As different as the symptoms, the affected organs, and the course of sarcoidosis are, so individual is the approach to sarcoidosis therapy. In mild forms of sarcoidosis, regular therapy may be unnecessary; in severe courses, preparations are used in which the benefits and side effects of therapy must be carefully weighed.
Drug therapy for sarcoidosis
In principle, there are four groups of drugs in sarcoidosis therapy, which – depending on the extent of the symptoms and organ involvement – complement each other or are used alternatively. Many of these therapeutic agents are also used for rheumatism and other autoimmune diseases:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): preparations such as diclofenac and ibuprofen, as well as acetylsalicylic acid (ASA), help primarily against the inflammation-related pain in joints and muscles and are therefore the first choice in acute sarcoidosis.
- Cortisone: This hormone (and its derivatives) has an anti-inflammatory effect and is the drug of first choice for chronic sarcoidosis. It is intended to prevent further granulomas from forming. The dose and duration of sarcoidosis therapy depends on many factors such as stage and previous course of the disease, organ involvement, condition of the patient and complications that have occurred. Usually, sarcoidosis therapy with cortisone tablets for pulmonary sarcoidosis and other organ involvement lasts six to nine months, rarely longer. Skin lesions and eye inflammation can also be treated with ointments. It is important not to interrupt sarcoidosis therapy too soon, as this increases the risk of relapse. In addition, the dose must be reduced slowly (“ausschleichen”).
- Immunosuppressants and cytostatics are used when symptoms do not improve with the other agents. They sometimes have severe side effects, so their use must be well weighed and closely monitored. The agents most commonly used in sarcoidosis are methotrexate (MTX), azathioprine and pentoxifylline; cyclophosphamide is also used in particularly severe cases.
- Rarely, chloroquine is also used – a drug that is indicated not only in immune diseases, but especially in malaria.
In stage IV lung involvement, saccular bronchodilatations (bronchiectasis) often occur. These are prone to infection, so that sarcoidosis therapy with antibiotics is often necessary. In cutaneous sarcoidosis, a trial of allopurinol may be indicated. It has shown a beneficial effect in several studies, although the mechanism of action in sarcoidosis therapy has not been deciphered.
Complementary therapy for sarcoidosis
Depending on organ involvement, additional therapies may be indicated as part of sarcoidosis therapy. For example, in cases of cardiac involvement, the use of a pacemaker or defibrillator may be appropriate. In the case of advanced lung or heart involvement, transplantation of the corresponding organs may need to be discussed. In addition, anthroposophic therapy with phosphorus, iron and graphite, supported by mistletoe preparations, should stimulate the body’s self-healing powers.
However, scientific confirmation of its efficacy in sarcoidosis is pending.
