medical supervision. Facilities traditional medicine can only be aimed at activating the immune system.

Can the disease turn into cancer?

Sarcoidosis of the lymph nodes is characterized by the systemic formation of inflammatory granulomas, which has nothing to do with the oncological process. The disease only at the time of diagnosis may resemble cancerous lesion lymphoid system. But, during histological and cytological examination, these two pathologies are clearly separated.

Forecast

In most cases, the disease is benign. At the same time, in 30% of people the disease goes into a stage of lifelong remission.

In 25% of clinical cases sarcoidosis of lymph nodes spreads to nearby lung tissue. Damage to the respiratory system results in disability and, in rare cases, death.

Pulmonary sarcoidosis is a systemic disease accompanied by the formation of granulomas consisting of Piragov-Langhans cells and epithelial cells. Granulomas are also diagnostic sign, which is revealed using microscopic examination, however, sarcoid nodules are not accompanied by caseous necrosis and tuberculous mycobacteria are absent. Also, the nodules merge as they grow and form lesions of different sizes.

Not only the lungs, but also many organs are affected by sarcoidosis. Most often these are lymphatic, intrathoracic, tracheobronchial, bronchopulmonary nodes, spleen and liver. Possible damage to the organs of vision, bones, joints, nervous system, heart, parotid salivary glands, skin. However, pulmonary sarcoidosis can occur long time without clinical manifestations. It is also not transmitted from patient to patient and is not infectious.

The etiology is currently unknown. People of any age are susceptible to the disease, but pulmonary sarcoidosis in children is quite rare. What is known is that pulmonary sarcoidosis has racial and geographic characteristics. For example, per 100,000 African Americans there are 36-64 people who have sarcoidosis, in the United States there are 10-14 cases per 100,000 fair-skinned people. In European countries, there are 40 cases per 100,000 people, however, the incidence is much higher in the Nordic countries.

In sarcoidosis, granulomas of two types form on the bronchial walls and in the lungs:

The first type is sclerosing or stamped. Small granulomas that have a border from surrounding tissues, as well as cells connective tissue– fibroblasts surround granulomas;

The second type is large granulomas that do not have clear boundaries.

Quite often, sarcoid granulomas are confused with tuberculous granulomas. For precise definition Diagnosis requires laboratory testing of the tissue.

Depending on the location, the disease is divided into sarcoidosis of the intrathoracic glands and lungs, lymph nodes, respiratory system with damage to other organs, and generalized sarcoidosis.

According to the course of the disease, it is divided into:

— Regression phase ( reverse development, process fading). The reverse development is accompanied by resorption, compaction and, quite rarely, calcification of formed sarcoid granulomas in the lymph nodes and lung tissue;

— Stabilization phase;

— Exacerbation phase or active phase.

Directly depending on the speed with which changes increase, pulmonary sarcoidosis is divided into:

— Chronic sarcoidosis;

— Delayed sarcoidosis;

— Progressive sarcoidosis;

— Abortive sarcoidosis.

Causes of pulmonary sarcoidosis

Oddly enough, the true causes of pulmonary sarcoidosis are still unknown. Some scientists believe the disease is genetic, others that pulmonary sarcoidosis occurs due to impaired functioning immune system person. There are also suggestions that the cause of the development of pulmonary sarcoidosis is a biochemical disorder in the body. But at the moment, most scientists are of the opinion that the combination of the above factors is the cause of the development of pulmonary sarcoidosis, although not a single theory put forward confirms the nature of the origin of the disease.

Scientists studying infectious diseases, suggest that protozoa, histoplasma, spirochetes, fungi, mycobacteria and other microorganisms are the causative agents of pulmonary sarcoidosis. Endogenous and exogenous factors can also cause the development of the disease. Thus, today it is generally accepted that pulmonary sarcoidosis of polyetiological origin is associated with a biochemical, morphological, immune disorder and genetic aspect.

The incidence is observed in persons of certain professions: firefighters (due to increased toxic or infectious exposure), mechanics, sailors, millers, agricultural workers, postal workers, chemical industry and healthcare workers. Pulmonary sarcoidosis is also observed in people with tobacco addiction. Availability allergic reaction to some substances perceived by the body as foreign due to impaired immunoreactivity does not exclude the development of pulmonary sarcoidosis.

A cascade of cytokines is responsible for the formation of sarcoid granuloma. They can form in various organs, and also consist of a large number of T-lymphocytes.

Several decades ago, there was an assumption that pulmonary sarcoidosis was a form of tuberculosis that was caused by weakened mycobacteria. However, according to the latest data, it has been established that these are different diseases.

Pulmonary sarcoidosis begins with the involvement of alveolar tissue in the pathological process and the development of interstitial pneumonitis or alveolitis.

Symptoms of pulmonary sarcoidosis

Pulmonary sarcoidosis does not have a clear clinical picture, since it is often asymptomatic. For example, in most patients, the intrathoracic lymphoglandular form of the disease does not manifest itself clinically. Most often, pulmonary sarcoidosis is suspected when lymphadenopathy of the roots of the lungs is detected. Signs of pulmonary sarcoidosis are as follows: joint pain, fever, shortness of breath, cough with sputum, chest pain, restless sleep, insomnia, night sweats. Fever, weight loss, loss of appetite, increased fatigue, weakness, anxiety, severe malaise.

