Sarcoidosis is a chronic inflammatory disease characterised by the formation of granulomas — small collections of immune cells in various organs of the body, most commonly the lungs and lymph nodes. While the exact cause of sarcoidosis remains unknown, it is believed to result from an abnormal immune response to an unidentified trigger, possibly involving genetic, environmental, and infectious factors. Sarcoidosis most

commonly involves the lungs, lymph nodes, skin, eyes, and liver. 

Symptoms of sarcoidosis

Symptoms vary widely depending on the organs involved and may include cough, shortness of breath, chest pain, fatigue, skin rashes, joint pain, vision changes, and constitutional symptoms such as fever and weight loss.¹ Fatigue is a common and debilitating symptom of sarcoidosis, impacting patients' quality of life and daily functioning. Fatigue is reported by up to 70-80% of sarcoidosis patients, making it one of the most prevalent and distressing symptoms of the disease.²

Sarcoidosis-related fatigue

Sarcoidosis-related fatigue can significantly impair the patient’s physical, cognitive, and emotional functioning, leading to decreased productivity, social withdrawal, and decreased overall well-being.³

The exact mechanisms underlying fatigue in sarcoidosis are not fully understood but are believed to involve a complex interplay of factors, including inflammation, dysregulation of the immune system, autonomic dysfunction, sleep disturbances, deconditioning, and psychological factors such as depression and anxiety.⁴ Chronic inflammation, a hallmark feature of sarcoidosis, may contribute to fatigue by triggering cytokine release and altering neurotransmitter pathways involved in regulating energy levels and mood.⁵

Sarcoidosis-related fatigue is often described as overwhelming and disproportionate to the level of physical activity or exertion. Patients may experience persistent feelings of tiredness, weakness, exhaustion, and a lack of energy, which can fluctuate throughout the day and may not improve with rest or sleep. Fatigue has a profound negative impact on various aspects of sarcoidosis patients’ quality of life, including physical functioning, social interactions, emotional well-being, and work or school performance. Patients with sarcoidosis-related fatigue report higher levels of disability, greater healthcare utilisation, increased rates of unemployment, and poorer overall health status compared to those without fatigue.⁶

Managing fatigue associated with sarcoidosis involves a multifaceted approach that combines medical treatment, lifestyle modifications, and self-care strategies. It’s important for individuals with sarcoidosis-related fatigue to have a comprehensive management plan tailored to their specific needs and preferences developed by healthcare providers. Treatment

strategies may include pharmacological interventions (e.g., corticosteroids, antidepressants), lifestyle modifications (e.g., exercise, sleep hygiene), energy conservation techniques, stress management, and psychosocial support.

In conclusion, sarcoidosis-related fatigue is a complex and multifaceted symptom that significantly impacts patients' quality of life and requires comprehensive management strategies to address its diverse underlying mechanisms and optimise patient outcomes.

Following evidence-based practices can be recommended to manage fatigue associated with sarcoidosis:

Healthcare administration

• Medication: To control inflammation and treat sarcoidosis symptoms, such as fatigue, doctors may occasionally administer immunosuppressive medications or corticosteroids (such as prednisone).²
• Symptom-Specific Treatments: Reducing symptoms including pain, depression, and sleep difficulties that are frequently linked to sarcoidosis can help reduce fatigue.²

Physical activity and exercise

• Gradual Exercise Programme: Engaging in a structured and gradual exercise program tailored to individual abilities can help improve energy levels and reduce fatigue in sarcoidosis patients. Exercises should include whole body stretching especially large group muscles and strengthening exercises.³
• Aerobic Exercise: Moderate-intensity aerobic exercise, such as walking, treadmill, jogging, swimming, or cycling, has been shown to be beneficial for managing fatigue and improving overall well-being in sarcoidosis patients. Incorporate moderate-intensity aerobic exercise into the routine, aiming for at least 150 minutes per week, as tolerated. Aerobic activity has been shown to enhance cardiovascular health, increase vigour, and lessen weariness.
• Strength Training: To increase muscle strength, endurance, and general functional capacity, incorporate strength training routines that focus on the major muscle groups. . Include strength training regimens that target the main muscle groups in order to improve overall functional ability, muscle strength, and endurance. Start with light weights or resistance bands and gradually progress as strength improves.⁴

