The Grace of God

God is “the God of all grace” (1 Peter 5:10).

As “the God of all grace,” and because grace is a part of His eternal nature, God is gracious in His dealings with people.

In grace, God deals favorably with people in a way they do not deserve.

Grace often involves God giving to us the exact opposite of what we deserve.

The Greek term translated “grace” is charis, which signifies a favor freely done, without being deserved or expecting anything in return.

From the first mention of grace (Genesis 6:8) until the last (Revelation 22:21), the glorious theme of grace is echoed throughout the Word of God.

God is described as abounding in grace.

“Where sin abounded, grace did much more abound” (Romans 5:20).

Grace is God’s characteristic of love combined with His energetic action.

Every person is the recipient of God’s grace to an certain degree.

“The LORD is gracious, and full of compassion; slow to anger, and of great mercy. The LORD is good to all; and His tender mercies are over all His works” (Psalm 145:8-9).

God sends certain blessings to all mankind.

Jesus commanded His followers to love others -- even their enemies (Matthew 5:43-44)
-- because God exhibits His grace toward all people:

“He [God] maketh His sun to rise on the evil [people] and on the good [people], and sendeth rain on the just [people] and on the unjust [people]” (Matthew 5:45).


God demonstrates grace toward His enemies.

“When we were yet without strength, in due time Christ died for the ungodly. For scarcely [rarely] for a righteous man will one die; yet peradventure [possibly] for a good man some would even dare to die. But God commendeth [demonstrated] His love toward us, in that, while we were yet sinners, Christ died for us” (Romans 5:6-8).

God has provided spiritual blessings for all mankind.

God’s grace is evident in restraining sin in the world.

God’s grace is evident in convicting people of their sin.

God’s grace is supremely evident in His sending the Lord Jesus Christ to die for sin.

“The grace of God that bringeth salvation hath appeared to all men” (Titus 2:11).

“We trust in the living God, who is the Savior of all men, specially of those that believe” (1 Timothy 4:10).

This does not teach universalism -- that everyone will be saved.

It simply indicates that spiritual provision has been made for everyone. Since Jesus is God, His death had infinite value.

God saves people by His grace.

“He [Abram] believed in the LORD; and He [God] counted it to him for righteousness” (Genesis 15:5-6).

“Blessed is he whose transgression is forgiven, whose sin is covered. Blessed is the man unto whom the LORD imputeth not iniquity” (Psalm 32:1).

“To him that worketh is the reward not reckoned of grace, but of debt. But to him that worketh not, but believeth on Him that justifieth the ungodly, his faith is counted for righteousness . . . Therefore it is of faith, that it might be by grace” (Romans 4:5-6, 16).

“If [salvation is] by grace, then is it no more of works; otherwise grace is no more grace.
But if it be of works, then is it no more grace; otherwise work is no more work” (Romans 11:5-6).

“In whom [Jesus] we have redemption through His blood, the forgiveness of sins, according to the riches of His grace” (Ephesians 1:7).

“By grace are ye saved through faith; and that not of yourselves; it is the gift of God; not of works, lest any man should boast” (Ephesians 2:8-9).

God “hath saved us, and called us with an holy calling, not according to our works, but according to His own purpose and grace, which was given us in Christ Jesus before the world began” (2 Timothy 1:9).

The grace of God is the other side of the coin, so to speak, as compared to His mercy.

Mercy and grace function harmoniously and are expressions of God’s love.

1. In mercy, God withholds deserved punishment.

In grace, God freely bestows undeserved favor.

2. Mercy pardons; grace justifies.

“Who [Paul] was before a blasphemer, and a persecutor, and injurious; but I obtained mercy, because I did it ignorantly in unbelief” (1 Timothy 1:13).

“Being justified freely by His grace through the redemption that is in Christ Jesus” (Romans 3:24).

3. Mercy removes the guilt and penalty of sin; grace imputes righteousness.

“He that covereth his sins shall not prosper; but whoso confesseth and forsaketh them shall have mercy” (Proverbs 28:13).