Pulmonary sarcoidosis is divided into three stages: initial, mediastinal-pulmonary and pulmonary.

Symptoms of early stage pulmonary sarcoidosis are similar to the symptoms of many other diseases: causeless anxiety, weakness, sleep disturbances, etc. A common sign Pulmonary sarcoidosis is fatigue, which is felt in the morning (a person feels it without even getting out of bed) and in the afternoon. At this stage, as a rule, there is an asymmetric and bilateral enlargement of the lymph nodes: tracheobronchial, paratracheal, bifurcation, bronchopulmonary.

The second stage of pulmonary sarcoidosis is manifested by symptoms characteristic of the disease respiratory tract: painful sensations in the chest, in the joints, cough, wheezing, shortness of breath, weakness. It is possible that an inflammatory process may develop in the subcutaneous fatty tissue of the skin vessels. This stage of pulmonary sarcoidosis is accompanied by bilateral dissemination (miliary, focal), infiltration of lung tissue.

The third stage includes a combination of symptoms of the first and second stages of pulmonary sarcoidosis. However, increased wet and dry wheezing, pain in the affected area of the lungs, crunching and wheezing sounds, and arthralgia are observed. Also, the third stage is manifested by damage to the lymph nodes, parotid glands(Herford syndrome), eyes and other organs that are not associated with the respiratory system. Damage to the brain nerves, formation of cysts in the bones, and enlargement of the liver are possible.

The last stage of pulmonary sarcoidosis can be manifested by severe fibrosis or pneumosclerosis of the lung tissue, while enlargement of the intrathoracic lymph nodes is not observed. The increase in emphysema and pneumosclerosis occurs due to the formation of drainage conglomerates as the disease progresses. The disease also manifests itself as cardiopulmonary failure.

As pulmonary sarcoidosis progresses, it manifests itself with extrapulmonary symptoms as adjacent tissues are affected.

Sarcoidosis extends beyond the lungs, affecting the spleen and liver, and does not manifest itself clinically. Ultrasound examination may show slight enlargements internal organs. If the liver is significantly enlarged, the patient feels heaviness in the right hypochondrium. The patient will complain of loss of appetite, but the functions of the spleen and liver will not be impaired. Occasionally, choleostasis also develops.

The differences between granulomatous and sarcoid hepatitis are unclear. Gastric granulomas are quite rare. Mesenteric lymphadenopathy causes pain in the abdominal area.

Affecting joints and bones, the disease does not manifest itself clinically, but enzymes may be elevated in patients. Sometimes acute or silent myopathy develops, accompanied by muscle weakness. There may be pain when moving. However, the bone damage in pulmonary sarcoidosis differs from arthritis in that it is less damaging to the joints and bones. The development of lymphadenopathy of the roots of the lungs is possible, erythema nodosum, acute polyarthritis, osteopenia.

If myocardial damage occurs, the main symptom of the disease will be episodic, and the heartbeat. An attack is possible sudden death in case of severe compaction of cardiac muscle granulomas. Pulmonary or contribute to the development of heart failure. Quite rarely develops.

Pulmonary sarcoidosis has a significant impact on the nervous system. Sensory loss may occur, unilateral facial paralysis, swallowing is more difficult, paralysis of limbs, dizziness. Eighth cranial nerve neuropathy causes hearing loss. The development of neuropathy is possible optic nerve and peripheral neuropathy, polyphagia.

If the kidneys are damaged due to sarcoidosis of the lungs, hypercalciuria most often occurs. Nephrocalcinosis requiring a kidney transplant, nephrolithiasis caused by chronic renal failure and interstitial nephritis also develop.

In case of defeat visual organs, a burning sensation occurs, the mucous membranes turn red, sensitivity to light is increased, and lacrimation is present. The disease is also accompanied by increased pressure (intraocular). Secondary glaucoma, optic neuritis, dacryocystitis, chorioretinitis, iridocyclitis, etc. develop. If left untreated, progression leads to blindness, but most often resolves spontaneously.

At skin lesions, medium-sized reddish nodules form on the body. Quite rarely seen severe damage skin. Developing erythema nodosum: on the front surface lower limb Hard red nodules appear. Nonspecific lesions include subcutaneous nodules, papules, macules, spots, hyperpigmentation, and hypopigmentation. The development of lupus pernio is possible: protruding spots appear on the ears, lips, cheeks and nose.

In sarcoidosis, the lymph nodes are usually not enlarged, with only occasionally visible enlarged lymph nodes in the groin or neck. In some cases, cervical or mild peripheral lymphadenopathy occurs.

