A Gentle Introduction to a Rare, but Often Benign Disease: Sarcoidosis by agmoore2

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steemstem · @agmoore2 ·
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A Gentle Introduction to a Rare, but Often Benign Disease: Sarcoidosis
<div class="MarkdownViewer Markdown"><div><p><img style="width: 433px;" src="https://res.cloudinary.com/drrz8xekm/image/upload/v1576522735/ubhmidhwqp5o0tsddx18.jpg" data-filename="ubhmidhwqp5o0tsddx18"><br></p><p>A few weeks ago, a Steemit 
friend wrote that her daughter had recently been diagnosed with 
sarcoidosis. My vague understanding of this disease was that it somehow 
involved the lungs.  After reading a bit, I learned that besides the 
lungs,  other organs may be affected.  Also, though sarcoidosis was 
first described more than a hundred years ago, many questions remain:  
What is the cause? Who is affected?  How best to treat it? Even, what 
are the symptoms? There are partial answers to each of these questions, 
but satisfactory, complete explanations are lacking.</p>
<p>In the midst of all the unanswered questions, one piece of reassuring information stands out: <a href="https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201511-760OC" rel="noopener" title="This link will take you away from steemit.com"><strong>75%</strong></a> of  people who are diagnosed with sarcoidosis never seek follow-up treatment.  This statistic is offered by the <em>American Journal of Respiratory and Critical Care Medicine</em>.<br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmYSzGrP5wQSmXRpSuQmUPcree2qqQfWfvmQY3rTYfytrr/accent%20fractal2.jpg" alt="accent fractal2.jpg"></p>
<p><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmYSzGrP5wQSmXRpSuQmUPcree2qqQfWfvmQY3rTYfytrr/accent%20fractal2.jpg" alt="accent fractal2.jpg"><br>
<a href="https://www.ypsyork.org/resources/yorkshire-scientists-and-innovators/jonathan-hutchinson/" rel="noopener" title="This link will take you away from steemit.com">Jonathan Hutchinson</a> (1828-1913)</p>
<p><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmUra6MQZb9E1uKRh812EZWcUJFcgcebF8Hs7zPq2n9SeL/Jonathan%20Hutchinson%20caricature%20sir%20Leslie%20Spy%20Vanity%20fair%20public%20domain%201890.jpg" alt="Jonathan Hutchinson caricature sir Leslie Spy Vanity fair public domain 1890.jpg"><br>
<em><a href="https://commons.wikimedia.org/wiki/File:Jonathan_Hutchinson_by_Spy.jpg" rel="noopener" title="This link will take you away from steemit.com">Image Credit:</a> Sir Leslie Ward ("Spy") in Vanity Fair, 1890.  Public domain</em>.<br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWJhZ7zeRSxWaGdewTdjGi3nuLNU3nyEWcemG3o7TJqLJ/line%20steemstem.jpg" alt="line steemstem.jpg"><br>
Jonathan Hutchinson is credited with being the first physician to 
describe  sarcoidosis.  At the time--1869--sarcoidosis  was considered a
 dermatological disease.  Hutchinson noted "the formation of multiple, 
raised, dusky-red patches" on his patient's skin. The patches, he 
observed, did not tend to become inflamed, nor did they tend to 
ulcerate.  Also, these patches  occurred in groups, and extended 
"slowly".  Hutchinson  named the disease after one of his patient's, <a href="https://journals.sagepub.com/doi/pdf/10.1177/014107688107400212" rel="noopener" title="This link will take you away from steemit.com">Mrs. Mortimer.</a></p>
<p>Not until 1900 was sarcoidosis recognized as  a systemic disorder.  
It was then that the term 'sarkoid' was first used to describe the 
disease.  The doctor credited with this insight was <a href="https://books.google.com/books?id=_OJ8DwAAQBAJ&amp;pg=PA127&amp;lpg=PA127&amp;dq=boeck+is+first+person+to+use+the+word+sarcoid&amp;source=bl&amp;ots=IVL6PLYtAa&amp;sig=ACfU3U2dNAjnz_TGxhIQmGQM8jRppunoFw&amp;hl=en&amp;sa=X&amp;ved=2ahUKEwj34L-L3qzmAhUNnlkKHcz2BFkQ6AEwD3oECAkQAQ#v=onepage&amp;q=boeck%20is%20first%20person%20to%20use%20the%20word%20sarcoid&amp;f=false" rel="noopener" title="This link will take you away from steemit.com">Caesar Boeck,</a> of Norway.</p>
<p>It's interesting that Dr. Boeck was Norwegian, because today we understand that people of Scandinavian descent seem to have an <a href="https://www.stopsarcoidosis.org/what-is-sarcoidosis/causes-risk-factors/" rel="noopener" title="This link will take you away from steemit.com">elevated risk</a> of developing sarcoidosis.<br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWJhZ7zeRSxWaGdewTdjGi3nuLNU3nyEWcemG3o7TJqLJ/line%20steemstem.jpg" alt="line steemstem.jpg"></p>
<p><strong><em>Although It's Rare, Beagles Can Get Sarcoidosis, Also</em></strong><br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmfPGLNNjpcNHXKFH3sx81MKgP5yjGe3K3xvxrVZKJSET6/Beagle2%20NiniJule%20user%20Groppe%203.0.jpg" alt="Beagle2 NiniJule user Groppe 3.0.jpg"><br>
<em>Image Credit: User Groppe, used under CC 3.0 license</em></p>
<p>While these two beagles, Nini and Jule, appear to be well, I found <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/vde.12775" rel="noopener" title="This link will take you away from steemit.com">one case</a>
 where an 11-year old beagle was successfully treated for cutaneous 
sarcoidosis.  Apparently, sarcoidosis, while rare, does occur in dogs.</p>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center>
<h3><center>What is Sarcoidosis? What Do We Understand Today?</center></h3>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center><br>
There are some things we know about sarcoidosis for certain.  It is a 
disease of inflammation.  The "dusky-red patches" referred to by 
Hutchinson have a name now: <a href="https://www.mayoclinic.org/granuloma/expert-answers/faq-20057838" rel="noopener" title="This link will take you away from steemit.com">granulomas.</a> Granulomas are described by the Mayo Clinic as <a href="https://www.mayoclinic.org/granuloma/expert-answers/faq-20057838" rel="noopener" title="This link will take you away from steemit.com">"small areas of inflammation".</a>
  The Clinic explains that these patches, or small lumps, may be formed 
by the body as a defense against infection or injury.  Tissue surrounds a
 foreign body.  This process is called <a href="https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/foreign-body-reaction" rel="noopener" title="This link will take you away from steemit.com">'foreign body encapsulation',</a> and it is the mechanism at work in granuloma formation.<br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWJhZ7zeRSxWaGdewTdjGi3nuLNU3nyEWcemG3o7TJqLJ/line%20steemstem.jpg" alt="line steemstem.jpg"><br>
<strong><em>Ultrasound Image Showing Silicone Granuloma in a Breast</em></strong><br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmfUE9nygaLyBA1UG9p8AYrNidoHodfBat8CTTvW9ni9dL/Ultrasound%20silicone2%20granuloma%20breast_3.0%20Nevit%20Dilmen%20(talk).jpg" alt="Ultrasound silicone2 granuloma breast_3.0 Nevit Dilmen (talk).jpg"><br>
<em>Image credit: <a href="https://commons.wikimedia.org/wiki/File:Ultrasound_of_silicone_granuloma_of_breast_13112514542431207.jpg" rel="noopener" title="This link will take you away from steemit.com">Nevit Dilman (talk)</a>. Used under a CC 3.0 license.</em>
<p>The caption under this image <a href="https://commons.wikimedia.org/wiki/File:Ultrasound_of_silicone_granuloma_of_breast_13112514542431207.jpg" rel="noopener" title="This link will take you away from steemit.com">reads:</a> "Ultrasound images of breast with silicone granuloma. Snow like echogenicity with posterior shadowing"<br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWJhZ7zeRSxWaGdewTdjGi3nuLNU3nyEWcemG3o7TJqLJ/line%20steemstem.jpg" alt="line steemstem.jpg"></p>
