Sarcoidosis: An Update for the Primary Care Physician

Oluranti A. Aladesanmi, MD, MPH

Disclosures
In This Article

Treatment

Observation would be appropriate in asymptomatic patients with mild disease, provided they are monitored periodically for evidence of clinical and radiologic progression.

Corticosteroids

Corticosteroids should be initiated when clinically necessary, and collaborative care with other subspecialists, including pulmonologists, rheumatologists, ophthalmologists, cardiologists, gastroenterologists, or dermatologists, may be necessary.

A recent systematic review of evidence from randomized, controlled trials for the effect of corticosteroids in sarcoidosis provided only limited guidance to physicians.[16] Because of the lack of evidence of sustained benefit and the potential adverse effects of corticosteroids, their use should be restricted to those patients in whom careful clinical assessment with monitoring of chest radiographs and lung function confirm a clear need for treatment.

Corticosteroids are usually effective and are indicated for progressive pulmonary disease, threatening critical organ involvement such as the eye, and central nervous system and cardiac involvement. After 6 months to 2 years, they should be withdrawn with careful patient monitoring. Chest x-rays may improve in patients with Stage 2 or 3 disease. Inhaled steroids may be useful for confirmed bronchial hyperreactivity.

Noncorticosteroids

Noncorticosteroids may be effective. Antimalarials are used for skin, bone, and joint involvement; methotrexate and azathioprine are steroid-sparing or steroid-replacing agents for serious organ involvement when steroid therapy is ineffective or not tolerated. Other agents include anti-TNF-alpha inhibitors such as pentoxyfylline, thalidomide, etanercept, and remicade, which have recently shown successes.[17]

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....