Stages of pulmonary sarcoidosis

According to its development, pulmonary sarcoidosis is divided into four stages:

Stage 0 is asymptomatic. In patients undergoing prophylactic medical examinations, the disease will not be detected even on x-rays;

At stage 1, the lung tissue remains unchanged, but slight enlargements of the intrathoracic lymph nodes are observed;

At stage 2, a pathological process is observed in the lung tissue, the intrathoracic lymph nodes are significantly enlarged;

Stage 3 is accompanied by significant changes in the lung tissue, however, the lymph nodes do not enlarge;

Stage 4 is accompanied by the formation of fibrosis - this is an irreversible process of compaction of lung tissue with the formation of scars on it ( lung tissue is replaced by a connecting one).

The first three stages are not clinically apparent. Patients can learn about the presence of pulmonary sarcoidosis only from the results of a preventive X-ray examination during examination. Changes in lung tissue will be visible on the images. Quite rarely, there are patients with early stages of pulmonary sarcoidosis, in whom the body temperature rises, the joints of the limbs swell, and the lymph nodes are enlarged.

Diagnosis of pulmonary sarcoidosis

Diagnosing pulmonary sarcoidosis is not easy, but it is possible, regardless of stage. An accurate medical history of the patient is necessary, everything clinical manifestations, laboratory blood test (acceleration of ESR, eosinophilia, leukocytosis, increase in globulins). It is also necessary to conduct an X-ray, ultrasound examination, computed and magnetic resonance imaging, biopsy with bronchoscopy and further histological examination, radionuclide methods. The need for an ultrasound examination with a fine-needle biopsy of the lymph nodes is decided by a specialist. The patient is always prescribed general analysis urine and functional test of the kidneys and liver. Additional research will be prescribed if complications are detected.

The acute course of pulmonary sarcoidosis is characterized by changes in laboratory blood values, which indicate an inflammatory process: a significant or moderate increase in ESR, lympho- and monocytosis, eosophilia. However, blood counts may be normal in pulmonary sarcoidosis. Leukocytosis will appear if affected Bone marrow, spleen and liver. To exclude kidney damage, urine tests are performed and functional tests (blood urea nitrogen, creatine) are determined.

More characteristic changes can be detected during x-ray examination. MRI and CT scans of the lungs make it possible to identify tumor-like enlargements of the lymph nodes, especially at the root, focal disseminations: fibrosis, emphysema, cirrhosis of the lung tissue.

Most patients have a positive Kveim reaction - after intradermal injection of a specific antigen (substrate of the patient's sarcoid tissue) 0.2 ml, a purplish-red nodule is formed.

During a biopsy with bronchoscopy, direct and indirect signs pulmonary sarcoidosis: dilated vessels at the mouths of the lobar bronchi, as well as sarcoid lesions of their mucous membranes (the presence of warty growths, tubercles, plaques), signs of enlarged lymph nodes at the site of bifurcation, atrophic or deforming.

A more reliable method for diagnosing pulmonary sarcoidosis is a histological examination of biological material taken during bronchoscopy, open lung biopsy, transthoracic puncture, prescale biopsy, mediastinoscopy. In biological material, specialists identify elements of granuloma (epithelioid) without signs of perifocal inflammation and necrosis.

Angiotensin-converting enzyme (ACE) is a marker of the activity of the process and in pulmonary sarcoidosis its content in the blood is significantly increased. Also, increased levels of calcium in the urine and blood are evidence of complications in the body.

In order to exclude, it is necessary to conduct a Mantoux tuberculin test. If the body has an active form of pulmonary sarcoidosis, the Mantoux test is usually negative, however, there are exceptions.

Despite the fact that many tests are required to make a diagnosis medical manipulations, it is correct diagnosis that allows you to choose the right treatment.

Treatment of pulmonary sarcoidosis

Pulmonary sarcoidosis in most patients is accompanied by spontaneous remission and for this reason, the patient will be under observation for 8 months. This allows you to determine the prognosis and the need for specific treatment.

As a rule, for mild forms of the disease that occur without deterioration, treatment is not prescribed. Even in the case of minor changes in the lung tissue and the patient’s satisfactory condition, only observation is carried out. This is due to the fact that granulomas that have formed in the lungs dissolve and pulmonary sarcoidosis goes away on its own.

Severe forms of pulmonary sarcoidosis require treatment, as there is a risk of complications, including death. The development of tuberculosis and serious diseases of other organs is possible.

If pulmonary sarcoidosis is detected, a long course of antioxidants (Acetate, Tocopherol, Retinol and others), immunosuppressants (Azathioprine, Rezoquin, Delagil), anti-inflammatory drugs (Indomethacin), steroids (Prednisolone) is prescribed. If the patient is intolerant to Prednisolone, then non-steroidal anti-inflammatory drugs (Nimesulide, Diclofenac) are prescribed. On average, the course of treatment lasts 8 months, however, in severe cases of the disease, this period may be longer. In rare cases, specialists prescribe anti-tuberculosis drugs.

As a rule, during the first 4 months, Prednisolone should be taken 30–40 mg per day, after which the dosage is reduced to 5–10 mg. This drug must be taken for several months. After 24–48 hours, the doctor prescribes glucocorticosteroid drugs in case of side effects from Prednisolone. The course of treatment also includes anabolic steroid and potassium preparations (Nerobol, Retabolil).

