Drug of choice in sarcoidosis is

Management of sarcoidosis Patients who present with acute illness and erythema nodosum should receive NSAIDs and, on occasion, a sho course of glucocoicoids. The majority of patients enjoy spontaneous remission and so, if there is no evidence of organ damage, systemic glucocoicoid therapy can be withheld for 6 months. However, prednisolone (at a staing dose of 20-40 mg/day) should be commenced immediately in the presence of hypercalcaemia, pulmonary impairment, renal impairment and uveitis. Topical glucocoicoids may be useful in cases of mild uveitis, and inhaled glucocoicoids have been used to shoen the duration of systemic glucocoicoid use in asymptomatic parenchymal sarcoid. Patients should be warned that strong sunlight may precipitate hypercalcaemia and endanger renal function. Features suggesting a less ourable outlook include age over 40, Afro-Caribbean ethnicity, persistent symptoms for more than 6 months, the involvement of more than three organs, lupus pernio and a stage III/IV chest X-ray. In patients with severe disease, methotrexate (10-20 mg/week), azathioprine (50-150 mg/day) and specific tumour necrosis factor alpha (TNF-a) inhibitors have been effective. Chloroquine, hydroxychloroquine and low-dose thalidomide may be useful in cutaneous sarcoid with limited pulmonary involvement. Selected patients may be referred for consideration of single lung transplantation. The overall moality is low (1-5%) and usually reflects cardiac involvement or pulmonary fibrosis. ref - Davidsons 23e p608-610