Because no causes of sarcoidosis are known, there are no known methods of prevention. However, many patients do not need treatment. In fact, according to the National Institutes of Health (NIH), up to 60 percent receive no treatment. When treatment is used, its goal is to control symptoms, improve the function of the affected organs and shrink the granulomas.
Sarcoidosis is typically treated only when symptoms are severe or if critical organs (e.g., heart, eyes, kidneys, central nervous system) are involved. Treatment is usually restricted to the most minimal forms that control symptoms and prevent serious complications. Even patients who require treatment can typically lead normal lives with no lasting disability. Treatment also depends on which organ system is involved.
In many cases, sarcoidosis improves or clears up spontaneously, with or without treatment. The granulomas (collections of inflammatory cells) go away, either disappearing or becoming scar tissue. In some cases, however, the scars may remain with or without treatment and symptoms may never go away. An affected organ may continue to function poorly. In rarer cases, symptoms continue to worsen and organ function continues to degrade.
The likelihood for full recovery is better when sarcoidosis has not spread beyond the chest, particularly if enlarged lymph nodes are present in the chest but there are no signs of lung disease. Chances are typically best when the disease begins with erythema nodosum (warm, tender, discolored bumps on the shins). Relapse occurs in about half of all sarcoidosis cases, both acute and chronic. Patients who experience spontaneous remissions (those without treatment) usually do not relapse. Patients whose remissions were induced by medications have a high rate of relapse. Spontaneous remission usually occurs within two to three years.
Very few instances of sarcoidosis lead to serious disability. When disability occurs, it is usually due to damage to the eyes (sometimes leading to blindness) or damage to the respiratory system. Damage elsewhere, such as in the heart or kidneys, can also cause serious problems. Fatalities are very rare, both in the acute and chronic forms of sarcoidosis. Lung scarring leading to respiratory failure is the most common cause of death, followed by bleeding caused by lung infections.
Sarcoidosis is typically actively monitored during and after treatment and when treatment is not required. Pulmonary function (breathing) tests are the most common method of monitoring the disease when it affects the lungs, but chest x-rays may also be used. Blood tests monitoring levels of calcium and enzyme tests measuring angiotensin-converting enzyme (ACE) are commonly used. Frequent eye tests are used to catch the possible development of sarcoidosis in the eyes and to monitor the disease when already present. These monitoring tests are also repeated regularly to detect relapses. Routine follow-up care typically lasts for two to three years.
Because most medications used for sarcoidosis suppress the immune system, patients may be more likely to get sick from an infection. Local therapy is typically the safest way to treat the disease because only the affected area is exposed to the drug. However, local therapy is possible only if the affected area can be easily reached. Drops and creams may be used for the eyes and skin. The eyes almost always respond well to treatment. Inhalers may be used to help with affected lung tissue but may not reach deep lung tissues.
Sarcoidosis typically does not increase chances of complications during pregnancy for the baby or the mother. The disease often improves during pregnancy and worsens after delivery.
When treatment is necessary, it is accomplished by means of medication. The medications that may be used include:
* Nonsteroidal anti-inflammatory drugs (NSAIDs), sometimes including COX-2 inhibitors. May be used in acute, minor cases.
* Corticosteroids. The main treatment for sarcoidosis. These may be given to suppress severe symptoms (e.g., shortness of breath, joint pain) that may occur when there are high levels of calcium, the heart, liver or nervous system is affected, or lung disease continues to worsen. Patients without symptoms typically do not take corticosteroids. These drugs control symptoms well but do not prevent lung scarring in chronic disease. They almost always relieve symptoms due to inflammation. However, there are some rare cases where patients do not respond to corticosteroids.
Corticosteroid treatment cannot be suddenly halted and usually lasts for several Osteoporosis involves the bones becoming thin, brittle and more prone to fracture, causing pain.months or even years in rare cases. Relapse is common but may depend on how quickly treatment was stopped. Longtime use of corticosteroids may have serious side effects, such as diabetes, glaucoma, cataracts or osteoporosis.
* Disease-modifying anti-rheumatic drugs (DMARDs). When corticosteroids are not effective, the patient may be switched to DMARDs, such as methotrexate. According to the National Institutes of Health, methotrexate works in 60 to 80 percent of patients with sarcoidosis. However, it is required for up to six months or more to relieve symptoms and may cause side effects, including an increased risk of infection, liver damage, and damage to fetuses. Another type of DMARD, hydroxychloroquine, is also effective in some patients with sarcoidosis. It is more likely to be effective if the disease has affected the skin or there is a high level of calcium in the blood. It may be helpful in eliminating skin lesions.
When sarcoidosis affects the heart, arrhythmia (irregularities in the heartbeat) may be present. Cardiac devices to regulate the heartbeat may be implanted under the skin. These include pacemakers and defibrillators.
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