Treatment always depends on the activity, progression and severity of pulmonary sarcoidosis. In the case of combination therapy, including Dexamethasone or Prednisolone, the drugs are alternated with non-steroidal anti-inflammatory drugs (Indomethacin, Voltaren).

In rare cases, they are prescribed for severe cough inhaled glucocorticoids. They help reduce cough in patients with endobronchial lesions. Also, in rare cases of eye and skin lesions, topical glucocorticoids will be prescribed.

Dispensary observation of patients is carried out by a phthisiatrician. Patients with pulmonary sarcoidosis are divided into two clinical groups:

♦ The first group includes patients with an active form of the disease;

Group IA includes persons in whom the disease is first diagnosed;

Group IB includes people whose disease has worsened or relapsed after the prescribed course of treatment;

♦ The second group includes people who have an inactive form of the disease.

Patients also need to pay special attention to diet. Table salt should be limited and consumed as much as possible more products, enriched with proteins. In order to restore immunity, it is necessary to include medicinal and food plants, which concentrate certain biologically active substances (BAS) - zinc, manganese, silica and other minerals.

It is necessary to consume food plants that have immunocorrective properties - chokeberry, raw sunflower seeds, decoction of young shoots of sea buckthorn, walnuts, seaweed, noble laurel, pomegranates, basil, legumes, blackcurrant leaves and fruits. The following products should be excluded from the daily diet: dairy products, cheese, sugar, flour.

Pulmonary sarcoidosis in children is also treated by a phthisiatrician. The medication course is selected individually, depending on the child’s condition. For the purpose of prevention, it is necessary to harden the child, accustom him to daily physical exercise, and monitor his social circle to prevent pulmonary diseases. It is also necessary to include vegetables and fruits in his daily diet. Children who have had pulmonary sarcoidosis need to be explained that they should not start smoking in the future. Parents should protect their child from various contacts with chemicals. Many cleaning products contain a large number of chemicals that a child should not breathe.

Also, many patients include folk remedies in their treatment. For example, from medicinal herbs (calendula, goralthea, sage, oregano) a decoction is prepared at home, which must be taken 3 times a day for 1.5 months before meals, 50 ml. Also popular is a tincture made from vodka and vegetable oil. Mix 50 ml and take 3 times a day for a year. Cases have been reported full recovery thanks to this tincture. You can also dilute 20% propolis tincture in warm water and 10–15 grams of the product per glass of water will be enough. Should be taken for 15 days 40 minutes before meals.

Most patients in the early stages of the disease prefer treatment folk remedies. If the disease progresses similar methods become ineffective. Every patient should understand that most herbs have side effect. It is for this reason that treatment of pulmonary sarcoidosis with folk remedies usually causes a deterioration in the general condition.

Since pulmonary sarcoidosis is rarely diagnosed, special diet has not yet been developed, however, you should lead a healthy lifestyle. Sleep and nutrition should be adequate. It is recommended to spend as much time in the fresh air as possible and do physical exercise. However, direct contact with the sun's rays must be avoided (sunbathing is strictly prohibited). You should also avoid contact with vapors of chemical liquids, dust, and gases.

Prognosis of pulmonary sarcoidosis

Typically, symptoms of pulmonary sarcoidosis go away without treatment. In 60% of cases, 9 years after diagnosis, patients have no symptoms. After a few months, extensive pneumonia and swollen lymph nodes may disappear. About 75% of patients who experience only enlarged lymph nodes and damage only to the lungs recover completely within 5 years.

The most beneficial consequences of pulmonary sarcoidosis are for patients in whom the disease has not spread beyond chest, especially if it started with erythema nodosum. In 50% of cases, relapses are observed.

Although patients often recover spontaneously, the manifestations and severity of pulmonary sarcoidosis are quite variable. In most cases, a repeat course of glucocorticoids is necessary. It is for this reason that regular monitoring is necessary to detect relapses. In 90% of cases where spontaneous recovery occurs, relapses develop in the first two years after diagnosis. In 10% of cases, relapses are detected after two years. Patients who do not experience remission within two years will have chronic pulmonary sarcoidosis.

Pulmonary sarcoidosis is generally considered chronic in 30% of patients and is observed in 10–20% constant flow. The disease is considered fatal in 5% of cases. Most common cause The fatal outcome is pulmonary fibrosis with respiratory failure, followed by pulmonary hemorrhage due to aspergilloma.

More unpleasant consequences Pulmonary sarcoidosis occurs in patients with the extrapulmonary form of the disease and in African-Americans. In 89% of cases, recovery occurs in European countries. Signs of a favorable outcome are the presence of acute arthritis and erythema nodosum. However, unfavorable signs of pulmonary sarcoidosis are: extensive pulmonary damage, myocardial disease, nephrocalcinosis, neurosarcoidosis, hypercalcemia chronic form, uveitis. In 10% of cases, damage to the respiratory organs and eyes develops.

