Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.
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Treatment for sarcoidosis is tailored to each person. Many people get better on their own and do not need medicine. Doctors decide to treat based on how bad the symptoms are and how much damage there is to the organs. The main goal is to reduce inflammation, shrink granulomas, and prevent permanent scarring. At Liv Hospital, we aim to balance the benefits of treatment with its risks, ensuring each patient receives the care that best fits their needs.
Corticosteroids: The First Line
Corticosteroids are the mainstay of treatment for active sarcoidosis.
Drugs like prednisone work by powerfully suppressing the immune system and reducing inflammation. They are effective at shrinking granulomas and improving organ function. High doses are often used initially to gain control of the disease, followed by a slow taper to the lowest effective dose.
Long-term steroid use carries significant risks, including weight gain, diabetes, osteoporosis, hypertension, and mood swings. Therefore, the management plan always includes strategies to mitigate these side effects, such as monitoring blood sugar levels, bone density scans, and lifestyle modifications.
Steroid Sparing Agents
For patients who cannot tolerate steroids or who require high doses for a long time, steroid-sparing agents are introduced.
Methotrexate is the most commonly used second-line agent. It is an antimetabolite that suppresses the immune system. It takes longer to work than steroids (often months), but allows for the reduction or discontinuation of prednisone. Regular monitoring of liver function and blood counts is required due to potential toxicity.
Other medicines, like azathioprine and leflunomide, are used if methotrexate does not work or causes side effects. Azathioprine works by stopping immune cells from making new DNA. Like methotrexate, these drugs need regular blood tests to check for side effects on the bone marrow and liver.
Biologic Therapies
For severe, refractory sarcoidosis that does not respond to standard immunosuppression, biologic agents are the next step.
Medicines like infliximab and adalimumab block TNF-alpha, a protein that helps form granulomas. These drugs are effective for long-lasting lung, skin, and neurosarcoidosis. They are given by injection or infusion, but can increase the risk of infections like tuberculosis coming back.
Treatment of Specific Organ Involvement
Management is tailored to the specific organ affected.
Inhaled steroids can help with a mild cough, but if lung function gets worse, stronger treatment is needed. If oxygen levels drop, oxygen therapy is used. For people with severe lung scarring from sarcoidosis, a lung transplant may be needed.
Treating sarcoidosis in the heart needs strong treatment with steroids and often other medicines to prevent heart failure and abnormal heart rhythms. Many people need a pacemaker or defibrillator to prevent sudden death from heart problems.
Since the nervous system is so important, neurosarcoidosis is treated with high doses of steroids and often with medicines like infliximab, which can reach the brain and spinal cord well.
Mild skin problems can be treated with steroid creams or injections into the affected area. For more serious skin changes, such as lupus pernio, treatment with medications like methotrexate or TNF inhibitors is often needed.
Symptom Management
Even after treating the granulomas, some symptoms, such as fatigue and pain, may not completely resolve.
Fatigue in sarcoidosis can be complicated. Treatment may include making sure the disease is under control, checking for sleep problems, and sometimes using medicines to boost energy. Gentle exercise programs can also help people feel less tired.
Medicines like ibuprofen can help with joint pain and fever. For long-lasting nerve pain caused by sarcoidosis, drugs like gabapentin may be helpful.
Monitoring and Follow Up
Treatment for sarcoidosis needs to be checked and adjusted regularly.
Patients on treatment undergo regular pulmonary function tests, blood work, and imaging to monitor the response to therapy and check for drug toxicity. The goal is to achieve remission, defined as the absence of active inflammation, and then attempt to taper off medications.
Many women with sarcoidosis have healthy pregnancies, but it is important for the disease to be well controlled before getting pregnant. Some medicines, like methotrexate, can harm a baby and must be stopped months before trying to conceive. Steroids are usually safer during pregnancy.
Managing Complications
Having sarcoidosis for a long time can cause certain problems that need special treatment.
Scarring in the lungs can press on blood vessels and cause high blood pressure in the lungs. This is treated with medicines that open blood vessels and with oxygen.
Aspergilloma
In people with old lung damage from sarcoidosis, a fungus ball called an aspergilloma can form in the lung. This can cause serious bleeding and may need treatment with a procedure or surgery.
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CT scans use X-rays to create detailed cross-sectional images and are excellent for visualizing kidney stones, detecting tumors, and evaluating traumatic injuries. They are fast and widely available. MRI uses strong magnetic fields and radio waves to produce detailed images of soft tissues, making it superior for staging prostate cancer, evaluating bladder wall invasion, and assessing pelvic floor disorders without ionizing radiation.
Contrast dye, usually iodine-based, is injected into a vein to highlight the blood vessels and urinary tract organs. As the kidneys filter the dye from the blood, it opacifies the urine. This allows the radiologist to see the internal structure of the kidneys, the ureters, and the bladder clearly, revealing blockages, tumors, or structural abnormalities that would be invisible on a non-contrast scan.
Multiparametric MRI is an advanced imaging technique that combines standard anatomical sequences with functional sequences like Diffusion-Weighted Imaging and Dynamic Contrast-Enhanced imaging. This provides a comprehensive assessment of the prostate, allowing doctors to distinguish between benign conditions like BPH and significant prostate cancer, and to guide targeted biopsies.
CT scans do involve exposure to ionizing radiation, which carries a small theoretical risk of cellular damage over time. However, modern CT scanners use dose-modulation technology to minimize this exposure to the lowest level necessary for a diagnostic image. The benefit of an accurate and timely diagnosis for serious urological conditions typically far outweighs the minimal risk of radiation.
Many modern orthopedic implants are MRI-safe, although they may cause some image distortion. However, older pacemakers, defibrillators, and certain metal clips may be unsafe in the strong magnetic field. It is critical to inform the imaging team of any metallic implants so they can verify their safety compatibility or recommend an alternative test like a CT scan.
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