Treatment of pulmonary sarcoidosis

Pulmonary sarcoidosis (Besnier-Beck-Schaumann disease) is a benign systemic disease, which is based on damage to the reticuloendothelial system with the formation of epithelioid cell granulomas in the lungs without caseation and perifocal inflammation, which subsequently resolve or transform into connective tissue in the absence of Mycobacterium tuberculosis.

Treatment of pulmonary sarcoidosis

Not yet fully developed.

The mainstay of therapy for pulmonary sarcoidosis is the use of glucocorticoid drugs.

Indications for the use of glucocorticoid drugs:

• generalized forms of sarcoidosis;
• combined damage to various organs;
• sarcoidosis of the intrathoracic lymph nodes with their significant enlargement;
• pronounced dissemination in the lungs, especially with a progressive course and obvious clinical manifestations of the disease.

There are two regimens for using prednisolone.

The first regimen: the patient is given prednisolone daily at 20-40 mg per day for 3-4 months, then prescribed 15-10 mg per day for another 3-4 months, and then a maintenance dose of 5-10 mg per day is used for 4-6 months; the treatment thus lasts 6-8 months or more, depending on the effect.

The second scheme involves intermittent use of prednisolone (every other day). Treatment of pulmonary sarcoidosis also begins with a dose of 20-40 mg per day, gradually reducing it. The effectiveness of this method is quite high and is not inferior to the method of daily administration of prednisolone.

Intermittent treatment is prescribed to patients with poor tolerance to prednisolone, when side effects appear, or when concomitant diseases worsen (hypertension, etc.).

In the case of an initially benign, low-activity course of sarcoidosis, the presence of favorable dynamics in the form of resorption of dissemination in the lungs and a decrease in the size of the intrathoracic lymph nodes, it is possible to refrain from treatment for 6-8 months, systematically monitoring the patients. When the above-mentioned indications appear, treatment with prednisolone should be started.

In case of intolerance to even small doses of prednisolone, non-steroidal anti-inflammatory drugs are prescribed in the early stages of the disease.

In recent years, combined treatment of pulmonary sarcoidosis has become widespread: during the first 4-6 months, prednisolone is used daily or intermittently, and then non-steroidal anti-inflammatory drugs - indomethacin, voltaren, etc. During this period, with incomplete resorption of focal changes in the lungs or continued enlargement of the intrathoracic lymph nodes, it is possible to use kenalog in the form of injections once every 10-14 days.

The issue of the need for anti-tuberculosis therapy for sarcoidosis has been discussed for a long time due to the fact that the connection and closeness of this disease with tuberculosis has not yet been rejected.

Indications for anti-tuberculosis therapy for sarcoidosis:

• positive (especially hyperergic) tuberculin reaction;
• detection of Mycobacterium tuberculosis in sputum, bronchoalveolar lavage fluid;
• signs of associated tuberculosis, especially with clear clinical and radiological signs.

Treatment of sarcoidosis should begin in hospital and continue for at least 1-1.5 months. Further treatment is carried out on an outpatient basis.

Outpatient observation and treatment of pulmonary sarcoidosis are carried out in the tuberculosis dispensary.

Outpatient observation is carried out in two registration groups:

1. active sarcoidosis;
2. inactive sarcoidosis, i.e. patients with residual changes after clinical and radiological stabilization or cure of sarcoidosis.

The first group is divided into two subgroups:

• A - patients with a newly established diagnosis;
• B - patients with relapses and exacerbations after the main course of treatment.

Patients of group 1A are prescribed treatment and active observation. The frequency of visits to the dispensary is at least once a month, and in case of outpatient treatment with prednisolone - once every 10-14 days.

The total duration of observation in case of favorable course of the disease is 2 years (during the first year, control examination is conducted once every 3 months, during the second year - once every 6 months). In case of exacerbation or relapse of the disease, patients are transferred to group 1B and observed until the disappearance of the process activity at the same intervals as in subgroup A.

Outpatient observation of patients in group 2 should be carried out for 3-5 years. They should visit the anti-tuberculosis dispensary once every 6 months.