PULMONARY SARCOIDOSIS

Sarcoidosis(Greek sarx, sarkos - meat, flesh; eidos - type, likeness) - a benign systemic disease with primary damage to the lungs, characterized by the formation of epithelioid cell granulomas that resolve or transform into hyaline tissue and, as a rule, do not lead to caseous necrosis.

Epidemiology. The highest incidence of sarcoidosis is observed in the countries of North America and Northern Europe, where it ranges from 12 to 40 per 100,000 inhabitants, the lowest (isolated cases) - in the countries Southern Europe and Africa.
Women get sick 2 times more often than men.

Classification. The most common classification of pulmonary sarcoidosis is K. Wurm et al. (1958), based on X-ray characteristics diseases:
Stage I - mediastinal lymphadenopathy (intrathoracic lymphoglandular stage);
Stage II - focal shading in the lung tissue against the background of an enhanced pulmonary pattern, with a decrease in the severity of mediastinal lymphadenopathy (mediastinal-pulmonary stage); This stage is divided into substages:
IIA - strengthening and mesh deformation of the pulmonary pattern;
IIB - bilateral small-focal widespread shading;
IIB - bilateral mid-focal widespread shading;
IIG - bilateral large-focal widespread shading;
Stage III - widespread interstitial fibrosis of the lung tissue (chronic sarcoidosis).

Etiology sarcoidosis is unknown.
There are hypotheses about the tuberculosis and viral etiology of the disease. They are contradicted by the ineffectiveness of antituberculosis and antiviral therapy and the high effectiveness of GCS therapy.

Pathogenesis. Sarcoidosis is a primarily immunopathological disease that develops in response to an unknown etiological agent or antigen.
Immunological disorders are characterized by systemic T-cell immunodeficiency leading to lymphopenia, with an increase in the number of T-lymphocytes and alveolar macrophages in the lungs (in bronchoalveolar lavage fluid).
The content of B-lymphocytes, IgG, IgM and CEC increases in the circulating blood.
The initial stage is the accumulation of immunocytes (lymphocytes and macrophages) and cells involved in inflammation in the lung parenchyma. The functional activity of alveolar macrophages increases.
They excessively produce various mediators that activate lymphocytes and fibroblasts - IL1, fibronectin, growth factor, fnbroblast activating factor, plasminogen activator, IFN, etc.

Sarcoidosis can affect not only the lungs, but also other internal organs (kidneys, liver, heart, spleen), various lymph nodes, glands, bones, skin, nervous system, eyes.
The increase in plasma concentrations of ACE, lysozyme and calcium, characteristic of sarcoidosis, as well as hypercalciuria, are explained by dysfunction of the vascular endothelium of the lungs, alveolar macrophages and the endocrine activity of cells that form granulomas in the lungs.

Pathomorphology. A characteristic pathological sign of sarcoidosis is a well-formed compact noncaseating granuloma. This granuloma consists in the center of mononuclear phagocytes, epithelioid and multinucleated giant cells surrounded by a rim of lymphocytes, monocytes and fibroblasts.

Lymphocytes are predominantly CD4+ T cells, although some CD8+ T cells are also present in the periphery.

In active pulmonary sarcoidosis, the number of T lymphocytes and alveolar macrophages is increased.
The predominance of CD4+ T cells leads to an increase in the CD4+/CD8+ ratio from 2:1 to >10:1.

The increased population of T cells secretes cytokines predominantly of the Th1 profile, which are characterized by increased production of TNF-a and IFN-a, IL-2, IL-12 and IL-18, simultaneously with a decrease in the production of IL-4 and IL-10. However, there is no information on the long-term evolution of the cytokine pattern and correlation with clinical manifestations.

Clinical picture depends on the stage of sarcoidosis and the severity of the process.
In stage I of sarcoidosis (intrathoracic lymphoglandular stage), in half of the patients the disease is detected by a bilateral increase in the shadows of the roots of the lungs, determined on an x-ray or fluorogram, in the absence of other symptoms.

Subacute onset is characterized by low-grade fever, aching pain behind the sternum and in the interscapular space, arthralgia.
The acute onset of sarcoidosis is characterized by the development of Löfgren's syndrome (hyperpyrexia, wrist and interphalangeal arthralgia, erythema nodosum).
Radiologically detected bilateral enlargement of the roots of the lungs is a consequence of an increase in the hilar (bronchopulmonary) lymph nodes, reaching 3-5 cm in diameter and having clear polycyclic contours.

In stage II (mediastinal-pulmonary), some patients have no subjective symptoms in the presence of characteristic radiological signs, however, most often the disease manifests itself as cough, shortness of breath, and chest pain.
Extrapulmonary manifestations of sarcoidosis are becoming more frequent. Mumps with uveitis or iridocyclitis (Heerford syndrome), bone sarcoidosis (Morozov-Jungling-Perthes cyst-like osteitis) is characteristic of the pulmonary manifestations of sarcoidosis.

On radiographs, along with enlarged hilar lymph nodes or without their enlargement, an almost symmetrical large or finely looped pattern is determined in the hilar, inferomedial and (or) subcortical parts of the lungs, appearing as a result of the development of lymphogenic pneumofibrosis. Against this background, multiple scattered or merging small-focal shadows are revealed. Linear or oval calcifications are detected in the lymph nodes.

