Sarcoidosis

Sarcoidosis

How to treat sarcoidosis

Sarcoidosis is a systemic disease whose cause is unknown, and it is manifested by the appearance of characteristic changes (Sarcoid granulomas) in the lymph nodes, lung, eye, liver, heart, skin. It is most common in young adults and can have abrupt and a gradual start.

Symptoms

Sarkoidose_der_Lunge_Stadium_4_nach_ScaddingThe most common symptoms are acute onset, with the pain, swelling and redness of joints, with the occurrence of painful nodules under the skin, usually on the shins (erythema nodosum), which leads patients to contact a doctor. When these patients make an X-ray, it is often seen enlarged lymph nodes in the middle of the chest, which together with the above problems arouses suspicion of sarcoidosis. The disease can begin seamlessly, with the only enlargement of the lymphatic glands at the middle of the chest that are discovered by chance, or when X-ray is made since the patients complain about a persistent cough. Less commonly, the disease begins with problems related to other organs.

Diagnosis

medical-563427_640Diagnosis is made by a series of procedures that include laboratory diagnosis (determining the level of angiotensin – converting enzyme – ACE , calcium levels in serum and urine), computed tomography of the chest, supplemented high-resolution computed tomography – CT and HRCT, testing the parameters of pulmonary function, determining the diffusion capacity of the lungs, with the inevitable bronchoscopy taking the appropriate excerpts from the lungs, whose examination reveals changes characteristic of sarcoidosis. A standard test includes eye examination, ultrasound of the upper abdomen and cardiology diagnostics (EKG, and if necessary, ECHO and Holter monitoring) to establish the existence of sarcoidosis in other organs.

Treatment

medicine-385947_640After diagnosis, treatment begins which is implemented in the majority of patients with corticosteroids at an initial dose that depends on body weight and disease severity (between 30 and 80 mg daily), and less frequently in therapy applies immunosuppressive therapy (methotrexate). Corticosteroids are given an average of six to eight months, with a gradual reduction of the daily dose. Treatment begins in the hospital setting, and if the patient is well to the tolerated medication, it is continued outpatient, with regular monthly control.

Side effects

Most patients’ symptoms are not a problem, but if they are expressed, very soon after the start of therapy, they are significantly mitigated and stop, so long-term sick leave during treatment is usually not necessary. The Bigger problem is drugs. The corticosteroids are powerful drugs that rapidly induce improvement and relieving pain, but on the other hand, high doses of the drug and their long-term use in patients can create numerous problems. Because of the potential damage to the mucous membrane of the stomach, with oral prednisone therapy regularly and provide remedies for its protection.  You should regularly control the level of blood sugar, and blood pressure, and take appropriate additional therapy if needed. When patients are in most cases, due to corticosteroid therapy, appears characteristic of obesity (face becomes round, fat accumulates in the back of the neck and stomach), but it temporary and withdraws after discontinuation of the drug.