<p>Granulomas are not unique to sarcoidosis and may be found in <a href="https://pmj.bmj.com/content/76/898/457" rel="noopener" title="This link will take you away from steemit.com">other diseases.</a>
 The problem with granulomas is that their presence in tissue, over 
time, may cause damage.  However, they may also be of no consequence.  
People often discover granulomas incidentally, during a scan for an 
unrelated complaint.</p>
<p>In sarcoidosis, as Caesar Boeck explained, granulomas may appear anywhere in the body.  The most common sites are the <a href="https://familydoctor.org/condition/sarcoidosis/" rel="noopener" title="This link will take you away from steemit.com">lungs, the skin,</a> <a href="https://my.clevelandclinic.org/ccf/media/Files/Respiratory/sarcoidosis-center/2012-sarcoidosis-patient-conference/ocular-sarcoidosis.pdf%3Fla%3Den" rel="noopener" title="This link will take you away from steemit.com">the eyes,</a> and <a href="https://worldwidescience.org/topicpages/s/sarcoidosis.html" rel="noopener" title="This link will take you away from steemit.com">lymph nodes</a>  in the thoracic cavity.<br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWJhZ7zeRSxWaGdewTdjGi3nuLNU3nyEWcemG3o7TJqLJ/line%20steemstem.jpg" alt="line steemstem.jpg"><br>
<strong><em>Thoracic Cavity</em></strong><br>
<img src="https://steemitimages.com/0x0/https://cdn.steemitimages.com/DQmPZvMCATdYwqL9V3dMJGNFH85MmMTVmtnLgXLUUjSZ1ZB/Body_Cavities%20gif4%20thoracic%203.0%20OpenStax%20eye.gif" alt="Body_Cavities gif4 thoracic 3.0 OpenStax eye.gif"><br>
<em>Image credit: Adapted from <a href="https://commons.wikimedia.org/wiki/File:Body_Cavities_Lateral_view_labeled.jpg" rel="noopener" title="This link will take you away from steemit.com">Open Stax,</a> used under a CC 3.0 license. Eyeball courtesy of <a href="https://commons.wikimedia.org/wiki/File:Mentor_Eye.svg" rel="noopener" title="This link will take you away from steemit.com">Mentor Eye.png: White Cat</a>, public domain</em></p>
<p>I adapted the diagram to make it look less clinical.  That model may even be winking at us :)</p>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center>
<h3><center>Who is Likely to be Diagnosed with Sarcoidosis?</center></h3>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center>
<p>This is a question with an evolving answer. One of the most recent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6558716/" rel="noopener" title="This link will take you away from steemit.com">articles</a> I read, in the <em>Journal of Biomedical Science</em> (June, 2019 ) explains that the demographics of the disease suggest both environment and genetics play a role.</p>
<p>According to the <em>Journal</em> article, women, overall, have a 
higher incidence of sarcoidosis.  Also, Northern Europeans  and African 
Americans have a relatively high incidence of disease (it's still rare).
  However, people of African descent who live in the Caribbean do not 
show an elevated incidence.   Asians--specifically, people who live in 
Taiwan and Japan--have a relatively low incidence.</p>
<p>If this sounds puzzling, yes it is.  And it's complicated by the fact
 that different areas of the world may have different diagnostic 
criteria.</p>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center>
<h3><center>Diagnosing Sarcoidosis</center></h3>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center>
<p><strong>PET/CT Scan</strong><br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmcPkXTNFtmG2SQpDJx6ej76gUsGvaDabSuhx2j3251AxE/PETCT%202%20credit%20Hg6996%20public.jpg" alt="PETCT 2 credit Hg6996 public.jpg"><br>
<em>Image credit: <a href="https://commons.wikimedia.org/wiki/File:16slicePETCT.jpg" rel="noopener" title="This link will take you away from steemit.com">Hg699,</a> public domain.</em></p>
<p>The machine shown in the picture combines the ability of a PET scan and a CT scan. According to an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060399/" rel="noopener" title="This link will take you away from steemit.com">article</a> in the <em>Journal of Clinical Imaging Science</em>,
 this machine can be useful (for people who have serious lung 
involvement) not only for diagnosing sarcoidosis, but also for 
monitoring its progress.</p>
<p><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWJhZ7zeRSxWaGdewTdjGi3nuLNU3nyEWcemG3o7TJqLJ/line%20steemstem.jpg" alt="line steemstem.jpg"><br>
Diagnosing sarcoidosis is a challenge, because symptoms may resemble 
those of  other diseases. Two blood tests that can offer some guidance 
are:  ACE <a href="https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&amp;contentid=angiotensin_converting_enzyme_blood" rel="noopener" title="This link will take you away from steemit.com">(Angiotensin Converting Enzyme)</a> and sIL-2R (<a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0223897" rel="noopener" title="This link will take you away from steemit.com">soluble interleukin 2 receptor.</a>)
  Elevated levels on either test suggest the possibility of sarcoidosis,
 but the results are not conclusive.   Other clinic evidence (symptoms) 
must be present, and more tests must be conducted.</p>
<p>A 2019 <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0223897" rel="noopener" title="This link will take you away from steemit.com">article,</a> published in PLOS/ONE, reports that if a patient is suspected of having sarcoidosis, and that patient does <em>not</em>
 have elevated levels of sIL-2R, then the diagnosis of sarcoidosis can 
be ruled out.  The study on which this article is based indicates that 
the sIL-2R test is more sensitive than the ACE in diagnosing the 
disease.   So, if there's a strong suspicion of sarcoidosis, and 
symptoms are troubling, testing for sIL-2R might be something a patient 
could ask for. I think I would.<br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWJhZ7zeRSxWaGdewTdjGi3nuLNU3nyEWcemG3o7TJqLJ/line%20steemstem.jpg" alt="line steemstem.jpg"></p>
<p>Other tests used to diagnose sarcoidosis--in cases where treatment 
may be necessary--include performing biopsies of suspected tissue.  One 
of the most recent developments in this area is a procedure called 
Transbronchial Lung Cryobiopsy.  This is for people who have suspected 
lung disease.   According to a November 2019 <a href="https://sarcoidosisnews.com/2019/11/04/transbronchial-lung-cryobiopsy-helps-provide-definitive-diagnose-of-sarcoidosis-study-suggests/" rel="noopener" title="This link will take you away from steemit.com">article</a> in <em>Sarcoidosis News</em>,
 the new procedure "safely and successfully helps to provide a 
definitive sarcoidosis diagnosis when the usual and less-invasive 
diagnostic tools are insufficient."</p>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center>
<h3><center>What Causes It?</center></h3>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center><br>
The most recent research points to a combination of factors--<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6558716/" rel="noopener" title="This link will take you away from steemit.com">pathogens,</a> environmental exposure, and genetics.
<hr>
<p><strong>Pathogens</strong></p>
<hr>