“To him that worketh not, but believeth on him that justifieth the ungodly, his faith is counted for righteousness” (Romans 4:5).



Salvation from start to finish is associated with the grace of God and not mankind’s works.

Grace Works

God deals favorably with people God deals with people in a
in a way they do not deserve. way they deserve.

Grace is the only way sinners Salvation by works bars sinners
can be saved from sin. from salvation, for no one can be good enough.

Grace does not involve human merit, Human merit, worth, or works
worth, or works as causing, earning, in some way cause, earn,
or contributing to salvation or contribute to salvation.

The human response of faith allows The human response of works
God to work graciously, as He has makes a claim on God and compels
promised to do. God to fulfill His obligation.

Salvation is entirely God’s work; Salvation would be a cooperative
He receives all the credit and praise. endeavor of God and man, and thus both receive praise.

Being solely God’s work, Relying on man’s doing his part,
salvation by grace cannot fail. salvation by works would never be absolutely certain.


The term “grace” is used to characterize the present age, just as the term “law” is used to characterize the age from Mt. Sinai to Calvary.

“The law was given by Moses, but grace and truth came by Jesus Christ” (John 1:17).

Law Grace

God prohibiting and requiring God pleading and giving
(Exodus 20:1-17) (2 Corinthians 5:18, 21)

A ministry of condemnation A ministry of forgiveness
(Romans 3:19) (Ephesians 1:7)

Curses Redeems from the curse
(Galatians 3:10) (Galatians 3:13)

Kills Makes alive
(Romans 7:9, 11) (John 10:10)

Shuts every mouth before God Opens every mouth to praise God
(Romans 3:19) (Romans 10:9-10; Psalm 107:2)

Puts great distance between God and man Brings guilty people near to God
(Exodus 20:18-19) (Ephesians 2:13)

Says, “An eye for an eye . . .” Says, “Turn the other cheek”
(Exodus 21:24) (Matthew 5:39)

Says, “Do and live” Says, “Believe and live”
(Luke 10:28) (John 5:24)

Utterly condemns the best person Freely justifies the worst person who
(Philippians 3:4, 9) believes (Luke 23:24; Romans
5:6; 1 Timothy 1:15)

Is a system of probation Is a system of favor
(Galatians 3:23-25) (Ephesians 2:4-5)

Stones an adulteress Says, “Neither do I condemn thee”
(Deuteronomy 22:21) (John 8:10-11)

Sheep are sacrificed for the shepherd The Shepherd is sacrificed for the
(Leviticus 7:9; 1 Samuel 7:9) sheep (John 10:11)


Jesus’ death brought the end of the Mosaic law.

“Sin shall not have dominion over you; for ye are not under the law, but under grace” (Romans 6:14).

“Christ is the end of the law for righteousness to every one that believeth” (Romans 10:4).

“The law having a shadow of good things to come, and not the very image [reality] of the things, can never with those sacrifices which they offered year by year continually make the comers thereunto perfect. . . . Then said He [Jesus], Lo, I come to do Thy will, O God. He taketh away the first [the Old Testament sacrifices], that He may establish the second [the New Covenant]” (Hebrews 10:1, 9).

By itself, the law could not justify a sinner; therefore if people are to be justified, another way must be provided.

“By Him [Jesus] all that believe are justified from all things, from which ye could not be justified by the law of Moses” (Acts 3:39).

“By the deeds of the law there shall no flesh be justified in His [God’s] sight” (Romans 3:20).

“Knowing that a man is not justified by the works of the law, but by the faith of [in] Jesus Christ, even we have believed in Jesus Christ, that we might be justified by the faith of [in] Christ, and not by the works of the law: for by the works of the law shall no flesh be justified” (Galatians 2:16).

The law could show people their need for salvation, but it could not provide the answer to that need.

“Before faith came, we were kept under the law, shut [locked] up unto the faith which should afterwards be revealed. Wherefore the law was our schoolmaster to bring us unto Christ, that we might be justified by faith. But after that faith is come, we are no longer under a schoolmaster” (Galatians 3:23-25).

