Definition
Sarcoidosis reflects a pathological condition in which we observe the formation and development of small clusters of inflamed cells (granulomas) in different body sites; normally, sarcoidosis affects the cells of the lungs, lymph nodes, eyes and skin, but can ideally spread to every anatomical area.
Causes
To date, a definite and precise cause responsible for sarcoidosis has not yet been identified; however, in some patients there is a marked genetic predisposition to the disease, triggered, in turn, by exposure to viruses, bacteria or other chemical substances. What is certain is that in sarcoidosis some cells of the immune system go mad and aggregate, forming inflamed cell clusters.
Symptoms
Symptoms depend on the anatomic site affected by sarcoidosis, although fever, weight reduction and inappetence are common signs for most forms of sarcoidosis.
- Pulmonary sarcoidosis → dyspnea, hemoptysis, shortness of breath, cough
- Sarcoidosis of the lymphatic glands → swelling and swelling of the lymph nodes of the neck, arms, chest
- Sarcoidosis of the skin → alteration of skin color (violet), erythema nodosum, raised skin rash on the face
- Renal sarcoidosis → kidney stones, hypercalcemia
- Hepatic and splenic sarcoidosis → hepatic / splenomegaly
- Sarcoidosis of the heart → cardiomyopathy, heart failure, cardiac irregularities (eg bradycardia)
- Ocular sarcoidosis → vision impairment, uveitis
- Joint / muscle sarcoidosis → pain, inflammation
- Sarcoidosis of the nervous system → alteration of vision, alteration of hearing, meningitis, problems with swallowing
Information on Sarcoidosis - Drugs for the Treatment of Sarcoidosis is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Sarcoidosis - Drugs for the treatment of Sarcoidosis.
drugs
Overall, the symptoms that accompany sarcoidosis are not particularly severe; since the statistical data reveal that 75% of patients do not complain of heavy symptoms, the administration of drugs is reserved for very few patients, as well as in those cases in which sarcoidosis generates imbalances that interfere with normal daily activities.
However, in the case of a diagnostic test even in the absence of symptoms, it is recommended to undergo regular medical checks to possibly intervene before the disease progresses, creating damage; among the most recurrent diagnostic analyzes, we mention chest radiography, pulmonary function monitoring and ambulatory examination.
Medical-pharmacological treatment becomes indispensable in the event of confirmed cardiac, pulmonary and other vital organs involvement.
The main goal of medical therapy is to reduce inflammation, clearly followed by a decrease in pain and the removal of secondary symptoms (when present). The most widely used drugs are corticosteroids which, as we know, cannot be used for long periods because of the consistent side effects they can cause; NSAIDs can also be taken, especially when the pain and inflammation associated with sarcoidosis are mild or moderate, however bearable.
If sarcoidosis involves more marked symptoms, a more powerful specific therapy is conceivable: anti-rejection drugs (used to suppress the immune system), drugs inhibiting the factor of tissue necrosis alpha (for sarcoidosis associated with rheumatoid arthritis) and drugs antimalarials (for the treatment of cutaneous sarcoidosis with involvement of the nervous system).
Rarely, sarcoidosis cannot be cured only with drugs: some particularly aggressive forms require a lung or heart transplant, or a peacemaker to coordinate the heart rhythm.
NSAIDs for the control of mild pain associated with sarcoidosis: non-steroidal anti-inflammatory drugs are used in therapy to mask mild pain in the context of sarcoidosis, simultaneously exerting a discreet anti-inflammatory effect. The following are the most used drugs:
- Ibuprofen (eg. Brufen, Moment, Subitene): for medium-moderate pain, it is recommended to take an active dose of 200-400 mg (tablets, effervescent sachets) by mouth every 4-6 hours after meals, at need. Do not take more than 2.4 grams per day.
- Naproxen (eg Aleve, Naprosyn, Prexan, Naprius): it is recommended to take the drug at an oral dose of 550 mg once a day, followed by 550 mg of active every 12 hours; alternatively, take 275 mg of naproxen every 6-8 hours, as needed. Do not exceed 1, 100 mg per day.
- Paracetamol or acetaminophen (eg Tachipirina, Efferalgan, Sanipirina, Piros, Tachidol): the drug is NOT an anti-inflammatory; however, it is still indicated in the context of sarcoidosis to reduce pain and fever. Paracetamol is administered at a dosage of 325-650 mg per day every 4-6 hours; alternatively, take 1 gram every 6-8 hours. The dosage depends on the patient's condition, age and weight.