<p><strong><em>Cutibacterium Acne</em></strong><br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWXpJMKz9qRptHZPFAdja6WWN96qvmC6WNE4zRGm62B4t/CDC%20Bobby%20Strong2%20Propionibacterium_acnes%20public%20cdc.jpg" alt="CDC Bobby Strong2 Propionibacterium_acnes public cdc.jpg"><br>
<em>Image Credit: <a href="https://commons.wikimedia.org/wiki/File:Propionibacterium_acnes.jpg" rel="noopener" title="This link will take you away from steemit.com">Bobby Strong,</a> of the CDC. Public domain</em><br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWJhZ7zeRSxWaGdewTdjGi3nuLNU3nyEWcemG3o7TJqLJ/line%20steemstem.jpg" alt="line steemstem.jpg"></p>
<hr>
<p>Pathogens associated with development of sarcoidosis include  <em>Candida</em>, <em>Cutibacterium acne</em> and <em>Mycobacterium tuberculosis</em>.   <em>Candida</em> causes candidiasis,  <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.15043" rel="noopener" title="This link will take you away from steemit.com"><em>Cutibacterium acne</em></a> is implicated in common acne, and <a href="https://www.nhs.uk/conditions/tuberculosis-tb/causes/" rel="noopener" title="This link will take you away from steemit.com"><em>Mycobacterium tuberculosis</em></a> causes tuberculosis.</p>
<p>It is also suggested that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6558716/" rel="noopener" title="This link will take you away from steemit.com">exposure to mycobacterial antigens,</a> may lead to development of disease. The exposure may be through natural infection, or through tuberculosis (BCG) vaccine.</p>
<p><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWJhZ7zeRSxWaGdewTdjGi3nuLNU3nyEWcemG3o7TJqLJ/line%20steemstem.jpg" alt="line steemstem.jpg"><br>
<strong>Apparatus Used for Giving BCG Vaccine</strong><br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmNsviXDoPDpvG3LUXchkYajMqycDAC7zeMXAsHK3PQmrC/BCGapparatus_ja1%20credit%20Y%20tambe%20%20GFDL%20and%20CC-by-SA%202.5,%202.0,%201.0.jpg" alt="BCGapparatus_ja1 credit Y tambe  GFDL and CC-by-SA 2.5, 2.0, 1.0.jpg"><br>
<em>Image credit: <a href="https://commons.wikimedia.org/wiki/File:BCG_apparatus_ja1.jpg" rel="noopener" title="This link will take you away from steemit.com">Y tambe</a> GFDL and CC-by-SA 2.5, 2.0, 1.0</em><br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWJhZ7zeRSxWaGdewTdjGi3nuLNU3nyEWcemG3o7TJqLJ/line%20steemstem.jpg" alt="line steemstem.jpg"></p>
<h4><center>Environmental Exposure</center></h4>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmURaFznt2U9MmcxzeGV6oLsg1oHVg44kSzVzRgoZdNw65/Smoke%20house2_training%20credit%20Staffsfire%204.0.jpg" alt="Smoke house2_training credit Staffsfire 4.0.jpg"><br>
<a href="https://commons.wikimedia.org/wiki/File:Smoke_house_training.jpg" rel="noopener" title="This link will take you away from steemit.com"><em>Image: Staffsfire, CC 4.0 license</em></a></center>
<hr>
<p>There seems to be general agreement that environmental exposures may 
trigger sarcoidosis in genetically susceptible individuals.  Not all the
 studies agree on the extent of this influence.  However, it has been 
shown that  people who work in certain industries have a higher 
incidence of disease.  And, in one specific case, people who worked at 
the World Trade Center after the 9/11 attack,  have an <a href="https://www.resmedjournal.com/article/S0954-6111(17)30170-1/pdf" rel="noopener" title="This link will take you away from steemit.com">elevated incidence</a> of sarcoidosis.</p>
<p>As for tying sarcoidosis to specific substances: a number of studies 
have shown a correlation between occupational exposure to the following 
materials  and development of the disease:</p>
<p><strong>Silica</strong></p>
<hr>
<p>Women at Work in a War Production Plant, WW I (1914-1918)<br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmUea84ypwZp1cu8ggVi9RZdGEKvMBxtwHqqzhMDG6bKht/THE%20WOMENS2%20WORK_IN_THE_WAR_PRODUCTION,_1914%201918_Q110084%20%20First%20World%20War%20Womens%20War%20work%20Collection%20public.jpg" alt="THE WOMENS2 WORK_IN_THE_WAR_PRODUCTION,_1914 1918_Q110084  First World War Womens War work Collection public.jpg"><br>
<em>Image and citation credit: <a href="https://commons.wikimedia.org/wiki/File:THE_WOMEN%27S_WORK_IN_THE_WAR_PRODUCTION,_1914-1918_Q110084.jpg" rel="noopener" title="This link will take you away from steemit.com">First World War Womens War Work Collection</a> Public domain</em></p>
<p>The picture shows a worker cutting fused silica basins for use in 
lavatories in a factory of Thermal Syndicate Limited at 
Wallsend-on-Tyne, July 1918.<br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWJhZ7zeRSxWaGdewTdjGi3nuLNU3nyEWcemG3o7TJqLJ/line%20steemstem.jpg" alt="line steemstem.jpg"></p>
<p>The association between silica exposure and sarcoidosis has been the 
subject of much research over the years.  Silica is not only implicated 
in the development of sarcoidosis, but has also been linked to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786551/" rel="noopener" title="This link will take you away from steemit.com">other inflammatory diseases,</a> including systemic lupus, rheumatoid arthritis  and silicosis, a debilitating lung disease.<br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWJhZ7zeRSxWaGdewTdjGi3nuLNU3nyEWcemG3o7TJqLJ/line%20steemstem.jpg" alt="line steemstem.jpg"><br>
Pallets of Silica in a Warehouse<br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmZxR7TZDcKJbVHbXwmLR57DadMnoYTLgDxKMU7XjjJ4zJ/Warehouse-plastic2%20_industry%201.0,2.0,2.5,3.0%20Cjp24.jpg" alt="Warehouse-plastic2 _industry 1.0,2.0,2.5,3.0 Cjp24.jpg"><br>
<em>Image credit: <a href="https://commons.wikimedia.org/wiki/File:Warehouse-plastic_industry.jpg" rel="noopener" title="This link will take you away from steemit.com">Cjp24,</a> CC 1.0,2.0,2.5,3.0 license</em><br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWJhZ7zeRSxWaGdewTdjGi3nuLNU3nyEWcemG3o7TJqLJ/line%20steemstem.jpg" alt="line steemstem.jpg"><br>
Silica is <a href="https://www.ncbi.nlm.nih.gov/pubmed/9246599" rel="noopener" title="This link will take you away from steemit.com">ubiquitous</a>
 in the environment.  It  is used in an amazingly wide variety of 
products.  Industrial exposure may occur in many different industries.  
Some of the products in which it may be found: paint, pharmaceuticals, 
plastic, food, cement, potting soil, plastic board, various construction
 material, and  <a href="https://www.researchgate.net/publication/51974119_Cat_litter_is_a_possible_trigger_for_sarcoidosis" rel="noopener" title="This link will take you away from steemit.com">cat litter (if it contains silica.)</a> This list of substances was derived from the <a href="https://www.ncbi.nlm.nih.gov/pubmed/9246599" rel="noopener" title="This link will take you away from steemit.com"><em>Journal of Exposure Analysis and Environmental Epidemiology</em></a><br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWJhZ7zeRSxWaGdewTdjGi3nuLNU3nyEWcemG3o7TJqLJ/line%20steemstem.jpg" alt="line steemstem.jpg"></p>
<p><strong>Ciprofloxocin (Cipro Antibiotic)</strong></p>
<p>A 2019 article published in the journal of the WSOG, <a href="https://www.wasog.org/" rel="noopener" title="This link will take you away from steemit.com">World Association of Sarcoidosis and other Granulomatous Disorders,</a> shows a correspondence between patients who took the antibiotic Ciprofloxocin, <a href="https://mattioli1885journals.com/index.php/sarcoidosis/article/view/7112/8163" rel="noopener" title="This link will take you away from steemit.com">Cipro.</a>
