Sarcoidosis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Roshan Dinparasti Saleh M.D.

Overview

Most sarcoidosis patients experience disease remission within the first 3 years of diagnosis with no long-term complications but one-third of patients have persistent disease, which causes organ failure. The treatment requires consideration of sarcoidosis-related complications and treatment side effects.

Medical Therapy

Most sarcoidosis patients experience disease remission within the first 3 years of diagnosis with no long-term complications but one-third of patients have persistent disease, which causes organ failure. The treatment requires consideration of sarcoidosis-related complications and treatment side effects.[1][2]

Not all patients require therapy at first[3][4][5]. The decision to treat the patients is based on symptoms and organ function impairment[4]

  • Infliximab is effective against refractory cases of pulmonary, lupus pernio, eye, and neurologic disease[22][23][24]

References

  1. Baughman RP, Nunes H: Therapy for sarcoidosis: evidence-based recommendations. Expert Rev Clin Immunol 8(1):95–103, 2012.
  2. Guyatt G, Gutterman D, Baumann MH, et al: Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians task force. Chest 129(1):174–181, 2006.
  3. Gibson GJ, Prescott RJ, Muers MF, et al: British Thoracic Society Sarcoidosis study: effects of long term corticosteroid treatment. Thorax 51(3):238–247, 1996.
  4. 4.0 4.1 Baughman RP, Judson MA, Teirstein AS, et al: Presenting characteristics as predictors of duration of treatment for sarcoidosis. QJM 99(5):307–315, 2006.
  5. Hunninghake GW, Gilbert S, Pueringer R, et al: Outcome of the treatment for sarcoidosis. Am J Respir Crit Care Med 149(4 Pt 1):893–898, 1994.
  6. Baughman RP, Nunes H, Sweiss NJ, Lower EE: Established and experimental medical therapy of pulmonary sarcoidosis. Eur Respir J 41:1424–1438, 2013
  7. Paramothayan S, Jones PW: Corticosteroid therapy in pulmonary sarcoidosis: a systematic review. JAMA 287:1301–1307, 2002.
  8. Schutt AC, Bullington WM, Judson MA: Pharmacotherapy for pulmonary sarcoidosis: a Delphi consensus study. Respir Med 104(5):717–723, 2010.
  9. Baughman RP, Meyer KC, Nathanson I, et al: Monitoring of nonsteroidal immunosuppressive drugs in patients with lung disease and lung transplant recipients: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 142(5):e1S–e111S, 2012.
  10. Siltzbach LE, Teirstein AS: Chloroquine therapy in 43 patients with intrathoracic and cutaneous sarcoidosis. Acta Med Scand 425:302S–308S, 1964.
  11. Baltzan M, Mehta S, Kirkham TH, Cosio MG: Randomized trial of prolonged chloroquine therapy in advanced pulmonary sarcoidosis. Am J Respir Crit Care Med 160(1):192–197, 1999.
  12. Adams JS, Diz MM, Sharma OP: Effective reduction in the serum 1,25-dihydroxyvitamin D and calcium concentration in sarcoidosisassociated hypercalcemia with short-course chloroquine therapy. Ann Intern Med 111(5):437–438, 1989.
  13. Webster GF, Razsi LK, Sanchez M, Shupack JL: Weekly low-dose methotrexate therapy for cutaneous sarcoidosis. J Am Acad Dermatol 24:451–454, 1991.
  14. Mosam A, Morar N: Recalcitrant cutaneous sarcoidosis: an evidencebased sequential approach. J Dermatolog Treat 15(6):353–359, 2004.
  15. Henderson CA, Ilchyshyn A, Curry AR: Laryngeal and cutaneous sarcoidosis treated with methotrexate. J R Soc Med 87:632–633, 1994.
  16. Braun JJ, Gentine A, Pauli G: Sinonasal sarcoidosis: review and report of ifteen cases. Laryngoscope 114(11):1960–1963, 2004.
  17. Maust HA, Foroozan R, Sergott RC, et al: Use of methotrexate in sarcoid-associated optic neuropathy. Ophthalmology 110(3):559–563, 2003.
  18. Lower EE, Broderick JP, Brott TG, Baughman RP: Diagnosis and management of neurologic sarcoidosis. Arch Intern Med 157:1864–1868, 1997.
  19. Muller-Quernheim J, Kienast K, Held M, et al: Treatment of chronic sarcoidosis with an azathioprine/prednisolone regimen. Eur Respir J 14:1117–1122, 1999.
  20. Swigris JJ, Olson AL, Fischer A, et al: Mycophenolate mofetil is safe, well tolerated, and preserves lung function in patients with connective tissue disease-related interstitial lung disease. Chest 130:30–36, 2006.
  21. Zamora AC, Wolters PJ, Collard HR, et al: Use of mycophenolate mofetil to treat scleroderma-associated interstitial lung disease. Respir Med 102:150–155, 2008.
  22. Doty JD, Mazur JE, Judson MA: Treatment of sarcoidosis with inliximab. Chest 127(3):1064–1071, 2005.
  23. Sweiss NJ, Welsch MJ, Curran JJ, Ellman MH: Tumor necrosis factor inhibition as a novel treatment for refractory sarcoidosis. Arthritis Rheum 53(5):788–791, 2005.
  24. Stagaki E, Mountford WK, Lackland DT, Judson MA: The treatment of lupus pernio: results of 116 treatment courses in 54 patients. Chest 135(2):468–476, 2009.
  25. Baughman RP, Lower EE, Ingledue R, Kaufman AH: Management of ocular sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 29:26–33, 2012.
  26. Erckens RJ, Mostard RL, Wijnen PA, et al: Adalimumab successful in sarcoidosis patients with refractory chronic non-infectious uveitis. Graefes Arch Clin Exp Ophthalmol 250:713–720, 2012.

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