IN Stage III(chronic sarcoidosis), despite the pronounced dissemination of the process along the middle and lower sections lungs, development of pneumosclerosis and emphysema, up to 25% of patients do not complain, but in most cases periodic exacerbations occur productive cough, shortness of breath, pain in the chest and joints and the formation of different terms from the onset of the disease typical physical signs of COB and LS.

At this stage, radiographs reveal signs of pulmonary fibrosis and emphysema, against which multiple shadows of focal pneumosclerosis are identified in the form of large, irregularly shaped conglomerates, as well as areas of bullous emphysema and signs of bronchiectasis.
A biochemical laboratory blood test reveals an increase in plasma concentrations of ACE, lysozyme and calcium, characteristic of sarcoidosis. Urine examination reveals hypercalciuria.

Diagnosis criteria.
The diagnosis of sarcoidosis can be considered established if its specific signs are found in biopsy samples of the intrathoracic lymph nodes or lung; when identifying a characteristic X-ray picture a probable diagnosis of sarcoidosis can be made.

Treatment. Basic drugs are GKS.
Prednisolone is prescribed at a dose of 20-40 mg/day for 3-4 months, followed by gradual decline doses up to 5-10 mg/day, which are maintained for 3-4 months.

If there are contraindications to the administration of GCS, use NSAIDs (indomethacin 75 mg/day, nimesulide 200 mg/day), delagil 250 mg/day, vitamin E 100 mg/day, sodium thiosulfate daily IV 10 ml 30 % solution.

With hyperergic tuberculin reaction, detection of Mycobacterium tuberculosis in sputum or identification of lung foci or infiltrates on radiographs, basic therapy is necessarily supplemented with anti-tuberculosis drugs (metazide 1 g/day, rifampicin 0.6 g/day, ethambutol 25 mg/kg/day).

Treatment started in stage I of the disease leads, in most cases, to recovery.
With a late start of treatment (in stages II-III), relapses and progression of the disease are likely, leading to the development of pulmonary fibrosis and EL.

Prevention not developed.

Forecast with timely diagnosis and treatment of pulmonary sarcoidosis, favorable.

The course of untreated pulmonary sarcoidosis in most cases is gradual or undulating, although spontaneous remission is observed in many cases.

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 Negative influence on the entire human body: the cardiovascular system, kidneys, liver, thyroid gland suffers. 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 in the initial stages of its development Clinical signs 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 it clinical picture“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 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.

To choose from therapeutic activities 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, manual therapy, 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? 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. Similar complications may 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, within the first three years after diagnosis, symptoms disappear without drug treatment. Death observed in less than 1% of cases and is associated with complications on the cardiovascular system.

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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, therefore it is not a direct contraindication for continuing labor activity. 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 hereditary predisposition to illness. 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. 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 human immunity in the fight against diseases. 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, decoctions from 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.

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

To get rid of the disease forever as soon as possible, find time every day to do 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 have been treated with medications prescribed by your doctor and have achieved improvements, for get well soon can be added to therapy traditional methods. 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 onions and sugar, 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.

Helps relieve 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 with the help of modern medicine.

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As an independent disease, pulmonary sarcoidosis has existed for more than 100 years, but the causes of its origin, many development options and optimal treatment regimens are still unknown. The approaches to its treatment are not entirely clear. Lung damage has been most well studied, and phthisiatricians and pulmonologists are the most informed specialists (although other organs, for example, the nervous system, can also be affected).

The origins of the study of this disease can be traced back to 1869, when the famous English doctor Hutchinson, during a trip to Christiania (Oslo), met with Beck, a professor of dermatovenerology and operative surgery(an almost unthinkable combination of positions for a modern scientist). Bem introduced an interesting patient. He was a miner, about 60 years old, and the skin of his arms and legs was covered with purple plaques on the back surface.

At first it was thought tuberculosis process skin, a type of psoriasis. Then it turned out that lymphatic tissue was involved. Growths on the skin, with light hand Ts. Beck, since 1899 they began to be called “sarcoids”, that is, “meat-like”, since fresh nodules are red in color, then they darken.

With the discovery of X-rays, which were later called X-rays, it turned out that almost all patients with “sarcoids” also have damage to the bones, tonsils, lungs, but biggest change concerns the lymph nodes. Finally, only in 1929 the first autopsy of a patient with such visceral sarcoidosis of internal organs took place, and it turned out that the lungs of a patient with sarcoidosis had pronounced fibrous, sclerotic changes, and the lymph nodes of the roots of the lungs and mediastinum were enlarged.

Since the 30s of the 20th century, pulmonary sarcoidosis has become the object of close study. It was named Schaumann-Besnier-Beck disease, named after the specialists who made the greatest contribution to the study of this disease. What is known about this disease today?

Pulmonary sarcoidosis - what is it?

Sarcoidosis of the lungs photo

What it is? Pulmonary sarcoidosis is a benign granulomatous inflammation of the systemic type, in which the lungs and lymphoid tissue Epithelioid cell granulomas develop. They lead to degeneration, destruction and sclerosis of tissue in which granulomatous inflammation occurred.