 and the later development of sarcoidosis.  The article reports that,  
the more severe the disease, the more likely it is that there exists a 
history of exposure to Cipro.</p>
<p><strong>Copper, and Iron</strong><br>
The WSOG <a href="https://mattioli1885journals.com/index.php/sarcoidosis/article/view/7112/8163" rel="noopener" title="This link will take you away from steemit.com">article</a>
 also reports that a "statistically significant" correspondence exists 
between sarcoidosis and occupational exposure to iron and copper. The 
association seems to be greatest in patients who experience CNS 
sarcoidosis.<br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWJhZ7zeRSxWaGdewTdjGi3nuLNU3nyEWcemG3o7TJqLJ/line%20steemstem.jpg" alt="line steemstem.jpg"></p>
<p>If anyone reading this blog has a strong interest in understanding 
environmental/lifestyle associations with sarcoidosis, I recommend 
reading the WSOG article.  There's a great graphic in the article, <a href="https://mattioli1885journals.com/index.php/sarcoidosis/article/view/7112/8163" rel="noopener" title="This link will take you away from steemit.com"><em>Seven Statistically Significant Sarcoidosis Linked Dichotomies</em>,</a> which shows specific environmental factors and their relative association with sarcoidosis.<br>
</p><center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center>
<h4><center>Genetics</center></h4>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center>
<p><strong><em>Drawing Showing Rh Positive and Rh Negative Blood Cells</em></strong><br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmXRYSXQRukroKrvHPyw4dosehnLbjjf4ja7pS56mZk5bV/rh%20factor2%20%20Sophiedionne14%204.0.jpg" alt="rh factor2  Sophiedionne14 4.0.jpg"><br>
<em>Image credit: <a href="https://commons.wikimedia.org/wiki/File:Rh_blood_cells_drawing.svg" rel="noopener" title="This link will take you away from steemit.com">Sophiedionne14,</a> CC 4.0 license</em></p>
<hr>
<p>One fact that suggests  a strong role for genetics in sarcoidosis is its occurrence in <a href="https://sarcoidosisnews.com/2018/07/19/sarcoidosis-risk-higher-families-with-disease-history-swedish-study/" rel="noopener" title="This link will take you away from steemit.com">family clusters.</a> According to the previously-referenced WSOG <a href="https://mattioli1885journals.com/index.php/sarcoidosis/article/view/7112/8163" rel="noopener" title="This link will take you away from steemit.com">article,</a>
 studies of cluster families show a correlation between blood type and 
the development of sarcoidosis. The authors suggest a need "to 
investigate the Rh blood group genotypes  as  the  triggering  stimuli  
for  sarcoidosis".</p>
<p>Another <a href="http://www.clpmag.com/2019/07/researchers-discover-causative-genetic-mutations-patients-familial-sarcoidosis/" rel="noopener" title="This link will take you away from steemit.com">study,</a> published July 2019 in the journal <em>Clinical Laboratories</em>,
 identifies a genetic mutation that is found infamily clusters.  
Researchers note that this mutation is passed on only to affected family
 members and not to those free of the disease. The mutation occurred in 
genes responsible for activating "metabolic sensor mTOR."<br>
</p><center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center>
<h4><center>Treatments</center></h4>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center><br>
The good news is, most people don't require treatment.  If treatment is 
necessary, however, many of the medicines used to treat sarcoidosis are 
the same ones used to treat autoimmune diseases.  This is true, despite 
the fact that the Foundation for Sarcoidosis Research states: <a href="https://www.stopsarcoidosis.org/what-is-sarcoidosis/causes-risk-factors/" rel="noopener" title="This link will take you away from steemit.com">"based on today’s science we do not advocate using the label “autoimmune” to describe sarcoidosis".</a>
 If the disease does progress, often several doctors from different 
specialties will collaborate on a plan, because a number of organs may 
be affected.
<p>Treatment options listed here are derived from information provided by the <a href="https://www.stopsarcoidosis.org/what-is-sarcoidosis/treatment-options/" rel="noopener" title="This link will take you away from steemit.com">Foundation for Sarcoidosis Research</a>.  This list does not include all possible therapies.<br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWJhZ7zeRSxWaGdewTdjGi3nuLNU3nyEWcemG3o7TJqLJ/line%20steemstem.jpg" alt="line steemstem.jpg"><br>
Bark of the Cinchona Tree<br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmesjwzrwAf2zQnrdjYpXj1nK1Dpr9mGyGEmSkg86uQRpA/Cinchona%20pubescens%20quinine%20bark2zz%20%20Photo%20by%20David%20J.%20Stang%204.0.jpg" alt="Cinchona pubescens quinine bark2zz  Photo by David J. Stang 4.0.jpg"><br>
<em>Image credit: <a href="https://commons.wikimedia.org/wiki/File:Cinchona_pubescens_2zz.jpg" rel="noopener" title="This link will take you away from steemit.com">David J. Stang</a> CC 4.0 license</em></p>
<p>Cinchona bark is a source of natural quinine, which has been used <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3121651/" rel="noopener" title="This link will take you away from steemit.com">since the seventeenth century</a> to treat malaria. During WWII, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052376/" rel="noopener" title="This link will take you away from steemit.com">it was discovered that synthetic forms of anti-malarials,</a>  were effective at treating  some inflammatory diseases. One of those, Plaquenil, is mentioned below.<br>
<img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmWJhZ7zeRSxWaGdewTdjGi3nuLNU3nyEWcemG3o7TJqLJ/line%20steemstem.jpg" alt="line steemstem.jpg"></p>
<p><em>Corticosteroids</em>: The first line of defense. Prednisone and Prednisolone are the most common forms administered.</p>
<p><em>Immune Suppressant Drugs</em>: These include Azathioprine, Methotrexate and Mycophenalate.</p>
<p><em>Anti-Malarial Drugs</em>: These include Plaquenil and Aralen.</p>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center>
<h4><center>International Resources for Patients and Families</center></h4>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center><br>
The World Association for Sarcoidosis and other Granulomatous Diseases offers a list of twenty treatment centers in the U. S. <a href="https://www.wasog.org/action/news/item/364/WASOG%20and%20FSR%20recognized%20Sarcoidosis%20Clinic.html" rel="noopener" title="This link will take you away from steemit.com">here.</a>
<p>The Foundation for Sarcoidosis Research has endorsed <a href="https://www.stopsarcoidosis.org/sarc-id/sarcoidosis-clinics/" rel="noopener" title="This link will take you away from steemit.com">treatment centers</a>
 in different areas of the world.  A few of these centers are listed 
below.  Please check the organization's website for a more extensive 
list, if your country is not included here.</p>
<p><strong>Canada</strong><br>
Mount Sinai Hospital – Toronto, Canada</p>
<p><strong>Germany</strong><br>
Hannover Medical School – Hannover, Germany<br>
Ruhrlandklinik University Hospital – Essen, Germany<br>
Thoraxklinik at Heidelberg University Hospital – Heidelberg, Germany<br>
University Medical Center Goettingen – Göttingen, Germany</p>
<p><strong>Greece</strong><br>
Corfu General Hospital – Corfu, Greece<br>
