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Sarcoidosis Diagnosis Treatment

The goals of treatment for sarcoidosis are to:

  • Improve how the organs affected by sarcoidosis work
  • Relieve symptoms
  • Shrink the granulomas.

Treatment may shrink the granulomas and even cause them to disappear, but this may take many months. If scars have formed, treatment may not help, and you may have ongoing symptoms.

Your treatment depends on:

  • What symptoms you have
  • How severe your symptoms are
  • Whether any of your vital organs (e.g., your lungs, eyes, heart, or brain) are affected
  • How the organ is affected.

Some organs must be treated, regardless of your symptoms. Others may not need to be treated. Usually, if you don't have symptoms, you don't need treatment, and you probably will recover in time.

Drugs

The main treatment for sarcoidosis is prednisone. Prednisone is a corticosteroid, or anti-inflammatory drug. Sometimes it is used with other drugs. Sometimes other corticosteroids are used.

Prednisone almost always relieves symptoms of inflammation. If a symptom doesn't improve with prednisone treatment within a couple of months, consult your physician.

Prednisone is usually given for many months, sometimes for a year or more. Low doses of prednisone can often relieve symptoms without causing major side effects, but high doses can cause serious side effects.

When it is time to stop taking prednisone, you should cut back slowly, with your doctor's help. This will help prevent flare-ups of sarcoidosis and allow your body to adjust to life without the drug.

You may also want to see an endocrinologist to make sure that your endocrine glands are making enough hormones. The endocrinologist may prescribe certain hormones for you to take until your endocrine glands are working well again.

Other Drugs Used To Treat Sarcoidosis

Other drugs are sometimes used to treat sarcoidosis. Your doctor may prescribe one of them if:

  • Your condition gets worse while you are taking prednisone
  • You can't stand the side effects of prednisone.

Most of these other drugs are immune system suppressants. This means that they prevent your immune system from fighting things like bacteria and viruses. As a result, you may have a greater chance of getting infections.

Most of these drugs also can cause serious side effects. Some also could increase your chances of getting cancer, especially if you take them at high doses. You and your doctor must weigh living with the symptoms of sarcoidosis against the side effects of the drugs.

Local therapy is the safest way to treat sarcoidosis. The drug is applied directly to the affected area. As a result, only small amounts of the drug reach other parts of your body.

Drugs used for local therapy include:

  • Eye drops
  • Inhaled drugs for your lungs
  • Skin creams.

The other drugs used to treat sarcoidosis include:

  • Hydroxychloroquine
  • Methotrexate
  • Azathioprine
  • Cyclophosphamide
Treatments for Specific Types of Sarcoidosis

Eyes. Sarcoidosis in your eyes almost always responds well to treatment. Often, the only treatment you need is eye drops containing corticosteroids. You should have yearly eye exams, even if you think your eyes are doing well.

Spleen. Sarcoidosis can cause your spleen to become larger. This can lead to a decrease in your red or white blood cells or platelets and increase your chances of infection and blood clotting disorders. Treatment is usually given to increase the number of your blood cells and ease your pain. In rare cases, your spleen may need to be removed.

Liver. Sarcoidosis rarely causes permanent liver damage. As a result, your liver usually isn't treated unless it's causing major symptoms (e.g., fever). Drug treatment can usually reduce granulomas in your liver. Liver transplantation has been successful in those rare cases in which the condition has become worse.

Nervous system. Sarcoidosis in your nervous system (neurosarcoidosis) usually needs treatment. Nerve tissue heals slowly, so treatment often takes a long time. You may need to take several drugs at high doses.

Erythema nodosum. These painful bumps on your shins often go away in weeks to months without treatment. Your doctor probably will not give you medication unless you are very uncomfortable. Aspirin or ibuprofen, an anti-inflammatory drug that you can buy without a prescription, will usually help.

Heart. Sarcoidosis in your heart is usually treated with steroids. You may also be given heart drugs to improve your heart's pumping ability or to correct a disturbed heart rhythm.

Lupus Pernio. This rash on your face, especially your cheeks and nose, can be distressing because it's in a very visible area. It often occurs with loss of your sense of smell, nasal stuffiness, and sinus infections. Options for treatment include:

  • Local treatment with skin creams
  • Oral drugs (plaquenil or prednisone, for example)
  • Local injections of steroid preparations.

Lupus pernio is often treated by dermatologists, doctors who specialize in skin diseases, working with a sarcoidosis specialist.

 

Reference:

National Heart, Lung, and Blood Institute, USA.