How Is Sarcoidosis Treated?
The goals of treatment 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.
When used at high doses, prednisone can cause
serious side effects.
Side effects can include:
- Weight gain.
- Diabetes.
- High blood pressure.
- Mood swings (depression).
- Difficulty sleeping at night.
- Heartburn.
- Acne.
- Thinning of the skin and bones (called
osteoporosis).
- Cataracts.
- Glaucoma.
- Adrenal gland insufficiency, which occurs when these glands
don't make enough of certain hormones. This requires treatment by an
endocrinologist (en"do-kri-nol'o-jist), a doctor who specializes in the
diagnosis and treatment of the
endocrine glands. The endocrine glands include your adrenal
and pituitary glands.
- Aseptic (a-sep'tik) or avascular (ah-vas'ku-lar)
necrosis (ne-kro'sis) of the hip, the development of cysts and hardened and
dead tissue in the hip.
Your doctor can usually help you manage
these 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.
Some drugs work better than others for
different people.
You may be given more than one drug.
Some drugs used to treat sarcoidosis
are taken by mouth. Others are applied locally to an affected area.
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.
Drugs can be used locally only if the
affected area is easily reached. For instance, inhaled steroids can ease
coughing and wheezing in the upper airways, but they don't seem to relieve
these symptoms when the affected lung tissue is deep within your chest.
Talk with your doctor about these
treatments and the side effects that may occur.
The other drugs used to treat
sarcoidosis include:
- Hydroxychloroquine (Plaquenil). This drug
can usually help people who have sarcoidosis in the skin or a high level of
calcium in their blood. This drug can irritate your stomach.
- It also can cause eye problems.
Before starting on this drug, you should see an ophthalmologist
(of"thal-mol'o-jist), or eye doctor, for some baseline tests. Once you start
taking it, you should have your eyes examined every 6 months.
- Methotrexate. This drug is taken once a
week by mouth or injection and usually takes up to 6 months to relieve
symptoms.
- This drug may cause side
effects, especially if you take high doses. These include:
- Nausea.
- Mouth sores.
- A decrease in infection-fighting white blood
cells. You then have a greater chance of getting an infection. If you take this
drug, you should have regular blood tests to check the levels of your white
blood cells.
- An allergic reaction in your lungs that goes
away when you stop taking the drug. This is extremely rare.
- Liver damage. This is the most serious side
effect. If you take methotrexate you should be followed regularly by your
physician.
If you are pregnant, you should not take this
drug.
- Taking folic acid can help you
reduce your chances of having bad side effects from methotrexate.
- Azathioprine (Imuran). This drug may work
in about half of the people who have sarcoidosis. You usually take it for at
least 6 months. Side effects include:
- Nausea
- Reduced white blood cell levels, which
increases your chances of getting an infection.
- This drug has caused cancer
in some people, especially when they have taken it at high doses.
- If you are pregnant, you
should not take this drug.
- Cyclophosphamide (Cytoxan). This is a very
toxic drug. It is rarely used to treat sarcoidosis. It is given only to people
who have serious forms of sarcoidosis, such as sarcoidosis in their central
nervous system (neurosarcoidosis).
- This drug is more likely to
cause nausea and reduce your white blood cell levels than either methotrexate
or azathioprine. Your doctor should check your white blood cell levels often
while you are taking this drug to make sure you have a high enough level to
fight infection.
- Cyclophosphamide can also
irritate your bladder. Some people who have taken it for more than 2 years have
developed bladder cancer.
- If you are pregnant, you should
not take this drug.
- Cyclophosphamide can be given
intravenously (through one of your veins), which lessens some of its side
effects, but this doesn't reduce the risk of cancer.
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.
- Followup care includes regular
blood tests to find out how well your liver is working. You should check with
your doctor to find out how often you need these tests.
- 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.
- If you have a severe heart
rhythm disturbance, your doctor may prescribe one of these devices:
- A cardiac pacemaker, a small battery-operated
device, often put under your skin, that regulates your heartbeat
- A defibrillator, an implanted device that
shocks your heart into a normal heartbeat or, if it has stopped, into beating.
If your heart is severely affected and doesn't
respond to treatment, a transplant may be done. But this is rarely needed.
- 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.
Because sarcoidosis varies so much
among different people, your doctor may find it hard to tell whether the
treatment is helping.
Other Drugs Being Studied for Possible
Use in Treating Sarcoidosis
Scientists also are studying drugs that
are used for other conditions to see if they can help people who have
sarcoidosis. These drugs include:
- Etanercept (Enbrel). This drug is an
immune system suppressant. It's injected under the skin to reduce symptoms of
rheumatoid arthritis. It may also be used to treat
psoriasis (so-ri'ah-sis) or
ankylosing spondylitis (ang"ki-lo'sing spon"di-li'tis), a type
of arthritis that affects the joints in the spine. Early studies suggest that
it will not be useful in treating sarcoidosis, but research is ongoing.
- Infliximab (Remicaide). This drug is an
immune system suppressant. It's injected into a vein in your arm. It's used to
treat
Crohn's Disease, rheumatoid arthritis, and ankylosing
spondylitis. Some studies have shown it to help sarcoidosis patients who also
have lupus pernio, eye disease, or neurosarcoidosis. This drug has serious side
effects but may improve lung function in some people who aren't helped by
corticosteroids. More research is needed.
- Pentoxifylline. This drug is an immune
system suppressant. Stomach and gastrointestinal side effects are common. Early
studies show that it has helped some people who have sarcoidosis in their lungs
reduce their doses of prednisone while taking it. More research is needed.
- Tetracycline. Tetracycline antibiotics
are used to treat
Lyme Disease, some types of pneumonia, and acne. A few small
studies suggest that they may help in treating sarcoidosis in the skin.
Research is ongoing.
- Thalidomide. This immune system
suppressant can cause bad side effects. It is effective against other
conditions that involve granulomas of the skin (e.g.,
leprosy, tuberculosis). Scientists are studying this drug to
see if it can be used to treat sarcoidosis in the skin. More studies are
needed.
What Does the Future Hold?
Scientists worldwide are trying to
learn more about sarcoidosis and how to improve its diagnosis and treatment.
Some recent studies have led to possible new treatments, which, in turn, are
being studied. Current research includes studies of:
- The agent or agents that cause sarcoidosis
- Why sarcoidosis seems to act differently in
people of different races
- Why sarcoidosis appears in some families
- How genes, passed from one generation to
another, may make some people more likely than others to develop sarcoidosis
- How cells act and communicate with each other to
cause sarcoidosis symptoms.
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