Hospital for the Diseases of the Chest – Athens, Greece</p>
<p><strong>Netherlands</strong><br>
Catharina Hospital – Noord Brabant, Netherlands<br>
Erasmus University Medical Center – Rotterdam, Netherlands<br>
ETZ Tilburg – Tilburg, Netherlands</p>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center>
<h4><center>Final Word About Vitamin D</center></h4>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center><br>
Proceed with caution.  While people with sarcoidosis may be deficient in
 Vitamin D, there is a risk of developing hypercalcemia.  A couple of 
articles that address this: <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060200/" rel="noopener" title="This link will take you away from steemit.com">Goldilocks, vitamin D and sarcoidosis</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/27650228" rel="noopener" title="This link will take you away from steemit.com">Vitamin D Supplementation: Not So Simple in Sarcoidosis.</a>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center>
<h4><center>Conclusion</center></h4>
<center><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmdaQPmjxr3ZDwcytLQn1DP6VuvyK3nuxtzuiJTjwop2aX/4th%20dimension%20accent.jpg" alt="4th dimension accent.jpg"></center><br>
I know this blog was rather dense, but I wanted to cover the topic 
responsibly.  As I said in a previous blog, information is power.  I 
tried to wade my way through  research papers and spread a little power 
around :))
<p><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmRnJ5rgo96JSBiHbjev34QedcmkFzG1zZQ9AN1eNaDWgB/accent%20fractal.jpg" alt="accent fractal.jpg"></p>
<center><em>Thank you for spending your  time with me and reading my long blog</em></center><br>
<center><img src="https://steemitimages.com/0x0/https://cdn.steemitimages.com/DQmVLV2kpmXe64d4Sf4boeo7X3UUpJjkwMj466n2WZv2DR2/fox%20and%20squirrel%20friendsgif.gif" alt="fox and squirrel friendsgif.gif"></center><br>
<center><em>Steem on!</em></center>
<p><img src="https://steemitimages.com/640x0/https://cdn.steemitimages.com/DQmRnJ5rgo96JSBiHbjev34QedcmkFzG1zZQ9AN1eNaDWgB/accent%20fractal.jpg" alt="accent fractal.jpg"></p>
<h3><center>Selected Sources</center></h3>
<ol><li><p><a href="https://pdfs.semanticscholar.org/72db/fcd91bfeace021ed6f7e740f075a99abee1e.pdf" rel="noopener" title="This link will take you away from steemit.com">A historical sketch; life and time of Jonathan Hutchinson(1828-1913), the first sarcoidologist</a></p></li><li><p>Journal of the Royal Society of Medicine  Volume74February1981147 <a href="https://journals.sagepub.com/doi/pdf/10.1177/014107688107400212" rel="noopener" title="This link will take you away from steemit.com">The eponymy of sarcoidosis</a></p></li><li><p>Yorkshire Philosophical Society, <a href="https://www.ypsyork.org/resources/yorkshire-scientists-and-innovators/jonathan-hutchinson/" rel="noopener" title="This link will take you away from steemit.com">Jonathan Hutchinson</a></p></li><li><p>Foundation for Sarcoidosis Research, <a href="https://www.stopsarcoidosis.org/what-is-sarcoidosis/causes-risk-factors/" rel="noopener" title="This link will take you away from steemit.com">Causes and Risk Factors</a></p></li><li><p>Boston Medical Journal, <a href="https://pmj.bmj.com/content/76/898/457" rel="noopener" title="This link will take you away from steemit.com">A clinicopathological classification of granulomatous disorders</a></p></li><li><p>Plastic Reconstructive Surgery, <a href="https://www.ncbi.nlm.nih.gov/pubmed/11932626" rel="noopener" title="This link will take you away from steemit.com">Breast implant-related silicone granulomas: the literature and the litigation</a></p></li><li><p>Boston Medical Journal, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6558716/" rel="noopener" title="This link will take you away from steemit.com">Host-microbe interactions in the pathogenesis and clinical course of sarcoidosis</a></p></li><li><p>Veterinary Dermatology, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/vde.12775" rel="noopener" title="This link will take you away from steemit.com">Clinical and histopathological presentation and successful treatment with ciclosporin for canine sarcoidosis: a case report</a></p></li><li><p>Boston Medical Journal <a href="https://bmjopen.bmj.com/content/7/7/e016839?rss=1" rel="noopener" title="This link will take you away from steemit.com">Risk
 of sarcoidosis and seropositive rheumatoid arthritis from occupational 
silica exposure in Swedish iron foundries: a retrospective cohort study</a></p></li><li><p>Burning Issues, <a href="http://burningissues.org/sarcoidosis.html" rel="noopener" title="This link will take you away from steemit.com">A Current Assessment of Rurally Linked Exposures as Potential Risk Factors for Sarcoidosis</a></p></li><li><p>Boston Medical Journal, <a href="https://bmjopen.bmj.com/content/3/12/e004065" rel="noopener" title="This link will take you away from steemit.com">Molecular analysis of sarcoidosis lymph nodes for microorganisms: a case–control study with clinical correlates</a></p></li><li><p>Environmental Science: Nano, <a href="https://pubs.rsc.org/en/content/articlelanding/2019/en/c8en01301b#!divAbstract" rel="noopener" title="This link will take you away from steemit.com">Nano to micron-sized particle detection in patients' lungs and its pathological significance</a></p></li><li><p>Current Opinion in Allergy and Clinical Immunology, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196683/" rel="noopener" title="This link will take you away from steemit.com">Occupational Causes of Sarcoidosis</a></p></li><li><p>Madison College.edu, <a href="http://faculty.madisoncollege.edu/mljensen/BloodBank/lectures/RhBloodGroupSystem.htm" rel="noopener" title="This link will take you away from steemit.com">Life's Blood</a></p></li><li><p>American Journal of Respiratory and Critical Care Medicine  <a href="https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201511-760OC" rel="noopener" title="This link will take you away from steemit.com">Sarcoidosis in America Analysis Based on Health Care Use</a></p></li><li><p>Journal of the Royal Society of Medicine, <a href="https://journals.sagepub.com/doi/pdf/10.1177/014107688107400212" rel="noopener" title="This link will take you away from steemit.com">The eponymy of sarcoidosis</a></p></li><li><p><a href="https://books.google.com/books?id=_OJ8DwAAQBAJ&amp;pg=PA127&amp;lpg=PA127&amp;dq=boeck+is+first+person+to+use+the+word+sarcoid&amp;source=bl&amp;ots=IVL6PLYtAa&amp;sig=ACfU3U2dNAjnz_TGxhIQmGQM8jRppunoFw&amp;hl=en&amp;sa=X&amp;ved=2ahUKEwj34L-L3qzmAhUNnlkKHcz2BFkQ6AEwD3oECAkQAQ#v=onepage&amp;q=boeck%20is%20first%20person%20to%20use%20the%20word%20sarcoid&amp;f=false" rel="noopener" title="This link will take you away from steemit.com">Sarcoidosis, A Clinician's Guide</a> pp 127</p></li><li><p>Stop Sarcoidosis.org, <a href="https://www.stopsarcoidosis.org/what-is-sarcoidosis/causes-risk-factors/" rel="noopener" title="This link will take you away from steemit.com">What Is Sarcoidosis</a></p></li><li><p>Mayo Clinic, <a href="https://www.mayoclinic.org/granuloma/expert-answers/faq-20057838" rel="noopener" title="This link will take you away from steemit.com">Granulomas</a></p></li><li><p>Veterinary Dermatology, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/vde.12775" rel="noopener" title="This link will take you away from steemit.com">Clinical and histopathological presentation and successful treatment with ciclosporin for canine sarcoidosis: a case report</a></p></li><li><p>Science Direst, <a href="https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/foreign-body-reaction" rel="noopener" title="This link will take you away from steemit.com">Foreign Body Reaction</a></p></li><li><p>Boston Medical Journal, <a href="https://pmj.bmj.com/content/76/898/457" rel="noopener" title="This link will take you away from steemit.com">A clinicopathological classification of granulomatous</a></p></li><li><p>Family Doctor, <a href="https://familydoctor.org/condition/sarcoidosis/" rel="noopener" title="This link will take you away from steemit.com">Sarcoidosis</a></p></li><li><p>My Cleveland Clinic, <a href="https://my.clevelandclinic.org/ccf/media/Files/Respiratory/sarcoidosis-center/2012-sarcoidosis-patient-conference/ocular-sarcoidosis.pdf%3Fla%3Den" rel="noopener" title="This link will take you away from steemit.com">Respiratory Sarcoidosis</a></p></li><li><p>Worldwide Science, <a href="https://worldwidescience.org/topicpages/s/sarcoidosis.html" rel="noopener" title="This link will take you away from steemit.com">Sarcoidosis</a></p></li><li><p>Journal of Biomedical Science <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6558716/" rel="noopener" title="This link will take you away from steemit.com">Host-microbe interactions in the pathogenesis and clinical course of sarcoidosis</a></p></li><li><p>Journal of Clinical Imaging Science, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060399/" rel="noopener" title="This link will take you away from steemit.com">Accuracy of Serial PET-CT Imaging in Systemic Sarcoidosis</a></p></li><li><p>University of Rochester Medical Center <a href="https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&amp;contentid=angiotensin_converting_enzyme_blood" rel="noopener" title="This link will take you away from steemit.com">Angiotensin Converting Enzyme (Blood)</a></p></li><li><p>PLOS/ONE,<a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0223897" rel="noopener" title="This link will take you away from steemit.com">Sensitivity
 and specificity of serum soluble interleukin-2 receptor for diagnosing 
sarcoidosis in a population of patients suspected of sarcoidosis</a></p></li><li><p>Sarcoidosis News, <a href="https://sarcoidosisnews.com/2019/11/04/transbronchial-lung-cryobiopsy-helps-provide-definitive-diagnose-of-sarcoidosis-study-suggests/" rel="noopener" title="This link will take you away from steemit.com">Transbronchial Lung Cryobiopsy</a></p></li><li><p>Journal of Biomedical Science, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6558716/" rel="noopener" title="This link will take you away from steemit.com">Host-microbe interactions in the pathogenesis and clinical course of sarcoidosis</a></p></li><li><p>NHS. UK, <a href="https://www.nhs.uk/conditions/tuberculosis-tb/causes/" rel="noopener" title="This link will take you away from steemit.com">Tuberculosis Causes</a></p></li><li><p>Respiratory Medicine,<a href="https://www.researchgate.net/publication/317392265_Post-911_sarcoidosis_in_WTC-Exposed_firefighters_and_emergency_medical_service_workers" rel="noopener" title="This link will take you away from steemit.com">Post-9/11 sarcoidosis in WTC-exposedfirefighters and emergencymedical service workers</a></p></li><li><p>Frontiers in Immunology, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786551/" rel="noopener" title="This link will take you away from steemit.com">Silica, Silicosis, and Autoimmunity</a></p></li><li><p>Journal of Exposure Analysis and Environmental Epidemiology,<a href="https://www.ncbi.nlm.nih.gov/pubmed/9246599" rel="noopener" title="This link will take you away from steemit.com">The regulation of crystalline silica: an industry perspective</a></p></li><li><p>Researchgate,<a href="https://www.researchgate.net/publication/51974119_Cat_litter_is_a_possible_trigger_for_sarcoidosis" rel="noopener" title="This link will take you away from steemit.com">Cat Litter a Possible Trigger for Sarcoidosis</a></p></li><li><p>Journal of Exposure Analysis and Environmental <a href="https://www.ncbi.nlm.nih.gov/pubmed/9246599" rel="noopener" title="This link will take you away from steemit.com">The regulation of crystalline silica: an industry perspective Epidemiology</a></p></li><li><p><a href="https://www.wasog.org/" rel="noopener" title="This link will take you away from steemit.com">World Association of Sarcoidosis and other Granulomatous Disorders,</a></p></li><li><p>Mattioli Journals, <a href="https://mattioli1885journals.com/index.php/sarcoidosis/article/view/7112/8163" rel="noopener" title="This link will take you away from steemit.com">Cipro.</a></p></li><li><p>Mattioli Journals, <a href="https://mattioli1885journals.com/index.php/sarcoidosis/article/view/7112/8163" rel="noopener" title="This link will take you away from steemit.com">Seven Statistically Significant Sarcoidosis Linked Dichotomies</a></p></li><li><p>Sarcoidosis News, <a href="https://sarcoidosisnews.com/2018/07/19/sarcoidosis-risk-higher-families-with-disease-history-swedish-study/" rel="noopener" title="This link will take you away from steemit.com">Sarcoidosis Risk Higher in Families with Disease History</a></p></li><li><p>Clinical Laboratories,<a href="http://www.clpmag.com/2019/07/researchers-discover-causative-genetic-mutations-patients-familial-sarcoidosis/" rel="noopener" title="This link will take you away from steemit.com">Researchers Discover Causative Genetic Mutations in Patients with Familial Sarcoidosis</a></p></li><li><p>Stop Sarcoidosis.org, <a href="https://www.stopsarcoidosis.org/what-is-sarcoidosis/causes-risk-factors/" rel="noopener" title="This link will take you away from steemit.com">What is Sarcoidosis Causes/Risk Factors</a></p></li><li><p>Foundation for Sarcoidosis Research, <a href="https://www.stopsarcoidosis.org/what-is-sarcoidosis/treatment-options/" rel="noopener" title="This link will take you away from steemit.com">What is Sarcoidosis Treatment Options</a></p></li><li><p>Malaria Journal, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3121651/" rel="noopener" title="This link will take you away from steemit.com">Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria</a></p></li><li><p>Rheumatologia,<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052376/" rel="noopener" title="This link will take you away from steemit.com">Antimalarials – are they effective and safe in rheumatic diseases?</a></p></li><li><p>WASOG, <a href="https://www.wasog.org/action/news/item/364/WASOG%20and%20FSR%20recognized%20Sarcoidosis%20Clinic.html" rel="noopener" title="This link will take you away from steemit.com">Recognized Sarcoidosis Clinics</a></p></li><li><p>Stop Sarcoidosis.org, <a href="https://www.stopsarcoidosis.org/sarc-id/sarcoidosis-clinics/" rel="noopener" title="This link will take you away from steemit.com">Sarcoidosis Clinics</a></p></li><li><p>Arthritis Research Therapy,<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060200/" rel="noopener" title="This link will take you away from steemit.com">Goldilocks, vitamin D and sarcoidosis</a></p></li><li><p>American Journal of Medical Science, <a href="https://www.ncbi.nlm.nih.gov/pubmed/27650228" rel="noopener" title="This link will take you away from steemit.com">Vitamin D Supplementation: Not So Simple in Sarcoidosis</a></p></li></ol>
</div></div>
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@chriddi · (edited)
@tipu curate 2

Hi Ag,
gonna read this thoroughly tomorrow. Promise!
It's such an interesting theme and worth much more than a quick glance.
In any case, you have gone to a lot of effort - thank you!
👍  ,
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@tipu · 
<a href="https://tipu.online/curator?chriddi" target="_blank">Upvoted &#128076;</a> (Mana: 0/10 - <a href="https://steemit.com/steem/@tipu/tipu-curate-project-update-recharging-curation-mana" target="_blank">need recharge</a>?)
👍  ,
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@agmoore2 · 
Thank you!
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@agmoore ·
$0.03
Hello @chriddi,
You are very kind, and very generous.  Yes, effort, but with joy.  I had a goal.  Years ago I was a teacher, so being a conduit for information comes naturally to me.  Wonderful when effort is appreciated.

Have the most peaceful day!

Warm regards, 
AG
👍  
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vote details (1)
@chappertron · 
Hey @agmoore2,

thank you for this excellent post. Sometimes I see elderly women with irritations in their face which are similar to pictures related to this disease on wikipedia. Horrible!

Stay healthy and have a nice X-mas time.

Best regards

Chapper
👍  ,
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@agmoore2 · 
Hi Chapper,
So glad it meets your standards.  When I write a blog that involves  biology, I think of you sometimes.  It's a good way to measure if I'm being responsible about research.  Nice to know I met the mark!

I hope you are having a peaceful, fulfilling week and that this season brings you joy.

Warm regards,
AG
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@kadna · 
In german: Du hast dich selbst übertroffen! ;-) meaning that you explored this topic so seeply... more as in your "normal" posts, which are already deeply researched each time! I hope you can get my point ;-) Thank you for your great work! So many sources, so many questions and different views... 
I know that you like to research and that you don't stop before you are satisfied... so i hope you had a bit fun while surfing through the internet ;-))))) Once more a big thank you for your time and your power! Big hugs Kadna
👍  ,
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@agmoore · 
My dear Kadna,
I think I can translate that, intuitively. "You've outdone yourself" we say in English, if I am correct.  

