Treatment of sarcoidosis depends on the form and stage of disease. In some cases, doctors do not prescribe at once, and watch how the disease develops, as very often it ends recovery without treatment. And since until now finally know why and how to start sarcoidosis
Sarcoidosis - how to protect themselves?
Treatment it is mostly symptomatic, that is directed to the effect, and not the cause.
Where to treat sarcoidosis
Until a few decades ago was considered one of sarcoidosis, tuberculosis, so he was treated with TB. The doctors of this specialty has a lot of experience in the treatment of sarcoidosis, but, unfortunately, all the experts agree that they can only be consultants such patients. Examination and treatment of patients with tuberculosis dispensaries sankoidozov dangerous because of the real possibility of contracting TB. The risk of infection is further enhanced due to the fact that treat sarcoidosis mainly glucocorticosteroid hormone (GCS), which perfectly remove inflammatory process of any origin, but suppress the immune system.
No less dangerous treatment of pulmonary sarcoidosis in the offices where the majority of patients are also carriers of the infection. So where is the treatment of patients with sarcoidosis?
Since 2003, patients with sarcoidosis in the tuberculosis dispensaries longer observed. It is assumed that the treated and they must be observed in specialized centers. But such centers at present does not exist. Therefore, most patients continue to be observed in tuberculosis dispensaries.
Most of the professionals involved in the treatment of sarcoidosis, it is recommended to conduct a survey of these patients on the basis of day-care general hospitals, and treatment carried out in an outpatient setting.
Treatment of respiratory sarcoidosis should be carried out as intended and under the control of Phthisiopneumology. If there are lesions of other organs - requires the participation of experts from other specialty - dermatologists, ophthalmologists, cardiologists, and so on.
How to cure sarcoidosis
How to treat sarcoidosis? On this issue there is no clear answer. During the initial detection of sarcoidosis, if the disease is asymptomatic or the symptoms of his small, in most cases, the sick just watching. The fact that this disease frequently (more than half) are themselves. It was found that untreated sarcoidosis after recovery gives less relapses than treatment with corticosteroids.
However, there are cases where treatment is required to carry out immediately after the detection of the disease. Treatment must be conducted:
- when progressive course of pulmonary sarcoidosis, when a respiratory failure;
- in severe ocular sarcoidosis, when there is a risk of complications and blindness;
- sarcoidosis of the heart - this is particularly dangerous form of the disease and it is usually not left untreated;
- sarcoidosis of the nervous system - are possible complications of the brain;
- in any form of sarcoidosis in an advanced stage.
Since the cause of the disease is unknown, symptomatic treatment of sarcoidosis, that is aimed at addressing the symptoms rather than its causes. For this purpose, the hormone therapy (corticosteroids), medicines that suppress the immune system (immunosuppressants) and antioxidants (medicines that inhibit the toxic effects of free radicals).
Is it possible to completely cure sarcoidosis? This question remains open, as the cause of the disease is unknown.
That is why recurrent sarcoidosis (or lack thereof) still no one could predict.
The main treatment for sarcoidosis - hormone therapy
The main treatment for sarcoidosis is the application of glucocorticosteroid (glucocorticoid) hormones - corticosteroids (prednisone, dexamethasone, and others). Prednisolone in sarcoidosis is a standard by which others are calculated dose corticosteroids.
SCS - a hormone of the adrenal cortex, which quickly relieve inflammation of any origin. Granulomas in sarcoidosis are formed under the influence of the SCS also regress. GCS also prevents the development of connective tissue on the site of the granulomas, that is loss of function of the affected organ. In sarcoidosis prednisolone
Prednisolone - against inflammation, allergy and pain, but with complications
or any other corticosteroids administered fairly long courses.
