Therapy goals
- Pain relief in arthritic complaints
- Stabilization of lung function
Therapy recommendations
- Analgesics (painkillers) or anti-inflammatories/drugs that inhibit inflammatory processes (non-steroidal anti-inflammatory drugs (NSAIDs), e.g., diclofenac, ibuprofen.
- To stabilize lung function:
- First-line agents: nonspecific immunosuppression with prednisolone (steroid therapy* ); these should be used for
- ≥ type II (with worsening pulmonary function).
- High disease activity
- Severe general symptomatology involvement of eye, skin, liver, myocardium, CNS.
- Hypercalcemia (increased serum calcium level)/hypercalciuria (increased excretion of calcium in the urine).
- Second-line agents: immunosuppressants/drugs that inhibit immune function (methotrexate (MTX), azathioprine, leflunomide, and hydroxychloroquine).
- Third-line agents: anti-TNF alpha and the inhibitors infliximab and adalimumab (monoclonal antibodies).
- First-line agents: nonspecific immunosuppression with prednisolone (steroid therapy* ); these should be used for
- Neurosarcoidosis (= absolute treatment indication):
- Initial high-dose intravenous corticosteroid pulse therapy.
- Long-term immunotherapeutics: such as azathioprine, ciclosporin A, mycophenolate mofetil.
- Aggressive courses: Infliximab, cyclophosphamide or rituximab.
- Löfgren’s syndrome (definition: see below “Symptoms – Complaints): symptomatic therapy with analgesics or anti-inflammatory drugs (non-steroidal anti-rheumatic drugs (NSAIDs), eg diclofenac, ibuprofen, cooling and compression therapy of erythema nodosum (usually spontaneous regression).
* Note. It has been shown that patients receiving <500 mg prednisone cumulatively per year had better health-related quality of life than those receiving >500 mg prednisone.
