Treatment of sarcoidosis

Glucocorticosteroids represent the "drugs of choice" for treatment of sarcoidosis. Steroids can be given by all routes of administration. Daily therapy with oral steroids is most widely applied. Initial therapy should consist of prednisolone 30-60 mg/day or its equivalent. Alternate day therapy can be used during the maintenance phase. Inhaled steroids can also be tried during the maintenance phase for treatment of pulmonary sarcoidosis. Other drugs, which may be effective in sarcoidosis, and have a steroid-sparing capacity, are methotrexate, azathioprine, chlorambucil and cyclophosphamide. Chloroquine can be used for chronic skin lesions and potassium para-aminobenzoate may soften fibrotic lesions and keloids. Duration of treatment varies with the clinical situation; from between 6 and 18 months to lifetime. In principle, continuing signs of disease activity and functional impairment require continuing treatment. Determination of on-going activity may be a difficult task. Symptomatic patients with stage II-III pulmonary sarcoidosis, and many extrapulmonary manifestations of the disease, must be adequately treated. Symptom-free patients with deteriorating lung function and/or biochemical signs of disease activity also require treatment. Steroids are not indicated for pulmonary stage I disease (hilar lymphadenopathy) with or without erythema nodosum unless there are troublesome persistent chest symptoms (cough, pain, pressure symptoms) or arthralgia, oedema and pain of the legs.