But corticosteroids have many side effects that manifest the brighter than the duration of treatment. Side effects of corticosteroids include:
- suppression of the immune system; it is fraught with the addition of infections (bacterial, tuberculosis, viral, fungal);
- increases the risk of gastric ulcer and duodenal ulcers due to stimulation of gastric acid secretion;
- increases the risk of obesity and diabetes because of endocrine disorders;
- disrupted the heart muscle due to the excretion of large amounts of potassium; increasing muscle weakness is also related to gipokoliemiey (lack of potassium in the blood);
- high blood pressure - it can not affect the cardiovascular system and the patient's condition; there is a tendency to thrombosis.
Such a large number of side effects of GCS makes professionals seek new scheme sarcoidosis using these drugs. For example, recommendations on the use of so-called pulse therapy to patients with newly diagnosed sarcoidosis and relapsing disease.
Pulse therapy is to appoint a medium-dose prednisolone intravenously three times (once every 3 days). On the second day after each infusion of low-dose prednisolone appointed inside. After pulse therapy daily dose of prednisone was gradually reduced during the month leading up to the minimum maintenance, which is prescribed for several months, sometimes for six months.
In addition, the mild form of the disease are trying to heal with the help of local and external medicinal forms GCS. Thus, for the treatment of pulmonary sarcoidosis used inhaled corticosteroids are used to treat asthma (e.g., flunisolide). For the treatment of ocular sarcoidosis used ophthalmic suspension with prednisone for the treatment of cutaneous sarcoidosis - prednisolone ointment
Prednisolone ointment - can help relieve inflammation and itching of the skin
and so on. It was only under the threat of complications appoint MHC system.
The use of these treatments to avoid most of the side effects of corticosteroids.
Sarcoidosis - treatment by suppressing the immune system
Despite the fact that the causes of sarcoidosis are not known precisely, it is proved that the immune system plays a major role in the development of this disease. Therefore, to suppress the pathological process used drugs that suppress the immune system. One such drug is methotrexate - it has anti-tumor activity and the overwhelming influence of the immune system. The mechanism of action of methotrexate is associated with the suppression of the action of folic acid - it helps to suppress the development of granulomas in sarcoidosis is especially effective methotrexate for sarcoidosis of the skin and the musculoskeletal system. Methotrexate can have toxic effects on the liver, so in its application necessarily held control over the function of the body.
To suppress immunity in sarcoidosis is also used anti-malarial drugs - chloroquine (delagil) and hydroxychloroquine (Plaquenil), which have both anti-inflammatory and immunosuppressive effect. These drugs are often prescribed for the early stages of sarcoidosis, until the appointment of hormones or hormone therapy intolerance.
Treatment of sarcoidosis using drugs - TNF antagonists
Abbreviation TNF indicates tumor necrosis factor - cytokines (cytokines - this information molecules) participating in the formation of granulomas. So today, for the treatment of sarcoidosis used drugs that inhibit the action of this cytokine - antagonists of TNF. These drugs are angioprotector pentoxifylline, thalidomide immunomodulator and immunosuppressant infliximab.
The antioxidants in the treatment of sarcoidosis
Sarcoidosis is characterized by a sharp increase in the number of free radicals produced in cells as a result of redox reactions. The toxic effects of free radicals worsens the disease and reduces the effectiveness of the applied treatment. Therefore, in the complex treatment of sarcoidosis always includes antioxidants.
Most often prescribed for this purpose tocopherol
Vitamin E (tocopherol) - not to be carried away
(vitamin E), which is the most powerful natural antioxidant. Antioxidants can reduce the dose of the main drugs used to treat sarcoidosis.
Nonsteroidal protivovvospalitelnye drugs in the treatment of sarcoidosis
Nonsteroidal potivovospalitelnye drugs (NSAIDs) are also commonly prescribed to suppress the inflammatory process in sarcoidosis. They are often prescribed to patients who are not suitable hormonal therapy. NSAIDs (diclofenac, indomethacin, nimesulide and other) well relieve inflammation, but have no immunosuppressive effect.
Sarcoidosis - a systemic disease, the causes of which are unknown until now. Therefore, it is not an effective treatment, but active work in this direction is in many countries.
Galina Romanenko