The death of Jesus was God’s provision to meet mankind’s need.

The Old Testament law reveals a sinful condition and condemns sinners as deserving death.

Grace provides a righteousness that sinners could never attain by themselves.

Links to Other Information About Sarcoidosis

Non-NHLBI Resources

• Neurosarcoidosis Information Page (National Institute of Neurological Disorders and Stroke)
• Sarcoidosis (MedlinePlus)

Clinical Trials

• Current Research (ClinicalTrials.gov)
• Patient Recruitment for Studies Conducted by NHLBI/NIH

Sarcoidosis key points

Key Points

• Sarcoidosis is a disease of unknown cause that leads to inflammation. It can affect various organs in the body.
• Sarcoidosis is more likely to occur in some organs than in others. The disease usually starts in the lungs, skin, and/or lymph nodes (especially the lymph nodes in your chest). The disease also often affects the eyes and the liver.
• In people who have sarcoidosis, immune system cells cause inflammation and cluster to form lumps called granulomas.
• If many granulomas form in an organ, they can affect how the organ works. This can cause signs and symptoms. Signs and symptoms vary depending on which organs are affected. Many people who have sarcoidosis have no symptoms or mild symptoms.
• Some researchers think that sarcoidosis develops when your immune system responds to a trigger, such as bacteria, viruses, dust, or chemicals. Genetics also may play a role in sarcoidosis.
• Sarcoidosis affects people of all ages and races. In the United States, the disease affects African Americans somewhat more often and more severely than Whites. The disease also is slightly more common in women than in men. It usually develops between the ages of 20 and 50.
• In both adults and children, the disease most often affects the lungs. If granulomas form in your lungs, you may wheeze, cough, feel short of breath, or have chest pain. Some people who have sarcoidosis feel very fatigued (tired), uneasy, or depressed. Night sweats and weight loss are common symptoms of the disease.
• Lofgren's syndrome is a classic set of signs and symptoms that appear in some people when they first develop sarcoidosis. Signs and symptoms may include fever, enlarged lymph nodes, arthritis, and erythema nodosum (a rash of red or reddish-purple bumps on your ankles).
• Your doctor will diagnose sarcoidosis based on your medical history, a physical exam, and the results from tests. He or she will look for granulomas (inflamed lumps) in your organs. Your doctor also will try to rule out other causes of your symptoms.
• Whether you need treatment and what type of treatment you need depend on your signs and symptoms, which organs are affected, and whether those organs are working well.
• Your doctor may prescribe topical treatments and/or medicines to treat the disease. Not everyone who has sarcoidosis needs treatment. In some cases, the disease goes away on its own.
• If the disease affects certain organs, such as your eyes, heart, or brain, you may need treatment even if you don't have any symptoms.
• Sarcoidosis has no cure. However, you can take steps to manage the disease. Get ongoing care and follow a healthy lifestyle. Talk to your doctor if you're pregnant or planning a pregnancy.
• Getting ongoing care is important, even if you don't take medicine for your sarcoidosis. New symptoms can occur at any time. Also, your condition can slowly worsen without your noticing.
• The outcome of sarcoidosis varies. Many people recover from the disease with few or no long-term problems.
• Rarely, sarcoidosis can be fatal. Death usually is the result of complications with the lungs, heart, or brain. Poor outcomes are more likely in people who have advanced disease and show little improvement from treatment.

Living With Sarcoidosis

Sarcoidosis has no cure. However, you can take steps to manage the disease. Get ongoing care and follow a healthy lifestyle. Talk to your doctor if you’re pregnant or planning a pregnancy.

Ongoing Care

Getting ongoing care is important, even if you don't take medicine for your sarcoidosis. New symptoms can occur at any time. Also, the disease can slowly worsen without your noticing.

How often you need to see your doctor will depend on how severe your symptoms are, which organs are affected, what treatments you're using, and whether you have any side effects from treatments. Even if you don’t have symptoms, you should see your doctor for ongoing care.

Your doctor may recommend routine tests, such as lung function tests and eye exams. He or she will want to check to make sure that the disease isn’t damaging your organs.

