User:Sharp-shinned.hawk/sandbox/Sarcoidosis Additions

Treatments for sarcoidosis vary greatly depending on the patient.{{cite journal|last1=Baughman|first1=Robert|title=Treatment of Sarcoidosis|journal=Clinical Reviews in Allergy and Immunology|date=August 2015|volume=49|issue=1|pages=79-92|doi=10.1007/s12016-015-8492-9|url=http://link.springer.com/article/10.1007%2Fs12016-015-8492-9|accessdate=9 April 2016}} At least half of patients require no systemic therapy.{{cite journal|last1=Baughman|first1=Robert|last2=Grutters|first2=Jan|title=New treatment strategies for pulmonary sarcoidosis: antimetabolites, biological drugs, and other treatment approaches|journal=The Lancet Respiratory Medicine|date=October 2015|volume=3|pages=813-822|doi=10.1016/S2213-2600(15)00199-X|url=http://www.sciencedirect.com/science/article/pii/S221326001500199X|accessdate=9 April 2016}} Most persons (>75%) only require symptomatic treatment with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin. For persons presenting with lung symptoms, unless the respiratory impairment is devastating, active pulmonary sarcoidosis is observed usually without therapy for two to three months; if the inflammation does not subside spontaneously, therapy is instituted.

Major categories of drug interventions include glucocorticoids, antimetabolites, biologic agents especially monoclonal anti-tumor necrosis factor antibodies, and more recently, specific antibiotic combinations and mesenchymal stem cells. If drug intervention is indicated, a step-wise approach is often used to explore alternatives in order of increasing side effects and to monitor potentially toxic effects.

Corticosteroids, most commonly prednisone or prednisolone, have been the standard treatment for many years. In some people, this treatment can slow or reverse the course of the disease, but other people do not respond to steroid therapy. The use of corticosteroids in mild disease is controversial because in many cases the disease remits spontaneously.{{cite journal | last=White | first=ES |date=June 2007 | title=Current and emerging strategies for the management of sarcoidosis |journal=Expert Opinion on Pharmacotherapy | volume= 8 | issue=9 | pages=1293–1311 |doi=10.1517/14656566.8.9.1293 | pmid=17563264 |last2=Lynch Jp | first2=3rd }} {{cite journal | author = Paramothayan NS, Lasserson TJ, Jones PW | title = Corticosteroids for pulmonary sarcoidosis | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD001114 | date = 18 April 2005 | pmid = 15846612 | doi = 10.1002/14651858.CD001114.pub2 | url = http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001114.pub2/pdf | last2 = Lasserson | last3 = Jones }}

In addition to the symptoms related to affected organs, sarcoidosis patients may suffer from a wide range of symptoms that may not correspond with objective physical evidence of disease but significantly decrease quality of life.{{cite journal|last1=Drent|first1=Marjolein|title=Consequences of Sarcoidosis|journal=Clinical Chest Medicine|date=2015|volume=36|page=727-737|doi=10.1016/j.ccm.2015.08.013|url=http://dx.doi.org/10.1016/j.ccm.2015.08.013|accessdate=9 April 2016}}

Physical therapy, rehabilitation, and counseling can help avoid "a vicious circle of deconditioning",{{rp|733}} and improve patients' social participation, psychological well-being, and activity levels. Key aspects are avoiding exercise intolerance and muscle weakness, but researchers note a multidisciplinary approach is needed for the management of sarcoidosis.{{rp|734}}

Low or moderate-intensity physical training has been shown to improve fatigue, psychological health, and physical functioning in sarcoidosis patients without adverse effects.{{cite journal|last1=Marcellis|first1=Rik G. J.|last2=van der Veeke|first2=M. A. F.|last3=Mesters|first3=I.|last4=Drent|first4=M|last5=de Bie|first5=R. A.|last6=de Vries|first6=G. J.|last7=Lenssen|first7=A.F.|title=Does physical training reduce fatigue in sarcoidosis?|journal=Sarcoidosis vasculitis and diffuse lung disease|date=2015|volume=32|issue=1|pages=53-62|url=https://www.researchgate.net/profile/M_Drent/publication/279214648_Physical_training_in_sarcoidosis/links/5598f12b08ae5d8f39340049.pdf|accessdate=9 April 2016}}{{cite journal|last1=Strookappe|first1=Bert|last2=et al.|title=Benefits of Physical Training in Sarcoidosis|journal=Lung|date=2015|volume=193|pages=701-708|doi=10.1007/s00408-015-9784-9|url=http://link.springer.com/article/10.1007/s00408-015-9784-9/fulltext.html|accessdate=9 April 2016}} Inspiratory muscle training has also decreased severe fatigue perception in subjects with early stages of sarcoidosis, as well as improving functional and maximal exercise capacity and respiratory muscle strength.{{cite journal|last1=Karadalli|first1=Muserrefe Nur|last2=Bosnak-Gulcli|first2=Meral|last3=Camicioglu|first3=Burcu|last4=Kokturk|first4=Nurdan|last5=TUrktas|first5=Haluk|title=Effects of Inspiratory Muscle Training in Subjects With Sarcoidosis: A Randomized Controlled Clinical Trial|journal=Respiratory Care|date=April 2016|volume=61|issue=4|pages=483-494|doi=10.4187/respcare.04312|accessdate=9 April 2016}} The duration, frequency, and physical intensity of exercise needs to accommodate impairments such as arthralgia, muscle pain, and fatigue. {{rp|734}} {{cite journal|last1=Spruit|first1=MA|last2=Wouters|first2=EFM|last3=Gosselink|first3=R|title=Rehabilitation programmes in sarcoidosis: a multidisciplinary approach|journal=European Respiratory Journal|date=2005|volume=32|issue=3|pages=316-326|accessdate=9 April 2016}}

Neurostimulants such as methylphenidate (sold as Ritalin) have shown some effectiveness as an adjunct for treatment of sarcoidosis fatigue.{{cite journal|last1=Drent|first1=Marjolein|title=Consequences of Sarcoidosis|journal=Clinical Chest Medicine|date=2015|volume=36|page=727-737|doi=10.1016/j.ccm.2015.08.013|url=http://dx.doi.org/10.1016/j.ccm.2015.08.013|accessdate=9 April 2016}}{{rp|733}}.

Nutritional supplements{{cite journal|last1=Boots|first1=AW|last2=Drent|first2=M|last3=de Boer|first3=VC|last4=et al.|title=Quercetin reduces markers of oxidative stress and inflammation in sarcoidosis|journal=Clinical Nutrition|date=2011|volume=30|issue=4|doi=10.1016/j.clnu.2011.01.010|url=http://www.clinicalnutritionjournal.com/article/S0261-5614(11)00026-4/abstract|pages=506-512|accessdate=9 April 2016}} {{cite journal|last1=Boots|first1=AW|last2=Drent|first2=M|last3=Swennen|first3=EL|last4=et al.|title=Antioxidant status associated with inflammation in sarcoidosis: a potential role for antioxidants|journal=Respiratory Medicine|date=2009|volume=103|issue=3|doi=10.1016/j.rmed.2008.10.007|url=http://www.resmedjournal.com/article/S0954-6111(08)00358-2/abstract|pages=364-372}} and counseling have also benefitted sarcoidosis patients and helped them manage their own conditions.

Treatments for symptomatic neuropathic pain in sarcoidosis patients is similar to that for other causes, and include antidepressants, anticonvulsants and prolonged-release opioids, however also similar to other causes, only 30-60% of patients experience limited pain relief.{{rp|733}}