Sarcoidosis development is connected with immune system overreaction to bacteria, viruses or chemical substances. Immune inflammation leads to the formation of granulomas in various organs (lungs, lymph nodes, skin, eyes, etc.). Nevertheless, the intrathoracic involvement is the most common disease manifestation. Causing shortness of breath, chest pain and dry cough, sarcoidosis requires pharmacotherapy in combination with non-drug therapeutic options. Although there is no cure for sarcoidosis yet, the appropriate treatment regimen reduces the inflammation and alleviates symptoms. Clinics of Germany, Turkey, Switzerland and other developed countries offer comprehensive sarcoidosis therapy.
Confirming the diagnosis
Prior to the therapeutic regimen elaboration, a doctor estimates the extent of internal organs affection with clumps of inflammatory cells. Starting from the physical examination (checking skin for bumps or rash, checking lymph nodes, listening to the heart and lungs, etc.), he will proceed to more objective and informative instrumental methods:
- Chest X-ray allows checking lung tissue for granulomas and revealing swollen intrathoracic lymph nodes. This is the most easy-to-perform and cost effective diagnostic procedure.
- Chest CT scan gives detailed cross-sectional images of the thoracic organs. In some patients the CT scan is enough for the diagnosis confirmation.
- Lung function test reveals affection of the lung capacity. During the procedure a patient breathes out into a spirometer. This is a device that measures speed and amount of air a patient blows out. Being affected by sarcoidosis, lungs typically do not work as well as the healthy ones.
- Bronchoscopy includes the direct examination of the inner surface of lungs and the respiratory tracts. A bronchoscope is a tiny flexible tube with a small camera and light source. A doctor inserts a bronchoscope through mouth or nose. Sometimes sedation with a local anesthetic is performed in order to avoid unpleasant feelings.
- EBUS-TBNA procedure is somewhat similar to bronchoscopy except it is supplemented with the ultrasound examination and biopsy performing. The EBUS-TBNA procedure is more likely to give a precise diagnosis than the conventional bronchoscopy.
- Biopsy includes taking sample of the affected lung tissue for the subsequent microscopic investigation. Biopsy is typically performed during the bronchoscopy or EBUS-TBNA procedure.
Laboratory tests may be carried out additionally (e.g. complete blood count, blood test for vitamin D and angiotensin-converting enzyme). Such tests do not confirm the diagnosis but are helpful in assessing patient’s health state and prognosis making.
Treatment with focus on the pharmacotherapy
In most cases, treatment of sarcoidosis starts from the watchful waiting as symptoms of the disease may improve even without therapy due to abatement of the pathological immune response. If the immune inflammation is severe enough, the immunosuppressive medications are administered.
Corticosteroids. The most common drug from this pharmacological group is prednisone. Prednisone is the nonspecific anti-inflammatory agent. Initially, your doctor may prescribe higher prednisone doses in order to control the inflammation better. Once the symptoms alleviate, the dose is decreased slowly. The maintaining dose of prednisone is prescribed afterwards.
Methotrexate, azathioprine, hydroxychloroquine, and mycophenolate are nonsteroidal immunosuppressive agents. These drugs block different stages of immune cells repair and replication. Thus, the immune response abates and inflammation becomes less pronounced. Some of these drugs, e.g. methotrexate, can be administered simultaneously or in place of prednisone.
Infliximab and adalimumab are the chimeric monoclonal antibodies that prevent lungs damage due to TNF-alpha (tumor necrosis factor-alpha) blocking. TNF-alpha inactivation leads to the pro-inflammatory cytokines synthesis suppression at the local and systemic levels. This results in milder inflammatory processes and improving patient’s quality of life.
The length of therapy may vary. Some people take drugs for few years; others may need medications for much longer. The main aim is preventing complications of the disease (e.g. lung infections, cataracts, kidney failure, etc.) and improving patient’s quality of life.
Non-drug therapeutic options and lifestyle modifications
When a patient is in the partial or complete remission, preventive measures come to the fore. Actually, people with sarcoidosis are able to carry on with usual social and physical activities, leading their normal lives. By following simple and reasonable recommendations a person with sarcoidosis can avoid the disease exacerbations:
- Quit smoking and using tobacco products. Although smoking doesn’t cause sarcoidosis, it worsens the lung function.
- Avoid chemicals, toxic inhalants or dust that can damage your lungs, e.g. use gas filtering device if you need to stay in the severe environment.
- Restrict calcium-rich foods and vitamin D, give preference to fresh fruits and vegetables.
- Be physically active, pay attention to the pulmonary rehabilitation.
- Get 6 to 8 hours of sleep every night.
In addition, you should undergo regular medical check-ups. Make sure that you visit your healthcare provider at least once a year or as soon as possible in case of symptoms development.
Choosing optimal therapy of sarcoidosis with Booking Health
As sarcoidosis treatment includes not only preventive measures and conservative therapy, but also lungs transplantation (in severe cases), people may seek specialized healthcare services outside their native countries. For instance, medical treatment in Germany includes the full range of diagnostic and therapeutic procedures, guiding a patient from the precise diagnosis making to comprehensive pulmonary rehabilitation.
Those patients who do not have experience of undergoing therapy in the foreign hospital may use help of Booking Health, the unique international provider of medical tourism. Booking Health professionals will:
- Help in making choice between clinics based on the qualification profile
- Establish contact directly with your future doctor
- Book the appointment
- Elaborate the preliminary medical program
- Provide favorable cost for treatment; avoid additional coefficients for foreign patients (saving up to 50%)
- Issue the medical insurance with а coverage of 200,000 EUR that is valid for 4 years
- Monitor medical program at all stages
- Help in buying and forwarding drugs and medical products
- Keep in touch with the healthcare facility after treatment program completion
- Control invoices and take care about return of unspent funds
- Arrange additional examination
- Book hotels and plane tickets, arrange transfer
To start planning your treatment abroad, just fill in the “Send request” form on the official website of Booking Health.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova