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.