Discuss with your doctor how often you need to have followup visits. You may have some followup visits with your primary care doctor and others with one or more specialists.

Lifestyle Changes

Making lifestyle changes can help you manage your health. For example, follow a healthy diet and be as physically active as you can. A healthy diet includes a variety of fruits, vegetables, and whole grains.

It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar.

For more information on following a healthy diet, see the National Heart, Lung, and Blood Institute's Aim for a Healthy Weight Web site, "Your Guide to a Healthy Heart," and "Your Guide to Lowering Your Blood Pressure With DASH." All of these resources include general information about healthy eating.

If you smoke, quit. Talk to your doctor about program and products that can help you quit. Also, try to avoid other lung irritants, such as dust, chemicals, and secondhand smoke.

Emotional Issues

Living with a chronic disease may cause fear, anxiety, depression, and stress. It’s important to talk about how you feel with your health care team. Talking to a professional counselor also can help. If you’re feeling very depressed, your health care team or counselor may prescribe medicines to make you feel better.

Joining a patient support group may help you adjust to living with sarcoidosis. You can see how other people who have the disease have coped with it. Talk to your doctor about local support groups or check with an area medical center.

Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.

Pregnancy

Many women who have sarcoidosis give birth to healthy babies. Women who have severe sarcoidosis, especially if they’re older, may have trouble becoming pregnant. In some cases, sarcoidosis may get worse after the baby is delivered.

If you have sarcoidosis and are pregnant or planning a pregnancy, talk to your doctor about the risks. Also, if you become pregnant, it’s important to get good prenatal care and regular sarcoidosis checkups during and after pregnancy.

Some sarcoidosis medicines are considered safe to use during pregnancy; others are not recommended.

How Is Sarcoidosis Treated?

Not everyone who has sarcoidosis needs treatment. In some cases, the disease goes away on its own. Whether you need treatment and what type of treatment you need depend on your signs and symptoms, which organs are affected, and whether those organs are working well.

If the disease affects certain organs, such as your eyes, heart, or brain, you'll need treatment even if you don't have any symptoms.

In either case-whether you have symptoms or not-you should see your doctor for ongoing care. He or she will want to check to make sure that the disease isn't damaging your organs. For example, you may need lung function tests to make sure that your lungs continue to work well.

If the disease isn't worsening, your doctor may watch you closely to see whether the disease goes away on its own. If the disease does start to get worse, your doctor can prescribe treatment.

The goals of treatment are to:

• Relieve symptoms
• Improve organ function
• Control inflammation and reduce the size of granulomas (inflamed lumps)
• Prevent pulmonary fibrosis (lung scarring) if your lungs are affected

Your doctor may prescribe topical treatments and/or medicines to treat the disease.

Medicines

Prednisone

Prednisone, a type of steroid, is the main treatment for sarcoidosis. This medicine reduces inflammation. In most people, prednisone relieves symptoms within a couple of months.

Although most people need to take prednisone for 12 months or longer, your doctor may lower the dose within a few months after you start the medicine.

Long-term use of prednisone, especially at high doses, can cause serious side effects. Work with your doctor to decide whether the benefits of this medicine outweigh the risks. If your doctor prescribes this treatment, he or she will find the lowest dose that controls your disease.

When you stop taking prednisone, you should cut back slowly (as your doctor advises). This will help prevent flareups of sarcoidosis. Cutting back slowly also allows your body to adjust to not having the medicine.

If a relapse or flareup occurs after you stop taking prednisone, you may need a second round of treatment. If you remain stable for more than 1 year after stopping this treatment, the risk of relapse is low.

Other Medicines

Other medicines, besides prednisone, also are used to treat sarcoidosis. Examples include:

• Hydroxychloroquine. This medicine works best for treating sarcoidosis that affects the skin or brain. Your doctor also may prescribe this medicine if you have a high level of calcium in your blood due to sarcoidosis.
• Methotrexate. This medicine works best for treating sarcoidosis that affects your lungs, eyes, skin, or joints.

