Not everyone who has sarcoidosis needs treatment. Sometimes the disease goes away on its own. Whether you need treatment and what type of treatment you need depend on your signs and symptoms, which organs are affected, and whether those organs are working well.
If the disease affects certain organs—such as your eyes, heart, or brain—you'll need treatment even if you don't have any symptoms.
In either case, whether you have symptoms or not, you should see your doctor for ongoing care. He or she will want to check to make sure that the disease isn't damaging your organs. For example, you may need routine lung function tests to make sure that your lungs are working well.
If the disease isn't worsening, your doctor may watch you closely to see whether the disease goes away on its own. If the disease does start to get worse, your doctor can prescribe treatment.
The goals of treatment include:
- Relieving symptoms
- Improving organ function
- Controlling inflammation and reducing the size of granulomas (inflamed lumps)
- Preventing pulmonary fibrosis (lung scarring) if your lungs are affected
Your doctor may prescribe topical treatments and/or medicines to treat the disease.
Prednisone, a type of steroid, is the main treatment for sarcoidosis. This medicine reduces inflammation. In most people, prednisone relieves symptoms within a couple of months.
Although most people need to take prednisone for 12 months or longer, your doctor may lower the dose within a few months after you start the medicine.
Long-term use of prednisone, especially at high doses, can cause serious side effects. Work with your doctor to decide whether the benefits of this medicine outweigh the risks. If your doctor prescribes this treatment, he or she will find the lowest dose that controls your disease.
When you stop taking prednisone, you should cut back slowly (as your doctor advises). This will help prevent flareups of sarcoidosis. Cutting back slowly also allows your body to adjust to not having the medicine.
If a relapse or flareup occurs after you stop taking prednisone, you may need a second round of treatment. If you remain stable for more than 1 year after stopping this treatment, the risk of relapse is low.
Other medicines, besides prednisone, also are used to treat sarcoidosis. Examples include:
- Hydroxychloroquine or chloroquine (known as antimalarial medicines). These medicines work best for treating sarcoidosis that affects the skin or brain. Your doctor also may prescribe an antimalarial if you have a high level of calcium in your blood due to sarcoidosis.
- Medicines that suppress the immune system, such as methotrexate, azathioprine, or leflunomide. These medicines work best for treating sarcoidosis that affects your lungs, eyes, skin, or joints.
Your doctor may prescribe these medicines if your sarcoidosis worsens while you're taking prednisone or if you can't handle prednisone's side effects.
If you have Lofgren's syndrome with pain or fever, your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
If you're wheezing and coughing, you may need inhaled medicine to help open your airways. You take inhaled medicine using an inhaler. This device allows the medicine to go straight to your lungs.
Anti-tumor necrosis factor drugs, originally developed to treat arthritis, are being studied to treat sarcoidosis.
Researchers continue to look for new and better treatments for sarcoidosis. They're currently studying treatments aimed at the immune system. Researchers also are studying antibiotics as a possible treatment for sarcoidosis that affects the skin.
For more information about ongoing research, go to the “Clinical Trials” section of this article.
Living With and Managing Sarcoidosis05/17/2011