Treatment of pulmonary sarcoidosis
Last reviewed: 20.11.2021
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Sarcoidosis of the lungs (Bénier-Beck-Schaumann disease) is a benign systemic disease that is based on the defeat of the reticuloendothelial system with the formation of epithelioid cell granulomas in the lungs without caseous and perifocal inflammation, which are subsequently resorbed or transformed into connective tissue in the absence of mycobacterium tuberculosis.
Treatment of pulmonary sarcoidosis
Is not fully developed.
The main thing in the therapy of sarcoidosis of the lungs is the use of glucocorticoid drugs.
Indications for use of glucocorticoid drugs:
- generalized forms of sarcoidosis;
- combined defeat of various organs;
- sarcoidosis of the intrathoracic lymph nodes with their significant increase;
- marked dissemination in the lungs, especially in the progressive course and manifest clinical manifestations of the disease.
There are two schemes for the use of prednisolone.
The first scheme: the patient is given prednisolone daily for 20-40 mg per day for 3-4 months, then appoint 15-10 mg per day for another 3-4 months, and then use a maintenance dose of 5-10 mg per day for for 4-6 months; treatment lasts, therefore, 6-8 months or more, depending on the effect.
The second scheme consists in intermittent use of prednisolone (every other day). Treatment of sarcoidosis of the lungs also begin 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 intake of prednisolone.
Intermittent treatment is prescribed to patients with poor tolerance of prednisolone, with the appearance of adverse reactions, worsening during co-occurring diseases (hypertension, etc.).
With the initial benign low-active course of sarcoidosis, the presence of favorable dynamics in the form of resorption of dissemination in the lungs and a reduction in the size of the hilar lymph nodes, one can refrain from treatment for 6-8 months, systematically monitoring patients. If the above indications appear, you should begin treatment with prednisolone.
In case of intolerance of even small doses of prednisolone, in the early stages of the disease non-steroidal anti-inflammatory drugs are prescribed.
In recent years, combined treatment of pulmonary sarcoidosis has spread: during the first 4-6 months prednisolone is applied daily or intermittently, and then non-steroidal anti-inflammatory drugs - indomethacin, voltaren, etc. During this period, with incomplete resolution of focal changes in the lungs or continued increase in intrathoracic lymph nodes can be used by the Kenalog in the form of injections once every 10-14 days.
For a long time, the question of the need for anti-tuberculosis therapy in sarcoidosis is being discussed in connection with the fact that the relationship and the proximity of this disease to tuberculosis has not been rejected so far.
Indications for the appointment of antituberculous therapy in sarcoidosis:
- positive (especially hyperergic) tuberculin reaction;
- detection of mycobacterium tuberculosis in sputum, bronchoalveolar lavage fluid;
- signs of adherent tuberculosis, especially with clear clinical and radiological signs.
Treatment of sarcoidosis should begin in the hospital and last at least 1-1.5 months. In the future, treatment is outpatient.
Clinical follow-up and out-patient treatment of pulmonary sarcoidosis are carried out at the TB dispensary.
Clinical follow-up is conducted according to two groups of records:
- active sarcoidosis;
- 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 diagnosed diagnosis;
- B - patients with relapses and exacerbations after the main course of treatment.
Group 1A patients show treatment and active surveillance. Periodicity of visiting the dispensary - at least 1 time per month, and with outpatient treatment with prednisolone - once every 10-14 days.
The total duration of follow-up with a successful course of the disease is 2 years (during the first year, the control examination is carried out once every 3 months, during the second year - every 6 months). When an exacerbation or relapse occurs, the patients are transferred to the 1B group and observed until the activity of the process disappears with the same intervals as in subgroup A.
Clinical follow-up of patients with 2 groups should be carried out within 3-5 years. They must visit the TB dispensary once every 6 months.