I had a goal.  That gave my research added interest.  

If you only knew what a simple woman I am.  To be able to share something that might be of use...wow, that really makes my day. 

I wish you and your family good health, happiness and peace this season and throughout the year.

By the way, I've been listening to German poems on and off since I read yours.  I'm picking up different accents and realizing that some are easier to understand than others.  Just like English :))

Love,
Your friend from New York,
AG
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@steemstem ·
re-agmoore2-a-gentle-introductio-1576523640-20191216t211133171z
<div class='text-justify'> <div class='pull-left'> <center> <br /> <img width='200' src='https://res.cloudinary.com/drrz8xekm/image/upload/v1553698283/weenlqbrqvvczjy6dayw.jpg'> </center>  <br/> </div> 

This post has been voted on by the **SteemSTEM curation team** and voting trail. It is elligible for support from @curie and @minnowbooster.<br /> 

If you appreciate the work we are doing, then consider supporting our witness [@stem.witness](https://steemconnect.com/sign/account_witness_vote?approve=1&witness=stem.witness). Additional witness support to the [curie witness](https://steemconnect.com/sign/account_witness_vote?approve=1&witness=curie) would be appreciated as well.<br /> 

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@agmoore2 ·
wnbv5fptx
Thank you!  Really feels great to meet your standards :)
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@abigail-dantes · 
@agmoore2, 

Once again your research makes me aware of something I was not familiar with before. It's nice to start the day learning something new. Thank you for this my dear friend :) 

I was curious about the actual  granulomas: how they can form in various different body tissues (lungs', eyes', skin's), and how they can be harmless  or become damaging. I'm guessing that considering that treatment is not always required they mustn't be burdensome (itchy, painful...).

As anyone else, whenever reading about a disease my foremost interest is in its causes, and I must say you never fail to give a balanced account of different internal and external factors. 

This leads me to first, comment on the image of the women working in the war factory (I found it touching). And second, on the overall illustration of your article (including the guy winking at us! :D) There are many reasons why your work stick to our minds @agmoore2, and one of them is sure your attention to detail. 

You're commitment not only to deliver responsibly written information, but also  to provide a pleasant read to your audience.

Beautiful research!
Abigail :D

With love & admiration (always), from sunny, cold Portugal <3
👍  ,
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@agmoore2 ·
$0.03
ssscauldt
Thank you, dear Abigail for your kind words. Such a long blog...thank you for enduring to the end. 

 I knew so little about this disease, also.  One of my challenges was to inform and not alarm.  It's hard to look up stuff on the Internet without getting depressed--I've been there. The little touches you noticed (so happy you did!) were added to help make the blog  'gentle'.

As for how the granulomas can exist without being harmful:  I'm sure we've all had a scan where something was noted and the doctor said, "Don't worry, that will probably never give you trouble". It's amazing to me, sometimes, how our bodies chug along, year after year, with all the accumulated insults.  Whoever designed this machine had a pretty good plan:)

I'm glad the sun is shining in Portugal. Raining here, and cold.  Shopping from a computer terminal is very attractive.  If a gift is not available online, I don't think my family will receive it:))

Thank you again for your consistent encouragement and support.  

Peace, happiness and health to you and your family, dear Abigail.

Love from across the sea,
AG
👍  ,
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@abigail-dantes ·
$0.02
<blockquote>If a gift is not available online, I don't think my family will receive it:))</blockquote>

&#128514; 

Online shopping truly is a saviour! 

Thank you for your reply & good wishes my dear friend from across the sea.
May you and all your loved ones have a happy Christmas! <3 :)
👍  ,
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@steemitboard · 
Congratulations @agmoore2! You have completed the following achievement on the Steem blockchain and have been rewarded with new badge(s) :

<table><tr><td><img src="https://steemitimages.com/60x70/http://steemitboard.com/@agmoore2/commented.png?201912181013"></td><td>You got more than 1250 replies. Your next target is to reach 1500 replies.</td></tr>
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@agmoore2 ·
a7pb6z1tn
Thank you!
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@whatisnew ·
$0.03
Researching diseases is terribly confusing unless you have some schooling in the medical field. The way you put this information in laymen terms is remarkable AG.  I had to chuckle when I saw that you adapted the diagram to make the model look like it was winking.  Only you AG...only you would have thought to do that!  I said to myself, "That's my girl!"  
Keep spreading the power AG!  *Hugs!*
👍  , ,
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vote details (3)
@agmoore2 ·
snecpu6oa
What a lovely comment.  Yeah, those research papers are challenging.  I spend so much time looking up terms.  But I I think we all have been faced with a medical issue, for our families or ourselves.  If we're going to  be partners in care--and we must be--then we have to understand options. So I press on.

Thank you for liking my winking diagram.  If you saw the original--skeletal!--you'd laugh:)

Hope you are having a relaxing, peaceful season.  I'm in holiday mood  🌟 &#127775;  Hugs to you!
👍  
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@whatisnew ·
$0.03
Hi AG!  Just stopping by to wish you and yours a Merry Christmas!  *Hugs!*
👍  ,
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@agmoore2 · 
Thank you, dear @whatisnew. It is a lovely Christmas and I hope you and your family are well, peaceful and happy.
Love, AG
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@whatisnew · 
Thanks AG!  It was a great Christmas!  I spent the day and night at my brother's.  His wife (my SIL) is home for good now so that made us all happy.  The sad news is that she needs to have another knee surgery on January 15th but we are all going to make sure that nothing like the last time will happen to her ever again.
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@abigail-dantes ·
$0.02
My dearest @agmoore2,

This is just a very quick message to let you know I'm thinking of you and wishing that the new year that will soon begin brings tranquility and prosperity to your home. 

All the best my dear friend, who I never met in person but sure lives in my heart! <3

Happy 2020 :D

With infinite affection & respect,
Abigail :)
👍  ,
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@agmoore ·
$0.03
My dear Abigail,
How happy you make me today.  Last night I spoke about you, with a 'real' person, not a virtual friend. Your words and your influence have become part of me.  You have been on my mind and in my heart.
Thank you for your kindness, your affection and the example you set--for me, and everyone else. 
Looking forward to another year, and more inspiration from you.
With love, respect, and best wishes for you and your family,
Your friend, 
AG
👍  
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@abigail-dantes ·
$0.02
<3
👍  ,
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vote details (2)
@w74 · 
Ich habe nicht das Gefühl, als hatten wir uns aus unserer Umarmung nur ein paar Millimeter .......
Oh, dein Schoss  ein    OMGöttlich  behüteter Brunnen ......
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