Sarcoidosis
Treatment
Fortunately, many patients with sarcoidosis require no treatment.
Symptoms, after all, are usually not disabling and do tend to
disappear spontaneously. Most patients lead a normal life.
If you have sarcoidosis, you can help yourself by following sensible
health measures. You should not use tobacco (cigarettes, cigars,
pipes, chew, etc.). You should avoid exposure to dusts and chemicals
that can harm your lungs.
Patients with sarcoidosis are best treated by a lung specialist or a
doctor who has a special interest in sarcoidosis. If you have
sarcoidosis, see your doctor regularly so that the illness can be
watched and, if necessary, treated. If it heals naturally,
sarcoidosis is unlikely to recur. If you have had sarcoidosis, or
are suspected of having the illness but have no symptoms now, be
sure to have physical checkups every year, including an eye
examination.
Although severe sarcoidosis can reduce the chances of becoming
pregnant, particularly for older women, many young women with
sarcoidosis have given birth to healthy babies while on treatment.
Patients planning to have a baby should discuss the matter with
their doctor. Medical checkups all through pregnancy and immediately
thereafter are especially important for sarcoidosis patients. The
advice of your physician should be carefully followed. In some
cases, bed rest may be necessary during the last 3 months of
pregnancy.
When therapy is recommended, the main goal is to keep the lungs and
other affected body organs functional so that the patient may be
free of symptoms. The disease is considered inactive once symptoms
subside. After many years of experience, corticosteroids remain the
primary treatment for inflammation and granuloma formation.
Prednisone is probably the corticosteroid most often prescribed
today. Other steroids include methylprednisolone or medrol.
Currently, there is no treatment to reverse the fibrosis that may
already be present in advanced sarcoidosis.
Because sarcoidosis can disappear even without therapy, doctors
sometimes disagree on when to start the treatment, what does to
prescribe, and how long to continue corticosteroids. The doctor's
decision depends on the organ system involved and how far the
inflammation has progressed. If the disease appears to be
severe-especially in the lungs, eyes, heart, nervous system, spleen,
or kidneys the doctor may prescribe corticosteroids. Occasionally,
sarcoidosis patients may have elevated calcium levels in their
blood. When it does occur, the patient ay be advised to (1) avoid
calcium-rich foods, (2) vitamin D and, (3) sunlight, or (4) to take
prednisone; a corticosteroids that quickly reverses the condition.
Corticosteroid treatment usually results in improvement. Symptoms
may occur again when it is stopped. Treatment, therefore, may be
necessary for several years, sometimes for as long as the disease
remains active or to prevent relapse.
Frequent checkups are important so that the doctor can monitor the
illness and, if necessary, adjust treatment. Corticosteroids, for
example, can have side effects mood swings, swelling, and weight
gain because the treatment tends to make the body hold on to water;
high blood pressure; high blood sugar; and craving for food.
Long-term use can affect the stomach, skin, and bones. This
situation can bring on stomach pain, an ulcer, or acne, or cause the
loss of calcium from bones. However, if the corticosteroid is taken
in carefully prescribed, low doses, benefits from the treatment are
usually far greater than the problems.
Besides corticosteroids, various other drugs have been tried, but
their effectiveness has not been established in controlled studies.
These drugs include chloroquine and D-penicillamine. Several drugs
such as chlorambucil, methotrexate, and cyclophosphamide, which
might suppress alveolitis by killing the cells that produce
granulomas, have also been used. None has been evaluated in
controlled clinical trials, and the risk of using these drugs is
high, especially in pregnant women. Currently, these drugs are
considered when corticosteroids fail to control the disease.
Cyclosporine, a drug used widely in organ transplants to suppress
immune reaction, has been evaluated in one controlled trial. It was
found to be unsuccessful.
In addition to family and close friends, a number of local lung
organizations, other nonprofit health organizations, and self-help
groups are available to help patients with sarcoidosis (see section
below entitled For More Information). By keeping in touch with them,
you can share personal feelings and experiences. Members also share
specific information on the latest scientific advances and where to
find sarcoidosis specialists.
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