Treatment

Some sarcoidosis patients may require no treatment, or only intermittent nonsteroidal anti-inflammatory drugs (NSAIDs) for joint and constitutional symptoms. Topical corticosteroids may be effective for anterior uveitis and some skin lesions. Inhaled corticosteroids and bronchodilators are often used when cough is a prominent symptom in patients with pulmonary involvement, but response has been equivocal. Systemic therapy is needed for the majority of patients. Systemic corticosteroids are first-line therapy and, for patients with pulmonary involvement, improve symptoms, pulmonary function, and chest x-ray signs of disease.

Second-line therapies include cytotoxic agents and other immunomodulating agents (Baughman et al., 2008). Meth-otrexate and hydroxychloroquine can be used as steroid-sparing agents. In patients with cardiac or neural sarcoidosis, treatment regimens that include cytotoxic therapy (e.g., cyclo-phosphamide) are needed. Other treatment strategies include agents that inhibit tumor necrosis factor alpha (infliximab, adalimumab, etanercept) (Nunes et al., 2005). Comorbid illnesses and multiorgan involvement are common in sarcoid-osis (Cox et al., 2004; Westney et al., 2007), so health-related quality-of-life instruments should be used to monitor global response to therapy (DeVries and Drent, 2007), and multidis-ciplinary team-based care is recommended.

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