Sarcoidosis: Nursing

Sarcoidosis is a chronic, multisystemic disease characterized by the formation of non-caseating, meaning non-necrotizing granulomas, which are nodules of chronically inflamed tissue in the lungs and lymph nodes. Less commonly, these granulomas can accumulate in the heart, kidneys, joints, eyes, liver, spleen, and skin.

Now, let’s quickly recap the physiology of the immune system. So, normally, the cells of the immune system are ready to spot and destroy any foreign pathogens that could harm the body. Some cells that help with this are called macrophages. When these cells come in contact with a pathogen, they latch onto it and then engulf or swallow it. The macrophage then breaks down the pathogen, presents a piece of it, called an antigen, to its surface, and carries it to a lymph node. That’s where macrophages find other immune cells called T-helper lymphocytes, which recognize and bind to the antigen, and start proliferating.

Proinflammatory cytokines, or signaling molecules, like tumor necrosis factor alpha, or TNF-ɑ for short, are then released by macrophages to help activate the helper T-cell and it begins to divide or proliferate. The new T-cells leave the lymph node and start secreting other cytokines that recruit more immune cells like additional T-cells and macrophages.

Okay, now, the exact cause behind sarcoidosis is still unknown, but there are several risk factors that can be grouped into modifiable and non-modifiable ones. Modifiable risk factors include exposure to mold, silica, or pesticides, whereas non-modifiable risk factors include age between 20 and 60 years, being assigned female at birth, and family history of pulmonary sarcoidosis. Clients who are of Black race or Northern European descent are also at a higher risk of developing pulmonary sarcoidosis.

Now, the pathology of pulmonary sarcoidosis starts with an antigen entering the body. This antigen gets picked up by macrophages, which secrete cytokines that attract other immune cells, in addition to activating T helper cells. As more and more immune cells gather at a particular spot, they form small nodules, called granulomas, that have T cells on the periphery and macrophages in the center.