LYCOS RETRIEVER 
Sarcoidosis: Patients
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Corticosteroids, usually prednisone, are particularly effective in reducing inflammation are typically the first drugs used in the treatment of sarcoidosis. In patients with mild symptoms, such as skin lesions, eye inflammation, or cough, topical steroid therapy with creams, eye-drops or inhalers may be sufficient to control the disease. When necessary, oral steroids are generally prescribed for six to twelve months. In most cases, a relatively high dose is prescribed at first, followed by a slow taper to the lowest effective does.
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The treatment of ocular sarcoidosis depends on the type of involvement. Mild anterior uveitis is treated by topical steroids and cycloplegics. Systemic steroids are indicated in anterior uveitis not responding to topical steroids, and in patients with posterior uveitis, neovascularization, or orbital disease with visual symptoms or optic nerve compromise. Patients who are refractory to steroids may respond to the addition of oral non steroidal anti-inflammatory drugs. If inflammation persists, chemotherapy (azathioprine, cyclosporin, methotrexate) may be required. Secondary glaucoma not responding to medical treatment has been treated by trabeculectomy and cryoablative therapy.Retinal neovascularization with evidence of ischemia on angiography responds well to panretinal photocoagulation.
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Since sarcoidosis causes a dysregulation of Hormone D (1,25-dihydroxyvitamin D), a condition which causes calcium to be pulled from bones and teeth, the teeth can become weakened and susceptible to cracking easily. Sarcoidosis patients may experience multiple non-traumatic tooth fractures. Calcium pulled from bones and teeth is carried by the blood and deposited in soft tissues like the lungs, kidneys or dental pulp. Dental stones (pulp stones) can result from calcium deposits within the dental pulp. These may be found when root canal therapy is performed.
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Patients with sarcoidosis display a mixture of depressed cell-mediated immunity and increased humoral system activity. The absolute number of circulating T lymphocytes is usually decreased. Levels of B lymphocytes may be normal or increased. The presence of increased T cells in the granulomas indicate that these are T-lymphocyte related granulomas. Measurement of the macrophage migration inhibition factor in patients wit sarcoidosis is further evidence of the presence of increased numbers of activated lymphocytes. Patients are usually anergic to skin test antigens.
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Granulomas of the liver are found on liver biopsies of most patients with sarcoidosis even when liver function tests remain normal. Granulomatous uveitis occurs in about 15 percent of patients with sarcoidosis and usually affects both eyes. Granulomatous uveitis that remains untreated may cause severe vision loss or a secondary form of glaucoma. The heart is affected in 10-15 percent of patients. Myocardial granulomas may cause angina, heart failure or fatal conduction abnormalities.
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About half of all patients diagnosed with sarcoidosis have no or mild symptoms and do not need treatment of any kind. For example, a patient with no respiratory symptoms may have an abnormal chest x-ray during their yearly check-up. Further tests may or may not be ordered, and sarcoidosis is suspected but not confirmed. Since the patient is not bothered in any way, there is no need to do anything about it. The patient needs to be aware that they should have check-ups on a regular basis, just to make sure that their sarcoidosis is not starting to flare, and their doctor needs to be aware so that a sarcoidosis flare can be considered if the patient does report symptoms at a later time.
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