Treatment of Sarcoidosis
Section snippets
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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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.