As you can see, the definition of sarcoidosis is not entirely clear: since it is based on granulomatous inflammation, then it is necessary to give the concept of granuloma.

Sarcoidosis granuloma is a central zone, which consists of epithelioid cells, macrophages and a small number of giant multinucleated cells, and a periphery, which consists of macrophages, lymphocytes, fibroblasts, plasma cells, and collagen fibers.

The main “initiators of inflammation” with allergic component, according to the type of delayed hypersensitivity, these are epithelioid cells. In fact, the life of a granuloma is a sluggish immune inflammation that results in fibrosis and sclerosis.

This disease makes no difference between genders: women and men get sick equally often. There is some hesitation regarding race. Black people suffer more often than white people. For example, in Japan, the incidence of sarcoidosis of all forms and localizations is very low, amounting to 3 cases per 1 million people, and in India this figure reaches 1000 cases per million, that is, 0.1% of the entire population is affected.

Sarcoidosis is not a contagious disease.

The whole process is nothing more than an abnormal immune response. It has now been proven that there is no connection between sarcoidosis, but phthisiatricians are well versed in pulmonary sarcoidosis, since such patients, due to “suspicious shadows” on radiographs and during fluorography, are necessarily referred to a consultation with a phthisiatrician.

Essentially, clinical signs of pulmonary sarcoidosis occur only when the granulomatous reaction begins to lead to changes in organ structure. Moreover, in almost half of the cases, no lifetime diagnosis was made.

This suggests that pulmonary sarcoidosis tends to be asymptomatic. How does this disease manifest itself if the inflammatory process reaches a clinically significant level?

Degrees and symptoms of pulmonary sarcoidosis

Symptoms of pulmonary sarcoidosis, one way or another, are present in 80% of all patients with sarcoidosis of any location. Since this disease develops gradually, several classifications of pulmonary sarcoidosis have been created. In our country, the following classification of stages of lung damage has been adopted:

At the first stage of the disease, most often there is a bilateral enlargement of lymph nodes of various locations: in the mediastinum, next to the lungs and bronchi, the trachea, in the area of its bifurcation into the two main bronchi, and so on. Most often, this is clinically comparable to the onset of the disease, in which the initial, lymphoglandular and intrathoracic form is determined;
Pulmonary sarcoidosis grade 2, or stage 2, unlike the initial one, spreads or disseminates into the lung tissue. Damage to the alveoli occurs, and at this stage pronounced clinical manifestations and symptoms of the disease already appear;
During the third stage, the relay completely moves from the lymph nodes to the lung tissue: the lymph nodes again become normal size, but conglomerates of granulomatous inflammation appear in the lungs. Emphysema develops, pneumosclerosis increases with symptoms of restrictive respiratory failure.

Note: There are two forms of respiratory failure - obstructive and restrictive. In the first type, the lungs may be completely healthy, but the bronchi supplying air cannot cope and reduce the volume of air due to obstruction (narrowing or spasm). In restrictive respiratory failure, the lumen of the airways is normal, but in the pulmonary fields there are islands of “dead” tissue, for example, foci of pneumosclerosis. It is the second type of respiratory failure, already “final” and not amenable to correction, that develops in sarcoidosis.

Like any chronic disease, the course of pulmonary sarcoidosis can occur in several phases. Pulmonologists and immunologists distinguish a phase of active development, or an exacerbation phase of the process, a stable state and a regression phase, which is clinically manifested by the reverse development of symptoms.

As a rule, the reverse development of granulomatous inflammation rarely manifests itself as “complete resorption.” Most often, compaction, fibrosis, or the appearance of calcifications (lime) occurs in the lymph nodes of the lungs and mediastinum.

Symptoms of pulmonary sarcoidosis

There are no specific symptoms of pulmonary sarcoidosis that could immediately direct a doctor’s diagnostic thinking to this disease. When analyzing complaints and standard symptoms, it becomes clear why these patients, first of all, come to TB specialists. All complaints are nonspecific, namely:

malaise and weakness appear;
low-grade fever and low-grade fever may appear;
appears night sweats- this symptom is very characteristic of tuberculosis;
fatigue and decreased performance occur;
the person loses his appetite and his body weight begins to decrease.

At these first signs, any adequate doctor will refer the patient to a phthisiatrician, and first for fluorography, since this is how tuberculosis damage to the body begins. Please note: there is not yet a single symptom of damage to the bronchopulmonary system.

When symptoms of pulmonary sarcoidosis appear, they can also be “attached” to any disease. For example, patients have the following complaints:

chest pain occurs;
a cough appears, either dry or with scanty sputum;
during exacerbation and at the height of the disease, shortness of breath is determined - due to a narrowing of the lung volume from compression by the lymph nodes, and at the third stage - due to the development of pneumosclerosis;
a large number of different dry and moist rales of various calibers are heard in the lungs.

As a rule, in the later stages, signs of pulmonary sarcoidosis are combined with manifestations of “ pulmonary heart", or development pulmonary hypertension and the appearance of stagnation in the pulmonary circulation. What is the danger of such an untreated and long-existing process?

