Sarcoidosis is a condition in which small clumps of immune cells called granulomas appear in several organs as a result of chronic inflammation.

Sarcoidosis patients are regularly monitored by their physicians, and the disease goes away on its own without medication in many cases. However, people with ongoing or progressive symptoms usually require treatment to relieve their symptoms, prevent tissue damage, and help improve their well-being.

There are different treatment options available to manage sarcoidosis, which are discussed below.

Lifestyle changes

Some symptoms of sarcoidosis can be reduced by adopting a healthy diet that includes fresh fruits and vegetables, drinking adequate amounts of water, not smoking, getting regular and sufficient sleep, exercising regularly, and avoiding harmful environmental factors such as dust, gases, and fumes.

Patients with a high amount of calcium in their blood or urine are advised to avoid excessive sun exposure and calcium-rich foods, such as dairy products.

Anti-inflammatory medications

Sarcoidosis patients may experience fever and pain in the muscles and joints. Over-the-counter medicines such as aspirin, paracetamol, or ibuprofen can help relieve these symptoms.

Corticosteroids

Corticosteroids, which are hormones that act on the immune system, are the first-line treatment for sarcoidosis. The most commonly used corticosteroid therapy is prednisone, a medicine taken by mouth as a capsule. Prednisone is delivered all over the body and therefore is called a systemic therapy.

Corticosteroid treatments can also be limited to the affected tissue. Inhaled corticosteroids are used to treat lung-related symptoms, eye drops containing corticosteroids are used to treat some symptoms in the eyes, and corticosteroid creams or injections under the skin can help treat skin lesions.

Treatment schedules with corticosteroids are tailored to each patient based on the severity of his or her symptoms. Because corticosteroids may have serious side effects, therapy usually starts with a high dose that is later reduced. Long-term treatment is usually avoided.

Cytotoxic and cytostatic medications

Cytotoxic compounds are lethal to cells while cytostatics stop cells from growing. Because of their anti-cell growth activities, both types of medications are commonly used in cancer treatment. However, they also suppress the immune system, which helps reduce the inflammation caused by sarcoidosis.

Patients with symptoms that do not improve with corticosteroid treatment, or those experiencing severe side effects, can switch to cytotoxic or cytostatic medications upon their physician’s recommendation.

The most common cytotoxic medications are methotrexate and azathioprine. Leflunomide has also been shown to be a safe and effective cytostatic for sarcoidosis treatment. These can be used in combination with corticosteroids to improve the efficiency of the therapy.

In severe forms of sarcoidosis where other treatments fail, cyclophosphamide or chlorambucil, both of which have severe side effects, may rarely be offered.

Immune modulating therapies

Immune modulating therapies manipulate the activity of the immune system by interfering with its components. Similar to cytotoxic and cytostatic therapies, immune modulating medications are used as a second-line treatment for sarcoidosis.

Chloroquine and hydroxychloroquine, two anti-malaria medications, have been shown to be effective in treating sarcoidosis symptoms that are related to skin, joints, and kidneys.

Mycophenolate mofetil is a powerful immune suppressant that was first developed to prevent organ rejection and is currently among the standard therapies for sarcoidosis.

Cyclosporine, a medicine that also suppresses the immune system, is used to improve skin-related symptoms of patients who did not benefit from conventional therapies such as corticosteroids or cytotoxic medications.

TNF-alpha inhibitors

Tumor necrosis factor (TNF-alpha) is a protein secreted by some immune cells to stimulate inflammation in response to an infection or injury. In sarcoidosis patients, TNF-alpha levels can be higher than normal, contributing to chronic inflammation and the formation of granulomas.

Two TNF-alpha inhibitors, infliximab and adalimumab, are most commonly used to treat sarcoidosis patients who do not improve with other standard therapies. These medications are injected into the bloodstream or under the skin every few weeks. However, they increase the risk of infections in patients who receive them.

Other TNF-alpha inhibitors with limited benefits are pentoxifylline, thalidomide, golimumab, and etanercept.

Surgery

Severe forms of sarcoidosis may lead to extensive organ damage in some patients. Surgery can be performed to repair damage to the lungs or the heart. Very rarely, organ transplants may be necessary when sarcoidosis progresses further and results in lung, kidney, or liver failure.

Other therapies

Lungs are the main organs affected by sarcoidosis. In advanced cases, damage to the lungs leads to less efficient oxygen delivery to other organs, forcing the heart to work harder. Patients may benefit from oxygen therapy, which supplies additional oxygen and delays potential damage to the heart in the long term.

In addition to oxygen therapy, lung rehabilitation therapy can help patients use their lungs more effectively through respiratory muscle training and physical exercise.

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