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Related Subjects: |Idiopathic Pulmonary Fibrosis |Diffuse Parenchymal Lung disease |Asbestos Related Lung disease |Sarcoidosis |Coal Worker's Pneumoconiosis |Silicosis |Farmer's Lung |Cryptogenic Organising Pneumonia (COP-BOOP) |Extrinsic Allergic alveolitis (Hypersensitivity) |Byssinosis |Pneumoconiosis |Cor Pulmonale
Sarcoidosis is a systemic inflammatory disease characterized by the formation of non-caseating granulomas in various organs. The exact cause is unknown, but it is thought to result from an exaggerated immune response to an unknown antigen. The disease most commonly affects the lungs and lymph nodes but can involve any organ system.
The hallmark of sarcoidosis is the formation of non-caseating granulomas, which are clusters of immune cells, primarily macrophages and T lymphocytes. These granulomas can form in various organs, leading to tissue inflammation and damage. The exact trigger for this immune response is unknown, but it is believed to involve genetic susceptibility and environmental factors, such as infectious agents or occupational exposures
Treatment Option | Description |
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Observation | Appropriate for patients with asymptomatic or mild disease. Supported by regular clinical evaluation and imaging (e.g., CXR, pulmonary function tests). Many cases undergo spontaneous remission. |
Corticosteroids | First-line treatment for symptomatic sarcoidosis or significant organ involvement. Corticosteroids: Prednisolone 20-30 mg od for 6 weeks and then a reduced dose. Dosage and duration depend on the severity of disease and response to treatment. Long-term use may cause side effects such as weight gain, osteoporosis, and diabetes. |
Immunosuppressive Agents | For those who do not respond to corticosteroids or as steroid sparing agents. Methotrexate 10-20 mg/week, Azathioprine (50-150 mg/day), and Mycophenolate Mofetil. Control the immune response and reduce granuloma formation. Monitor for bone marrow suppression and liver toxicity. |
Antimalarial Drugs | Hydroxychloroquine or Chloroquine can be effective, particularly for skin, joint, or hypercalcemia-related manifestations. They modulate the immune response. Ocular toxicity is a potential side effect, requiring regular ophthalmologic monitoring. |
Biologic Agents | Considered in refractory cases where conventional therapies fail. TNF-alpha inhibitors (e.g., Infliximab, Adalimumab) are commonly used. These drugs target specific components of the immune system, reducing inflammation. Increased risk of infections; screening for latent tuberculosis is required before initiating therapy. |
Symptomatic Treatment | Treatment aimed at managing specific symptoms, such as cough, pain, or fatigue. Inhaled bronchodilators or corticosteroids may be used for respiratory symptoms. NSAIDs or analgesics for joint pain or arthritis. |
Organ-Specific Interventions |
Cardiac involvement: May require pacemaker or implantable cardioverter-defibrillator (ICD) for arrhythmias.
Ocular sarcoidosis: Treated with topical or steroids. Neurosarcoidosis: Aggressive immunosuppressive therapy with steroids and other agents. |
Lifestyle Modifications | Smoking cessation is crucial for lung health. Encourage regular, moderate exercise. Maintain a balanced diet |