Elsevier

Disease-a-Month

Volume 55, Issue 11, November 2009, Pages 704-718
Disease-a-Month

Treatment of Sarcoidosis

https://doi.org/10.1016/j.disamonth.2009.06.002Get rights and content

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Corticosteroids (Glucocorticoids)

Corticosteroids have been the mainstay of sarcoidosis therapy since reports of their efficacy in the 1950s.1 Corticosteroids induce gene transcription and synthesis of IκBα, which inactivates nuclear factor kappa B. Without this nuclear factor, the synthesis of just about all known cytokines is inhibited, which decreases the inflammatory response. Treatment of both pulmonary and extrapulmonary disease has been reported, although randomized, controlled trial data are lacking for extrapulmonary

Organ Transplantation

Surgical options exist as a last resort. Approximately 3% of lung transplants, 1% of heart transplants, and rarely kidneys and livers have been transplanted for advanced sarcoidosis, with survival rates comparable to other indications. Mortality rates are high (27-53%) among sarcoid patients awaiting lung transplant. Optimal timing of referral is not clear, as pulmonary function tests in sarcoidosis poorly predict mortality risk. Pulmonary arterial hypertension in sarcoidosis significantly

To Treat or Not To Treat?

Unfortunately, the quandary typically facing you as a clinician is not what agent to treat with, but rather whether treatment is required, and if so, for how long. This decision is often not an easy one, as the natural history of sarcoidosis can be highly variable. Nearly two-thirds of patients will have a spontaneous remission, whereas 10-30% will suffer a progressive course.4 It is also unclear whether treatment with steroids increases the eventual relapse rate,31 hypothetically by limiting a

Conclusions

Sarcoidosis is a fascinating but challenging disease to treat. Given the propensity for involvement of multiple organs, it is a disease which will be encountered by both subspecialists and general practitioners alike. Familiarity with the natural history and therapeutic options for this disease are important as its clinical course can be highly variable and its consequences grave.

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References (46)

  • A. Aizer et al.

    Usefulness of programmed ventricular stimulation in predicting future arrhythmic events in patients with cardiac sarcoidosis

    Am J Cardiol

    (2005)
  • Y. Yazaki et al.

    Prognostic determinants of long-term survival in Japanese patients with cardiac sarcoidosis treated with prednisone

    Am J Cardiol

    (2001)
  • E.E. Lower et al.

    Neurosarcoidosis

    Clin Chest Med

    (2008)
  • A.R. Berliner et al.

    Sarcoidosis: The nephrologist's perspective

    Am J Kidney Dis

    (2006)
  • L. Requena et al.

    Erythema nodosum

    Dermatol Clin

    (2008)
  • R.M. Wirnsberger et al.

    Evaluation of quality of life in sarcoidosis patients

    Respir Med

    (1998)
  • E.E. Lower et al.

    Double-blind, randomized trial of dexmethylphenidate hydrochloride for the treatment of sarcoidosis-associated fatigue

    Chest

    (2008)
  • H.L. Israel et al.

    Cortisone treatment of sarcoidosis: Experience with thirty-six cases

    J Am Med Assoc

    (1954)
  • N.S. Paramothayan et al.

    Corticosteroids for pulmonary sarcoidosis

    Cochrane Database Syst Rev

    (2005)
  • Statement on sarcoidosisJoint statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the world association of sarcoidosis and other granulomatous disorders (WASOG) adopted by the ATS Board Of Directors and by the ERS Executive Committee, February 1999

    Am J Respir Crit Care Med

    (1999)
  • S. Erkkila et al.

    Inhaled budesonide influences cellular and biochemical abnormalities in pulmonary sarcoidosis

    Sarcoidosis

    (1988)
  • C. Alberts et al.

    Inhaled budesonide in pulmonary sarcoidosis: A double-blind, placebo-controlled studyDutch Study Group on Pulmonary Sarcoidosis

    Eur Respir J

    (1995)
  • Targeted tuberculin testing and treatment of latent tuberculosis infection

    MMWR Recomm Rep

    (2000)
  • Cited by (0)

    No financial or other potential conflicts of interest exist for the above authors. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.

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