Corticosteroids for the treatment of sarcoidosis
A therapy based on steroid drugs is recommended when sarcoidosis occurs in the lung (to be taken in the form of nasal spray), joint, cutaneous, nervous and cardiac (in the form of tablets or injections).
In the form of eye drops, drugs can also be instilled into the eyes, if the granulomas obscure vision.
Medical statistics show that after stopping steroid therapy, sarcoidosis tends to recur; to avoid this inconvenience, we sometimes recommend an additional therapy (lasting 2-3 months) to prevent relapse from sarcoidosis.
- Prednisone (eg Deltacortene, Lodotra): the dosage must always be established by the doctor on the basis of the severity of the sarcoidosis and the patient's condition. Indicatively, the dose to be taken varies from 5 to 60 mg a day, possibly divided into several doses (1-4) during the 24-hour period. In general, the most effective dosage appears to be between 15 and 20 mg a day.
- Methylpredinone (eg Medrol, Urbason, Advantan, Depo-medrol, Solu-medrol) seems that most sarcoidosis patients respond positively to methylprednisone at a dose of 12-16 mg / day. In very serious cases, it is possible to increase the dose up to 48 mg a day.
- Triamcinolone (eg. Kenakort, Triamvirgi, Nasacort): the drug is particularly indicated for sarcoidosis with pulmonary involvement. Indicatively, take 16-48 mg orally, once a day. It is recommended to strictly follow the doctor's instructions.
- Dexamethasone (eg. Decadron, Soldesam): the drug is used in sarcoidosis therapy as a second choice. For the dosage: consult a doctor.
- Cortisone (eg Cortis Acet, Cortone): for the treatment of sarcoidosis, the indicative dosage is to take 25-300 mg a day of medication, orally, intramuscularly, in one or two doses a day. Consult your doctor.
It is recommended not to use corticosteroids for long periods: prolonged use can lead to weight gain, mood swings, osteoporosis, lethargy, liver damage and blood cells, petechiae / ecchymoses, hypertension, increased risk of diabetes, skin thinning.
Anti-rejection drugs for the treatment of sarcoidosis : the goals to be achieved in the case of severe sarcoidosis are both suppressing the immune system and reducing inflammation. This therapy is normally recommended when a treatment based on steroid drugs has not brought the desired therapeutic effects.
Do not forget that the administration of these active ingredients can make the subject more vulnerable to infections.
- Methotrexate (eg. Reumaflex, Methotrexate HSP, Securact): the drug is an antagonist of folic acid synthesis, able to heavily influence the body's immune response. In this regard, it is widely used in the treatment of sarcoidosis. Begin therapy - in patients with sarcoidosis who do not respond to corticosteroid therapy - with a low dose of 2.5 mg / week. The dosage can be gradually increased (2.5 mg / week), up to a maximum of 10-15 mg / week. Some patients require the combination of methotrexate + corticosteroid
- Azathioprine (eg Azatiopirina, Immunoprin): immunosuppressive drug of the immune system, indicated in the treatment of sarcoidosis to reduce the administration of corticosteroids. Initiate therapy with a dose of 2mg / kg per day, in combination with 0.6-0.8 mg / kg of prednisone; after 2-3 months of treatment, the dose of prednisone taken can be reduced up to 0.1 mg / kg. The maintenance dose suggests taking 2 mg / kg of drug a day with prednisolone (0.1 mg / kg / day) for long periods (21-22 months).
Antimalarial drugs for the treatment of sarcoidosis : indicated for the treatment of sarcoidosis with evident involvement of the skin and nervous system, especially when the patient is experiencing moderate or severe hypercalcaemia. When prolonged, therapy with these drugs may induce eye damage.
- Hydroxychloroquine (eg Plaquenil): the antimalarial drug is indicated for the treatment of mild rheumatoid arthritis in the context of sarcoidosis. The dosage suggests taking 200 mg of drug per day: this dosage has proved more useful than corticosteroids, especially for the cutaneous forms of sarcoidosis.
Alpha necrosis tissue factor inhibitor drugs : indicated for the treatment of sarcoidosis in patients with rheumatoid arthritis. The excessive / prolonged use with these drugs can promote lymphomas, blood diseases and congestive heart failure.
- Infliximab (eg Remicade): a last-generation drug able to stop the action of molecules involved in the inflammatory process that characterizes sarcoidosis. The dosage plans to take 5mg / kg of drug, by intravenous infusion to be repeated at the second, fourth and eighth week starting from the first injection performed for the treatment of sarcoidosis.