Energy conservation strategies

• Pacing Activities: You can preserve energy and avoid overexertion, which reduces weariness, by dividing work into smaller, more manageable tasks, and scheduling regular rest intervals. Taking frequent and long rest periods between routine work or exercises will help prevent fatigue.⁵
• Prioritising Activities: Plan activities ahead of time, and prioritise tasks based on importance and energy levels. Allocate energy resources wisely and avoid overcommitting to avoid fatigue. Managing energy levels and reducing weariness can be achieved by assigning non-essential work to others and concentrating on fun or vital activities.⁶
• Use Assistive Devices: Use assistive devices or adaptive equipment to reduce physical strain and make tasks easier to perform. Examples include bathing on a shower chair or moving large objects with a motorised cart.⁶

Stress management and relaxation techniques

• Mindfulness and Meditation: Using strategies based on mindfulness. For those experiencing exhaustion associated with sarcoidosis, Jacobson's progressive muscular relaxation or meditation can help lower stress, strengthen coping skills, and increase general energy levels. Incorporate mindfulness meditation into daily routines to increase awareness of the present moment, reduce negative thoughts, and enhance overall well-being. Practice mindfulness exercises such as body scans, mindful breathing, or guided imagery.⁷
• Deep Breathing Exercises: Relaxation and fatigue relief can be achieved by including gradual muscular relaxation exercises or deep breathing exercises into daily routines.⁸
• Progressive Muscle Relaxation (PMR): Perform PMR exercises to systematically tense and relax different muscle groups in the body, promoting physical and mental relaxation.⁸

Sleep hygiene

• Establishing a Sleep Routine: Maintaining a consistent sleep schedule and creating a restful sleep environment can improve sleep quality and reduce fatigue in sarcoidosis patients. ⁹
• Avoiding Stimulants: Limiting caffeine, nicotine, and alcohol consumption, particularly close to bedtime, can help promote better sleep hygiene and alleviate fatigue.¹⁰

Nutrition

• Balanced Diet: For those with sarcoidosis, eating a balanced diet full of fruits, vegetables, whole grains, lean meats, and healthy fats will help sustain overall energy levels and supply vital nutrients.¹¹
• Hydration: Staying adequately hydrated by drinking plenty of water throughout the day can help prevent dehydration-related fatigue and maintain optimal bodily functions.¹²

Social support

• Joining a support group or making connections with people who have gone through similar things can offer people encouragement, helpful advice, and emotional support to help them deal with the weariness and other difficulties brought on by sarcoidosis.¹²

Summary of sarcoidosis and fatigue management

Sarcoidosis is a chronic inflammatory disease that often leads to debilitating fatigue, affecting up to 70-80% of patients. This fatigue can stem from a complex interplay of factors, including inflammation, immune dysregulation, sleep disturbances, and psychological stress. Managing sarcoidosis-related fatigue requires a multifaceted approach, including:

1. Medical Treatment: Use of corticosteroids and symptom-specific therapies to manage inflammation and related symptoms.
2. Physical Activity: Implementing a structured exercise program that includes aerobic and strength training to improve energy levels and overall well-being.
3. Energy Conservation: Utilizing pacing techniques, prioritizing tasks, and using assistive devices to manage daily activities and prevent overexertion.
4. Stress Management: Incorporating mindfulness, meditation, and relaxation techniques to reduce stress and enhance coping skills.
5. Sleep Hygiene: Establishing a consistent sleep routine and minimizing stimulants to improve sleep quality.
6. Nutrition: Maintaining a balanced diet and staying hydrated to support overall health and energy levels.
7. Social Support: Engaging with support groups to foster connections and share experiences with others facing similar challenges.

A comprehensive management plan tailored to individual needs can significantly enhance the quality of life for those dealing with sarcoidosis-related fatigue.