How Is Sarcoidosis Treated?
Not everyone who has sarcoidosis needs treatment. Sometimes the disease goes away on its own. Whether you need treatment and what type of treatment you need depend on your signs and symptoms, which organs are affected, and whether those organs are working well.
If the disease affects certain organs—such as your eyes, heart, or brain—you’ll need treatment even if you don’t have any symptoms.
In either case, whether you have symptoms or not, you should see your doctor for ongoing care. He or she will want to check to make sure that the disease isn’t damaging your organs. For example, you may need routine lung function tests to make sure that your lungs are working well.
If the disease isn’t worsening, your doctor may watch you closely to see whether the disease goes away on its own. If the disease does start to get worse, your doctor can prescribe treatment.
The goals of treatment include:
- Relieving symptoms
- Improving organ function
- Controlling inflammation and reducing the size of granulomas (inflamed lumps)
- Preventing pulmonary fibrosis (lung scarring) if your lungs are affected
Your doctor may prescribe topical treatments and/or medicines to treat the disease.
Prednisone, a type of steroid, is the main treatment for sarcoidosis. This medicine reduces inflammation. In most people, prednisone relieves symptoms within a couple of months.
Although most people need to take prednisone for 12 months or longer, your doctor may lower the dose within a few months after you start the medicine.
Long-term use of prednisone, especially at high doses, can cause serious side effects. Work with your doctor to decide whether the benefits of this medicine outweigh the risks. If your doctor prescribes this treatment, he or she will find the lowest dose that controls your disease.
When you stop taking prednisone, you should cut back slowly (as your doctor advises). This will help prevent flareups of sarcoidosis. Cutting back slowly also allows your body to adjust to not having the medicine.
If a relapse or flareup occurs after you stop taking prednisone, you may need a second round of treatment. If you remain stable for more than 1 year after stopping this treatment, the risk of relapse is low.
Other medicines, besides prednisone, also are used to treat sarcoidosis. Examples include:
- Hydroxychloroquine or chloroquine (known as antimalarial medicines). These medicines work best for treating sarcoidosis that affects the skin or brain. Your doctor also may prescribe an antimalarial if you have a high level of calcium in your blood due to sarcoidosis.
- Medicines that suppress the immune system, such as methotrexate, azathioprine, or leflunomide. These medicines work best for treating sarcoidosis that affects your lungs, eyes, skin, or joints.
Your doctor may prescribe these medicines if your sarcoidosis worsens while you’re taking prednisone or if you can’t handle prednisone’s side effects.
If you have
Lofgren’s syndrome with pain or fever, your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
If you’re wheezing and coughing, you may need inhaled medicine to help open your airways. You take inhaled medicine using an inhaler. This device allows the medicine to go straight to your lungs.
Anti-tumor necrosis factor drugs, originally developed to treat arthritis, are now being studied.
Semin Respir Crit Care Med. 2010;31(4):452-462.
Abstract and Introduction
Ocular disease occurs in approximately a third of sarcoidosis patients. The rate of disease varies around the world, with Japanese sarcoidosis patients having ocular disease in more than 70% of cases. If untreated, ocular disease can lead to permanent visual impairment, including blindness. The most common manifestation is uveitis, with anterior involvement often being self-limiting, whereas posterior involvement can be chronic. The diagnosis of ocular sarcoidosis in patients with known sarcoidosis usually requires a specific examination by an ophthalmologist. For patients presenting with uveitis of unknown etiology, criteria have been proposed for diagnosing ocular sarcoidosis. The treatment of ocular disease ranges from topical therapy to systemic treatments such as methotrexate. Recent reports have demonstrated that monoclonal antibodies blocking tumor necrosis factor can be quite effective for chronic refractory ocular sarcoidosis.
Ocular disease is an important manifestation of sarcoidosis. If the inflammatory changes are treated quickly and effectively, vision loss can be reversed and blindness prevented.[2, 3] Some patients with newly diagnosed ocular sarcoidosis may have known sarcoidosis due to other organ involvement such as hilar adenopathy with positive bronchoscopy for noncaseating granulomas. However, other patients may present with de novo ocular findings suggestive of sarcoidosis but without obvious extraocular disease. Because ocular disease may be the first manifestation of sarcoidosis, physicians should adapt a multidisciplinary approach to evaluating uveitis. In one large study over half of patients referred for uveitis were found to have an underlying systemic disease, with sarcoidosis being the most common disease identified.