In many cases of sarcoidosis, no treatment is necessary and symptoms may resolve without medical treatment. However, some sarcoidosis patients require consistent treatment for the ongoing effects and symptoms. There is not yet a cure for sarcoidosis, and the goal of treatment is to reduce inflammation of the affected organs, slow the development of granulomas, prevent irreversible organ damage, and improve the overall quality of life. Even if sarcoidosis symptoms resolve on their own, patients should continue to work with a medical professional to manage the disease. It is advised that patients are knowledgeable of the adverse side effects for the medications which have been prescribed for treatment. Careful consideration should be given to determine if the side effects of the medications outweigh the possible benefits of the proposed treatment.
Acthar Gel
Acthar Gel is a highly purified preparation of adrenocorticotropin hormone (ACTH) obtained from pituitary glands isolated from pigs, which is then mixed with a gel and injected subcutaneously, under the skin, or intramuscularly, into a muscle, so that it is released slowly into the bloodstream.* It is not a steroid and is said to work differently from steroids, however, it can have similar side effects.
Acthar Gel works by stimulating the outer layer of cells of the adrenal gland and promoting the production of natural hormones that reduce inflammation, such as cortisol. By reducing inflammation, symptom flare ups associated with sarcoidosis can often be reduced in terms of severity and duration.
A study based on a review of medical records took a look at whether Acthar Gel was effective in treating those with advanced sarcoidosis. Of the 302 people studied, doctors saw sarcoidosis symptom improvements in 95% of them. For more information on Acthar Gel and how it can benefit you, give Kerry’s story a listen!
*Source: Sarcoidosis News
Corticosteroids
Corticosteroids, often prednisone and prednisolone, are effective in reducing inflammation and commonly used in the treatment of sarcoidosis. However, they can have significantly adverse side effects if taken for an extended period of time. Doctors advise that sarcoidosis patients are treated with prednisone in the short-term, and then tapered off with the improvement of symptoms. Side effects include excessive weight gain, insomnia, acne, diabetes, high blood pressure, cataracts, depression, and other symptoms that can have lasting effects.
Cyclophosphamide
Cyclophosphamide is a chemotherapy treatment used to suppress the immune system. This treatment is generally used in severe cases of sarcoidosis such as neurosarcoidosis and cardiac sarcoidosis, and is only pursued after other therapies have failed. Side effects may include bone marrow suppression, kidney damage, stomach discomfort, general fatigue, nausea and vomiting, and low white blood cell counts.
Hydroxychloroquine (Plaquenil)
Typically used to treat malaria, antimalarial drugs hydroxychloroquine and chloroquine may help with sarcoidosis of the skin, joints, lungs, and nervous system. Side effects of hydroxychloroquine may include headache, dizziness, loss of appetite, nausea, stomach pain, hair loss, blurred vision, light sensitivity, seeing halos around lights, and seizures. Due to potential macular toxicity, it is recommended that patients on hydroxychloroquine have an eye examination every 6-12 months.
Infliximab (Remicade)
Infliximab (Remicade) or adalimumab (Humira) have proven to be effective in treating inflammation in chronic sarcoidosis, and are only used after other standard treatments are unsuccessful or not tolerated. It is administered intravenously, or into the veins, every four to eight weeks, or every one to two weeks for severe cases of sarcoidosis. Side effects of Infliximab include respiratory infections, headaches, stomach pain, coughing, heart failure, rapid weight gain, easy bruising, hives, muscle or joint pain.
Methotrexate, Leflunomide, or Azathioprine
Methotrexate, leflunomide, or azathioprine have been used with, or sometimes instead of, prednisone to suppress the immune system. Methotrexate can be taken once a week orally or as an injection. Due to its low cost and relatively low risk of side effects compared to other agents, methotrexate is one of the most commonly used corticosteroid-sparing therapies for treating sarcoidosis. However, side effects of these medications can include liver toxicity, hair loss, seizures, blurred vision, and potential harm to an unborn child. Patients taking methotrexate should not drink alcohol due to the significantly increased risk of liver damage.
NSAIDS
Non-steroidal anti-inflammatory drugs, or NSAIDS, are helpful in the reduction of acute inflammation and the relief of arthritic pain and fever. NSAIDS include aspirin, ibuprofen, and naproxen, and are all taken by mouth and available over-the-counter. Long-term use of NSAIDs can lead to heartburn, vomiting, or stomach bleeding, so it’s important to consult a doctor before using these medications to treat sarcoidosis.
Organ Transplant
Organ transplants, such as lung, liver, and kidney transplants can be used to treat patients with sarcoidosis. Organ transplantation has a high success rate among many patients, although in some cases, the disease has recurred in the newly transplanted lung. Transplantation is an accepted treatment for patients with end-stage organ failure, and should be a last resort treatment. The risks associated with a lung transplant include bleeding, infections, blocked blood vessels or airways, blood or fluid in the lungs, and rejection.
Topical Corticosteroids
Topical corticosteroids formulations are available as eye drops, skin creams, gels, lotions, and respiratory sprays; and can be helpful for mild local symptoms of sarcoidosis. Topical corticosteroids are generally less effective than oral steroids, but are considered safer to use with fewer side effects which include itching, burning, redness, dryness, or irritation.
Complementary Medicine
While not a replacement for traditional medical treatment plans, complementary treatments can further reduce the severity and duration of sarcoidosis symptoms. Complementary medicine is defined as therapeutic techniques that are not a part of traditional techniques, but are combined with them to create safe and effective treatment plans. The combination of traditional and complementary medicine considers how illnesses affect patients physically, emotionally, spiritually, and socially. A patient’s primary healthcare professional should be consulted to discuss if any complementary medical treatments are safe and appropriate for their use.
For more information regarding complementary medicine for sarcoidosis, please visit our complementary medicine page.
Sarcoidosis Treatment Overview
Although all sarcoidosis patients, even those whose symptoms resolve on their own, should consult with their doctor, some patients will require a more in-depth plan for treating sarcoidosis. If symptoms are severe, you will likely be treated with medications, including corticosteroids, methotrexate, hydroxychloroquine, and other similar immunosuppressant medications. Treatment, and corresponding follow-up care, may be lifelong. As with other chronic conditions, those with sarcoidosis should have a network of support to exchange ideas, experiences, and expertise in order to enhance their quality of life. Many patient organizations host websites, podcasts, educational conferences, video posts, and/or newsletters that provide valuable information to enable patients to understand and manage the symptoms of the disease.
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