Your doctor may prescribe these medicines if your sarcoidosis worsens while you're taking prednisone or if you can't handle prednisone's side effects.

If you have Lofgren's syndrome with pain or fever, your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.

If you're wheezing and coughing, you may need inhaled medicine to help open your airways. You take inhaled medicine using an inhaler. This device allows the medicine to go right to your lungs.

Ongoing Research

Researchers continue to look for new and better treatments for sarcoidosis. They're currently studying treatments aimed at the immune system. Researchers also are studying antibiotics as a possible treatment for sarcoidosis that affects the skin.

Sarcoidosis, how is is diagnosed?

How Is Sarcoidosis Diagnosed?

Your doctor will diagnose sarcoidosis based on your medical history, a physical exam, and the results from tests. He or she will look for granulomas (inflamed lumps) in your organs. Your doctor also will try to rule out other causes of your symptoms.

Medical History

Your doctor may ask you detailed questions about your medical history. For example, he or she may ask whether you have a family history of sarcoidosis. Your doctor also may ask whether you've had any jobs that may have raised your risk for the disease.

Your doctor also may ask whether you've ever been exposed to inhaled beryllium metal. This type of metal is used to make aircrafts and weapons. Your doctor also may want to know whether you've had contact with organic dust from birds or hay.

Exposure to these substances can cause inflamed lumps in your lungs that look like the granulomas from sarcoidosis. However, these lumps are signs of other conditions.

Physical Exam

Your doctor will examine you for signs and symptoms of sarcoidosis. Signs and symptoms may include red bumps on your skin; swollen lymph nodes; an enlarged liver, spleen, or salivary glands; or redness in your eyes. He or she will check for other causes of your symptoms.

Your doctor also may listen to your lungs and heart. Abnormal breathing and heartbeat sounds may be a sign that sarcoidosis is affecting your lungs or heart.

Diagnostic Tests

You may have tests to confirm a diagnosis and to find out how the disease is affecting you. Tests include chest x ray, lung function tests, biopsy, and other tests to assess organ damage.

Chest X Ray

A chest x ray is a painless test that creates pictures of the structures inside your chest, such as your heart and lungs. The test may show granulomas or enlarged lymph nodes in your chest. About 95 percent of people who have sarcoidosis have an abnormal chest x ray.

Lung Function Tests

Lung function tests measure the size of your lungs, how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood. These tests may be used to find out whether sarcoidosis is affecting your lungs.

Biopsy

Your doctor may do a biopsy to confirm a diagnosis or rule out other causes of your symptoms. A biopsy involves taking a small sample of tissue from one of your affected organs.

Usually, doctors try to biopsy the organs that are easiest to access. Examples include the skin, tear glands, or the lymph nodes that are just under the skin.

If this isn't possible, your doctor may use a positron emission tomography (PET) scan to pinpoint areas for biopsy. For this test, a small amount of a radioactive substance is injected into a vein, usually in your arm.

The substance, which releases energy, travels through the blood and collects in organs or tissues. Special cameras detect the energy and convert it into three-dimensional pictures.

If lung function tests or a chest x ray shows signs of sarcoidosis in your lungs, your doctor may do a bronchoscopy (bron-KOS-ko-pee) to get a small sample of lung tissue.

During this procedure, a thin, flexible tube is passed through your nose (or sometimes your mouth), down your throat, and into the airways to reach your lung tissue. (For more information, see "What To Expect During Bronchoscopy.")

Other Tests To Assess Organ Damage

You also may have other tests to assess organ damage and find out whether you need treatment. For example, your doctor may recommend blood tests and/or an EKG (electrocardiogram).

Everyone who is diagnosed with sarcoidosis should see an ophthalmologist (eye specialist) for eye tests, even if they don't have eye symptoms. This is important because eye damage can occur without symptoms.

Sarcoidosis

Who Is At Risk for Sarcoidosis?

Sarcoidosis affects people of all ages and races. However, it's more common among African Americans and Northern Europeans. In the United States, the disease affects African Americans somewhat more often and more severely than Whites.

