TREATMENT OF SARCOIDOSIS

Glucocorticosteroids represent the ''drugs of choice'' for treatment o f sarcoidosis. Steroids can be given by all routes of administration. Daily therapy with oral steroids is most widely applied. Initial thera py should consist of prednisolone 30-60 mg/day or its equivalent. Alte rnate day therapy can be used during the maintenance phase. Inhaled st eroids can also be tried during the maintenance phase for treatment of pulmonary sarcoidosis. Other drugs, which may be effective in sarcoid osis, and have a steroid-sparing capacity, are methotrexate, azathiopr ine, chlorambucil and cyclophosphamide. Chloroquine can be used for ch ronic skin lesions and potassium para-aminobenzoate may soften fibroti c lesions and keloids. Duration of treatment varies with the clinical situation; from between 6 and 18 months to lifetime. In principle, con tinuing signs of disease activity and functional impairment require co ntinuing treatment. Determination of on-going activity may be a diffic ult task. Symptomatic patients with stage II-III pulmonary sarcoidosis , and many extrapulmonary manifestations of the disease, must be adequ ately treated. Symptom-free patients with deteriorating lung function and/or biochemical signs of disease activity also require treatment. S teroids are not indicated for pulmonary stage I disease (hilar lymphad enopathy) with or without erythema nodosum unless there are troublesom e persistent chest symptoms (cough, pain, pressure symptoms) or arthra lgia, oedema and pain of the legs.