Sarcoidosis in India: not so rare

Abstract

Sarcoidosis is a systemic inflammatory disease of unknown aetiology. In India, sarcoidosis is an under-diagnosed disease. All ethnic groups in the Indian sub-continent are affected by sarcoidosis. Most of the Indian patients with sarcoidosis are males, and a majority of them present in their fourth or fifth decade of life. Many patients with sarcoidosis are asymptomatic with incidental findings on the chest radiograph. Depending on the organ systems involved, patients with sarcoidosis present themselves to various specialities, with pulmonary involvement being the commonest. The diagnosis is based on a compatible clinical and/or radiological picture, histopathological evidence of non-caseating granulomas in tissue biopsy specimens, and exclusion of other diseases that can produce similar clinical or histopathological appearances. The disease runs a benign course with spontaneous remission of the activity. Only a minority of the patients develop complicated disease though some degree of residual pulmonary function abnormality persists. A high index of clinical suspicion and focussed attempts to secure histopathological confirmation of the diagnosis early in the illness are required to ascertain the diagnosis. For asymptomatic patients with pulmonary sarcoidosis, no therapy is required. In symptomatic patients, or those with complications, corticosteroids remain the mainstay of treatment and sometimes steroid-sparing alternative treatments may be beneficial. Treatment should be tailored to suit the needs of the individual patient under close clinical monitoring.