Studies have shown that sarcoidosis tends to vary in different ethnic groups. For example, eye problems due to the disease are more common in Japanese people.

Lofgren's syndrome, a type of sarcoidosis, is more common in people of European descent. Lofgren's syndrome may involve fever, enlarged lymph nodes, arthritis (usually in the ankles), and/or erythema nodosum. Erythema nodosum is a rash of red or reddish-purple bumps on your ankles and shins. The rash may be warm and tender to the touch.

Sarcoidosis is somewhat more common in women than in men. The disease usually develops between the ages of 20 and 50.

People who have certain jobs also may be at higher risk for sarcoidosis. Examples include:

• Health care workers
• Elementary and secondary school teachers
• People whose jobs expose them to agricultural dust, insecticides, pesticides, or mold
• Suppliers of building materials, hardware, or gardening materials
• Firefighters

People who have a family history of sarcoidosis also are at higher risk for the disease.

What Are the Signs and Symptoms of Sarcoidosis?

Many people who have sarcoidosis have no symptoms or mild symptoms. Often, the disease is found during a chest x ray done for another reason (for example, to diagnose pneumonia).

The signs and symptoms of sarcoidosis vary depending on which organs are affected. Signs and symptoms also may vary depending on your gender, age, and ethnic background. (For more information, see "Who Is At Risk for Sarcoidosis?")

Common Signs and Symptoms

In both adults and children, the disease most often affects the lungs. If granulomas (inflamed lumps) form in your lungs, you may wheeze, cough, feel short of breath, or have chest pain. Or, you may have no symptoms at all.

Some people who have sarcoidosis feel very fatigued (tired), uneasy, or depressed. Night sweats and weight loss are common symptoms of the disease.

Common signs and symptoms in children are fatigue, loss of appetite, weight loss, bone and joint pain, and anemia. Children who are younger than 4 years old may have a distinct form of sarcoidosis. It may cause enlarged lymph nodes in the chest (which can be seen on a chest x ray), skin lesions, and eye swelling or redness.

Other Signs and Symptoms

Sarcoidosis may affect your lymph nodes. The disease can cause enlarged lymph nodes that feel tender. Sarcoidosis usually affects the lymph nodes in your neck and chest. However, the disease also may affect the lymph nodes under your chin, in your armpits, or in your groin.

Sarcoidosis can cause lumps, ulcers, or areas of discolored skin. They may itch, but they don't hurt. These signs tend to appear on your back, arms, legs, and scalp. Sometimes they appear near your nose or eyes. These signs usually last a long time.

Sarcoidosis may cause a more serious skin condition called lupus pernio. Disfiguring skin sores may affect your nose, nasal passages, cheeks, ears, eyelids, and fingers. These sores tend to be ongoing. They can return after treatment is over.

Sarcoidosis also can cause eye problems. If you have sarcoidosis, it's important to have an annual eye exam. If you have changes in your vision and can't see as clearly or can't see color, call 9–1–1 or have someone drive you to the emergency room.

You should call your doctor if you have any new eye symptoms, such as burning, itching, tearing, pain, or sensitivity to light.

Signs and symptoms of sarcoidosis also may include an enlarged liver, spleen, or salivary glands.

Although less common, sarcoidosis can affect the heart and brain. This can cause a number of symptoms, such as abnormal heartbeats, shortness of breath, headaches, and vision problems. If sarcoidosis affects the heart or brain, serious complications can occur.

Lofgren's Syndrome

Lofgren's syndrome is a classic set of signs and symptoms that appear in some people when they first develop sarcoidosis. Signs and symptoms may include:

• Fever. This symptom only occurs in some people.
• Enlarged lymph nodes (which can be seen on a chest x ray).
• Arthritis, usually in the ankles. This symptom is more common in men.
• Erythema nodosum. This is a rash of red or reddish-purple bumps on your ankles and shins. The rash may be warm and tender to the touch. This symptom is more common in women.

Sarcoidosis Signs and Symptoms

The illustration shows the major signs and symptoms of sarcoidosis and the organs involved.