The danger of sarcoidosis of the lungs and intrathoracic lymph nodes

Sarcoidosis of the lungs and intrathoracic lymph nodes can be dangerous due to the following complications:

Development of progressive respiratory failure with painful attacks of suffocation;
The addition of a secondary infection with the development of specific inflammation (for example, pneumonia can occur against the background of sarcoidosis, or even tuberculosis can develop, which “feels great” against the background of a perverted immune response;
Development of the “pulmonary heart”. In this case, pain occurs in the heart, the neck veins swell, since blood flow to the right side of the heart is obstructed, and the liver enlarges. In case of decompensation of the pulmonary heart, or “cor pulmonale”, heart failure quickly develops. big circle blood circulation;
In some cases, granulomatous inflammation rises up and affects the parathyroid glands, which lose the ability to regulate calcium metabolism in the body. In this case, death quickly occurs.

What is a "cellular lung"?

One of the most serious complications of sarcoidosis is the so-called “honeycomb lung”. This term developed long before the introduction into everyday use of such gadgets as Cell Phones and smartphones.

“Honeycomb lung” is a pathomorphological syndrome characterized by the formation of “honeycombs”, or small cavities, in the lung tissue, air cysts, which have thick walls, made of fibrous connective tissue. The thickness of these walls can reach 3 mm.

In other words, these cavities are traces of “raging” autoimmune inflammation. Normally, lung tissue is “breathing alveolar foam,” and “honeycombs” are nothing more than firebrands and coals of an extinguished fire. This phenomenon is diagnosed radiographically, and its appearance is an unfavorable signal.

This means that the patient may soon experience severe pulmonary failure: severe shortness of breath with the slightest exertion, such a patient will need frequent oxygen to facilitate breathing. It is clear that with timely and proper treatment You don't have to take things to such extremes.

Much about the diagnosis of sarcoidosis

Since sarcoidosis is very similar to tuberculosis (both on x-ray and clinically), and the absence of CD (Koch's bacilli, or tubercle bacilli) also occurs with tuberculosis (for example, with tuberculoma), then crucial plays a biopsy and histological examination of the material.

Only isolation of a granuloma confirms the diagnosis of sarcoidosis.

All other methods (chest x-ray, CT scan of the lungs and mediastinum, routine biochemical and clinical tests, spirography, study of immunity indicators, search for extrapulmonary forms, examination by an otolaryngologist, neurologist and ophthalmologist, bronchoscopy) allow you to get as close as you like to the diagnosis, but do not confirm his.

Treatment of pulmonary sarcoidosis, drugs and methods

Treatment of pulmonary sarcoidosis is a long-term undertaking that must continue for many years. Since the formation of granuloma with Pirogov-Langhans giant cells is an autoimmune process, the main line of therapy is aimed at suppressing inflammation. Therefore, all anti-inflammatory drugs, as well as immunosuppressants and cytostatics, are used in the treatment of this disease.

At the very beginning, when lymph node damage is detected, the patient is simply monitored: after all, a significant number of cases are asymptomatic, subclinical. The patient is observed for six months, and treatment is prescribed only when complaints appear or when inflammation progresses.

As a rule, treatment of pulmonary sarcoidosis begins with the selection of a dose of prednisolone, and initially more high dosage, and then it is progressively reduced 3 to 4 months after the start of treatment.

Hormones are often combined with NSAIDs, for example, voltaren, acetylsalicylic acid. In severe cases, cytotoxic drugs are used. Some clinics prefer to use pulse therapy with methylprednisolone in the form of infusion therapy, 1 gram per day for 3 days. You can also use cyclophosphamide, methotrexate, cyclosporine.

For the treatment of progressive forms of pulmonary sarcoidosis (however, as with its other localization), they use antimalarial drugs: delagil, plaquenil. Their effect is due to the impact on the T-cell component of immunity.

Treatment uses pentoxifylline and drugs that suppress the production of tumor necrosis factor - monoclonal antibodies, such as infliximab. Extracorporeal detoxification methods that were fashionable in the 90s, such as plasmapheresis and hemosorption, can be used. During the procedures, circulating substances are removed from the blood. immune complexes, autoantibodies and other damaging agents.

Many savvy readers have already realized that the principles of treating autoimmune diseases are the same everywhere: for example, these medicines(of course, in other dosages), they treat both severe course.

Treatment prognosis

Unfortunately, the prognosis for pulmonary sarcoidosis in each individual patient, despite the fact that it is a benign disease, is difficult to determine. It is known that an unfavorable outcome of the disease occurs in 10% of patients, and 5% die.

The thing is that treatment with hormones may not change the course of the disease. The world's experience on the optimal dosage of drugs has not been accumulated, but sarcoidosis can proceed in any way: it does not obey the laws.

Only one thing is certain: pulmonary sarcoidosis, the symptoms of which are not detected at an early stage, and treatment is carried out in a timely, competent and complete manner - in more than 90% of cases it gives a stable, often lifelong remission.