Sarcoidosis patients with active inflammation and organ involvement have a high likelihood of fatigue. This can be due to both the underlying disease and side effects of common medications. An example would be corticosteroids, which are a first-line option in sarcoidosis and regularly lead to weight gain, diabetes, sleep apnoea, and exacerbation of fatigue.1
In addition, there are other conditions that can also cause fatigue and are common in sarcoidosis patients, such as depression, anxiety, thyroid dysfunction, anaemia, diabetes, sleep apnoea and lifestyle factors (alcohol or drug use, lack of or excessive exercise, poor sleep, certain medications, unhealthy diet).1
The therapeutic management of fatigue is considered equally difficult. The current prospective clinical trial TIRED therefore investigated the efficacy of Mindfulness-Based Cognitive Therapy (MBCT).2,3 Adults with stable sarcoidosis and fatigue (defined as a Fatigue Assessment Scale or FAS > 21) from three centres in the Netherlands were randomly assigned to either online MBCT (n = 46) or the control group (n = 47).
At baseline, the FAS score in the MBCT group was 34.57 (analogue 35.51 in the control group). FAS scores between 10 and 21 mean no fatigue (normal), scores between 22 and 50 correspond to relevant fatigue, with scores ≥ 35 as extreme fatigue. A change of at least 4 points or 10% from baseline is considered clinically important (minimal clinically important difference or MCID).4
After 12 weeks, FAS scores had decreased by -4.53 in the MBCT group (versus -1.28 in the control group; p = 0.0025). MBCT participants also experienced statistically significant improvements in anxiety and depression, mindfulness, and health compared to the control group (all of which had been evaluated using standardised tests).
The study authors conclude that implementing a 12-week mindfulness-based therapy can improve sarcoidosis-associated fatigue, anxiety, depressive symptomatology, mindfulness and health status.
If other causes, such as those listed above, are treated or ruled out and fatigue still persists, it is likely to be sarcoidosis-related fatigue. The Foundation for Sarcoidosis Research (FSR) also recommends: "Dietary optimisation, good sleep habits, weight reduction and exercise have been shown to improve symptoms in people with sarcoidosis".1 Experience has shown that most questions arise about the first point.
Finally, two books that are densely packed with practical, evidence-based advice, are recommended: The Autoimmune Fix by Tom O'Bryan and Eat for Energy: How to Beat Fatigue, Supercharge Your Mitochondria, and Unlock All-Day Energy by Ari Whitten. They provide an understanding of the cellular causes of chronic fatigue, burnout, and cognitive performance loss, and address aspects such as intestinal inflammation, its contribution to autoimmune diseases, gut barrier repair, and many other topics important in this context.