Sarcoidosis

What Is Sarcoidosis?

Sarcoidosis (sar-koy-DO-sis) is a disease of unknown cause that leads to inflammation. It can affect various organs in the body.

Normally, your immune system defends your body against foreign or harmful substances. For example, it sends special cells to protect organs that are in danger.

These cells release chemicals that recruit other cells to isolate and destroy the harmful substance. Inflammation occurs during this process. Once the harmful substance is destroyed, the cells and the inflammation go away.

In people who have sarcoidosis, the inflammation doesn't go away. Instead, some of the immune system cells cluster to form lumps called granulomas (gran-yu-LO-mas) in various organs in your body.

Overview

Sarcoidosis can affect any organ in your body. However, it's more likely to occur in some organs than in others. The disease usually starts in the lungs, skin, and/or lymph nodes (especially the lymph nodes in your chest).

The disease also often affects the eyes and the liver. Although less common, sarcoidosis can affect the heart and brain, leading to serious complications.

If many granulomas form in an organ, they can affect how the organ works. This can cause signs and symptoms. Signs and symptoms vary depending on which organs are affected. Many people who have sarcoidosis have no symptoms or mild symptoms.

Lofgren's syndrome is a classic set of signs and symptoms that is typical in some people who have sarcoidosis. Lofgren's syndrome may cause fever, enlarged lymph nodes, arthritis (usually in the ankles), and/or erythema nodosum (er-i-THE-ma no-DO-sum).

Erythema nodosum is a rash of red or reddish-purple bumps on your ankles and shins. The rash may be warm and tender to the touch.

Treatment for sarcoidosis also varies depending on which organs are affected. Your doctor may prescribe topical treatments and/or medicines to treat the disease. Not everyone who has sarcoidosis needs treatment.

Outlook

The outcome of sarcoidosis varies. Many people recover from the disease with few or no long-term problems.

More than half of the people who have sarcoidosis have remission within 3 years of diagnosis. "Remission" means the disease isn't active, but it can return.

Two-thirds of people who have the disease have remission within 10 years of diagnosis. People who have Lofgren's syndrome usually have remission. Relapse (return of the disease) 1 or more years after remission occurs in less than 5 percent of patients.

Sarcoidosis leads to organ damage in about one-third of the people diagnosed with the disease. Damage may occur over many years and involve more than one organ. Rarely, sarcoidosis can be fatal. Death usually is the result of complications with the lungs, heart, or brain.

Poor outcomes are more likely in people who have advanced disease and show little improvement from treatment.

Certain people are at higher risk for poor outcomes from chronic (long-term) sarcoidosis. This includes people who have lung scarring, heart or brain complications, or lupus pernio (LU-pus PAR-ne-o). Lupus pernio is a serious skin condition that sarcoidosis may cause.

Research is ongoing for new and better treatments for sarcoidosis.

What Causes Sarcoidosis?

The cause of sarcoidosis isn't known. More than one factor may play a role in causing the disease.

Some researchers think that sarcoidosis develops when your immune system responds to a trigger, such as bacteria, viruses, dust, or chemicals.

Normally, your immune system defends your body against foreign or harmful substances. For example, it sends special cells to protect organs that are in danger.

These cells release chemicals that recruit other cells to isolate and destroy the harmful substance. Inflammation occurs during this process. Once the harmful substance is destroyed, the cells and the inflammation go away.

In people who have sarcoidosis, the inflammation doesn't go away. Instead, some of the immune system cells cluster to form lumps called granulomas in various organs in your body.

Genetics also may play a role in sarcoidosis. Researchers believe that sarcoidosis occurs if:

• You have a certain gene (or certain genes) that raise your risk for the disease
• —And—
• You're exposed to something that triggers your immune system

Triggers may vary depending on your genetic makeup. Certain genes may influence which organs are affected and how severe your symptoms are.

Researchers continue to try to pinpoint the genes that are linked to sarcoidosis.

Did you ever think...................

When you are not looking for something, it shows up. Was it always there and I did not see it, or did God show me what was always there and I never seen it before?