Clinical Immunology focuses on the immune system’s health. Learn about the diagnosis and treatment of allergies, autoimmune diseases, and immunodeficiencies.
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The management of sarcoidosis is unique because not every patient requires treatment. Since a significant proportion of cases resolve spontaneously, the decision to treat is based on symptom severity and the threat to organ function. At Liv Hospital, the treatment philosophy balances the suppression of inflammation with the avoidance of unnecessary medication side effects. Management is dynamic, requiring frequent adjustments as the disease evolves and the patient responds to therapy.
For patients with no symptoms or only mild symptoms and normal organ function, no medication is typically prescribed.
Regular Monitoring
This approach is not “doing nothing.” It involves strict monitoring with regular physical exams, chest X-rays, and breathing tests every few months to ensure the disease is not progressing silently.
Spontaneous Remission
Many patients, especially those with Stage 1 or 2 disease, will see their granulomas disappear without ever taking a pill.
When treatment is necessary—usually for breathing difficulties, heart involvement, or threatened vision—oral corticosteroids like prednisone are the standard first-line therapy.
Mechanism
Steroids rapidly suppress the immune system and reduce inflammation, often bringing quick relief from symptoms.
Tapering Strategy
Because steroids have significant side effects (weight gain, diabetes, bone loss) when used long-term, the goal is to use the lowest effective dose and taper off slowly once the disease is controlled.
For patients who cannot tolerate steroids or who need long-term treatment, methotrexate is often added. It allows doctors to lower the steroid dose.
Azathioprine and Mycophenolate
These are alternative oral medications that suppress the immune system. They take longer to work than steroids (often months), but are safer for long-term maintenance.
Monitoring Toxicity
Patients on these drugs require regular blood tests to monitor liver function and blood cell counts to ensure safety.
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In severe, refractory cases where standard drugs fail, biologic agents like Infliximab or Adalimumab may be used.
Targeting Cytokines
These drugs specifically block Tumor Necrosis Factor-alpha, a key chemical that holds granulomas together. They are particularly effective for chronic skin sarcoidosis and neurosarcoidosis.
Intravenous Administration
These are potent medications administered via infusion or injection and require screening for latent infections like tuberculosis before starting.
Advanced sarcoidosis can compress blood vessels in the lungs, leading to high blood pressure in the pulmonary arteries.
Vasodilators
Treatment may involve specific medications to relax the blood vessels in the lungs, reducing the strain on the heart and improving oxygen delivery.
Fatigue is difficult to treat with anti-inflammatories alone. Stimulants or varying lifestyle pacing strategies may be employed.
Cough Control
Inhaled corticosteroids or bronchodilators (inhalers) can sometimes help with the persistent cough and wheezing, acting directly on the airways with fewer systemic side effects.
While no specific diet cures sarcoidosis, a diet rich in fruits and vegetables and low in processed sugars helps manage inflammation and offsets steroid-induced weight gain.
Smoking Cessation
Smoking acts as a direct irritant to inflamed lungs. Quitting is the single most effective lifestyle change a patient can make to preserve lung function.
Sun Exposure Caution
Because sarcoidosis patients can have abnormal Vitamin D metabolism, excessive sun exposure can raise calcium levels dangerously. Patients are often advised to avoid unregulated Vitamin D supplements and excessive tanning.
In very advanced cases where fibrosis has destroyed the lungs or heart, organ transplantation becomes the final therapeutic option.
Success Rates
Outcomes for transplantation in sarcoidosis are generally comparable to those of other diseases, although there is a small risk of granulomas recurring in the new organ.
Common side effects include weight gain, fluid retention, mood swings, difficulty sleeping, increased blood sugar, and, with long-term use, weakening of the bones (osteoporosis).
This varies. Some people need treatment for 6 to 12 months, while others with chronic sarcoidosis may need maintenance medication for years or indefinitely.
There is no proven natural cure. However, maintaining a healthy weight, exercising, and eating an anti-inflammatory diet support the body’s ability to handle the disease.
Yes, and it is encouraged. However, if you have lung or heart involvement, you should consult your doctor to determine safe limits. Pulmonary rehabilitation can be very helpful.
If the disease is mild, nothing may happen. However, if vital organs are involved, refusing treatment can lead to permanent scarring, organ failure (like blindness or heart failure), and irreversible disability.
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