Questions and Answers - The Treatment

Common questions, with answers about the treatment of sarcoidosis, by the late Dr. Om P. Sharma.

83. What is the treatment for a patient who has enlarged lymph nodes and involvement of the lungs, spleen, and liver? The patient also has diabetes mellitus?

Although prednisone would be an ideal drug, in this case the presence of diabetes mellitus is contraindicated. Hydroxychloroquine and methotrexate should be tried. If these two drugs do not work then infliximab and etanercept should be used.

84. What is the best treatment for neurosarcoidosis?

At least 10% of all patients with sarcoidosis have neurosarcoidosis. Prednisone is the drug of choice. Infliximab, etanercept, hydroxychloroquine, methotrexate, azathioprine, cyclophosphamide and radiation have been tried in varying dosages.

85. In sarcoidosis how long should prednisone be taken? Are there any tests to check on toxic levels?

Treatment is given as long as it is needed to control the effects of sarcoidosis.

86. How does one know if the adrenal glands are still producing corticosteroids?

By measuring blood cortisol levels and performing a challenge test.

87. If my calcium levels are in the normal range and I'm taking prednisone. Should I be taking calcium?

If your nutrition is inadequate, if you have osteoporosis, and if you are a woman in menopausal years, you should take a calcium supplement.

88. Is plastic surgery the right treatment for my skin lesions?

The most troublesome skin lesions are slowly developing reddish-blue patches (plaques) and scarred areas that occur on the face. Most of these rashes can be brought under control by corticosteroids, hydroxychloroquine, methotrexate, and infliximab. Plastic surgery is successful in selected cases. Rarely, a sarcoidosis patients will develop raised, disfiguring scars or keloids after surgery. This happens in patients who have a past or family history of keloid formation. You will need to discuss the pros and cons of plastic surgery with a sarcoidosis specialist before undergoing the surgery.

89. What are common side effects of corticosteroids?

Corticosteroids have many side effects; some are disabling. Your doctor will discuss the effect of these drugs. Common side effects include excessive weight gain, acne, diabetes in susceptible people, high blood pressure, glaucoma, cataracts, thinning of the bone (osteoporosis). infections, gastric ulcers, and depression and suicidal tendencies.

90. What are the side effects of the other drugs?

Methotrexate can cause liver dysfunction, anemia, and hair loss. Hydroxychloroquine does not have side effects seen either with methotrexate of corticosteroids. However, if given for a long period of time it may cause damage to the eyes. Azathioprine, cyclophosphamide and other immunosuppressive drugs have more serious side effects such as increased susceptibility to infections, anemia, renal failure, and suppression of the body's ability to fight disease.

91. I will start chemotherapy and radiation for uterine cancer. Will this affect my active pulmonary sarcoidosis? How?

Chemotherapy, particularly methotrexate, chlorambucil and azathioprine are used in treating sarcoidosis patients when prednisone fails to control the disease or produces too many side effects. It is conceivable that your sarcoidosis may indeed improve during the chemotherapeutic treatment.

92. When I'm off steroids, my doctor tells me that I could take up to 12 Advil per day. Is the drug of any value in treating sarcoid?

Advil is good for pain, particularly musculoskeletal pain. It is a nonspecific analgesic and anti-inflammatory drug but it is not used to treat sarcoidosis.

93. Has acupuncture any therapeutic value in managing sarcoidosis?

Acupuncture does not cure sarcoidosis. If a patient with sarcoidosis has muscle aches and pains, acupuncture may be of help.

94. Is deflazacort being used in this country? Besides being "bone sparing". is deflazacort better than prednisone? Deflazacort is not available in this country [USA].

95. Is hypertension a side effect of long term therapy of sarcoidosis with prednisone and Imuran?

Prednisone causes salt retention and may cause hypertension. Imuran does not cause an increase in blood pressure, but it may cause renal function impairment.

96. Do corticosteroids cause sterility and liver damage?

Corticosteroids cause weight gain, acne, osteoporosis, hypertension, diabetes mellitus in susceptible individual, depression and suicidal tendencies, cataract, skin bruising, and infections. There are many other side effects and patients should always discuss with the doctor. Prednisone does not cause either sterility or liver damage.

97. What should be done to help the fatigue of sarcoidosis?

Fatigue in sarcoidosis is common. It is perhaps related to its cause; some patients respond to prednisone and hydroxychloroquine.

98. Would physical therapy be helpful in treating joint inflammation and muscle involvement?

Yes, physical therapy along with analgesics and corticosteroids is very helpful in managing joint involvement.

99. What is the best treatment for sarcoidosis of the bones and bone marrow?

Prednisone and hydroxychloroquine is an effective combination.

100. If a person has been on prednisone and azathioprine for over six months and no improvement has been made, what other alternatives are there?

First, the physician will have to reevaluate the nature of sarcoidosis. If the lungs are completely scarred no medicine will be effective. If the disease is active, explore the possibility of giving her hydroxychloroquine 200 mg BID, methotrexate 15 mg/day, infliximab 3 mg/kg intravenous infusions.

101. Are there any preventative measures that may be taken to avoid seasonal relapses?

Pulmonary sarcoidosis, unlike hay fever, asthma and other allergic diseases, has no definite seasonal exacerbations. It is erythema nodosum that occurs in the spring season. No vaccine or other specific preventive measure is available.

102. What treatment is used to prevent sarcoidosis attacking the transplanted organ?

There is no known drug that will prevent sarcoidosis. If the disease appears in the transplanted organ and the patient has symptoms then the treatment includes prednisone, hydroxychoroquine, and immunosuppressive drugs.If patient has no symptoms then he/she should be observed.

103. Is childhood sarcoidosis treated differently from adult sarcoidosis?

No, the treatment is more or less the same, but immunosuppressive drugs are avoided in children.

104. Is treatment of enlarged spleen in sarcoidosis different?

The spleen is commonly enlarged by lymphoma, tuberculosis, leukemia, and many tropical infections. In sarcoidosis enlargement is less frequent. If an enlarged spleen causes anemia, low platelets, and leucopenia then treatment is required. An extremely enlarged spleen may need to be taken out surgically.

105. I have read that the patients with sarcoidosis should not take vitamin-D; it might worsen the disease. Is this true?

It only applies if your calcium level is very high. If your vitamin-D is low then it should be corrected because deficiency of vitamin D is dangerous.