Treatment of sarcoidosis

Treatment of sarcoidosis

Immune suppression, and in more severe cases immune cytotoxicity, is the main goal in treatment of sarcoidosis. However, between 30 and 70% of patients do not require therapy. Mild symptoms can be sufficiently treated with NSAIDs. Corticosteroids, most commonly prednisone, have been the standard treatment for many years. In some patients, this treatment can slow or reverse the course of the disease, but other patients do not respond to steroid therapy. Corticosteroids are known for their dose- and duration-related side effects and their use is generally limited to severe, progressive, or organ-threatening disease. When the disease resolves, the dose of can be tapered down slowly and eventually the corticosteroid can be discontinued.

Moderate symptoms might benefit from additional hydrochloroquine(Plaquenil®) therapy. This drug originates from the treatment of Malaria. More severe disease states require addition of stronger immunosuppressants which are cytotoxic. The alkylating drug cyclophosphamide (Endoxan®),

methotrexate and azathioprine are often used.

When these immunosuppressants fail, there are a few data on treatment with the anti-tumor necrosis factor-alpha (anti-TNFα, infliximab). However, there is some controversy about the therapy with anti-TNF: side effects such as an increased risk of reactivating latent tuberculosis. Moreover, anti-TNF treatment with etanercept (used in rheumatoid arthritis) has been observed to cause sarcoidosis.

Because sarcoidosis can affect multiple organ systems, follow-up on a patient with sarcoidosis should always include an electrocardiogram, ocular examination by an ophthalmologist, liver function tests, serum calcium and 24-hour urine calcium. In female patients close surveillance of thyroid function is recommended.