Longitudinal Study of Chronic Sarcoidosis with Low‐Dose Maintenance Corticosteroid Therapy

Abstract

A series of 181 patients with chronic persistent sarcoidosis for more than 5 years have been reviewed, with a mean follow-up period of 14 years, and 77% followed for more than 10 years. Efforts to identify more white patients meeting the criteria of such persistent disease were unsuccessful. Seventy-eight percent were black, and 69% were women. Pulmonary disease was the major manifestation in 70% and was present in 88%. The early major disease feature predicts the nature of the long-term manifestation in 94%. Ninety-four percent were treated with prednisone, with 63% for more than 5 years. Fifty-three percent required continued treatment, and of those receiving continued treatment, 91% were maintained on doses of no more than 15 mg daily and 65% on no more than 10 mg of prednisone daily. Relapses were frequent as prednisone was withdrawn, occurring at least once in 75% and several times in 51%. Low-dose prednisone treatment with 5-15 mg daily provides significant benefit. A mean treatment period of 8 years was observed (range: 10 days to 24 years). The benefits of treatment greatly exceed the infrequent complications. In Baltimore, chronic sarcoidosis with persistent disease seems to be more frequently encountered in black patients than in white patients.

Pleural Effusion with Splenic Rupture as Manifestations of Recurrence of Sarcoidosis following Prolonged Remission

“…Once treatment with corticosteroids is started, it is acceptable to complete at least 6–12 months of therapy. About 90% of the patients treated with corticosteroids respond favorably by improvement of symptoms, pulmonary function tests, and radiologic findings, and 60% remain in complete remission following withholding corticosteroids [2]. It is suggested that the rate of recurrence after discontinuation of corticosteroids may decrease as the initial course of corticosteroid therapy is more prolonged [3].…”

Sarcoidosis- A Clinicoradiological Profile of 30 Patients

“…34 In contrast to this, some studies from the United States and British Isles cite a disproportionate representation of radiographic stage III and IV disease. [35][36] Previous studies from India 6,8 report that most of the radiographic abnormalities belonged to stage I and II, 21, 37 but another study 26 found that stage II and III were more common. 38 In present study, the most common stage of sarcoidosis on presentation was found to be stage II (46.6 %) followed by stage I (40%).…”

Corticosteroid treatment in sarcoidosis

“…If a relapse occurs, as evidenced by reappearance of clinical signs, chest radiographic abnormalities or lung function impairment, prednisone levels are then increased to a dosage sufficient to control the disease and subsequently tapered to a maintenance dose that is likely to be higher than the dose at which the relapse occurred. It has been shown that almost all of these relapses occur within 1-2 months of steroid therapy withdrawal, and three-quarters of patients who require corticosteroids for o5 yrs relapse when corticosteroids are withdrawn [92]. Of these patients, .90% can be maintained on a regimen of f15 mg prednisone daily, and 65% on f10 mg [92].…”

“…It has been shown that almost all of these relapses occur within 1-2 months of steroid therapy withdrawal, and three-quarters of patients who require corticosteroids for o5 yrs relapse when corticosteroids are withdrawn [92]. Of these patients, .90% can be maintained on a regimen of f15 mg prednisone daily, and 65% on f10 mg [92]. Although an alternate-day regimen is effective, with considerable reduction in side-effects, daily treatment is recommended because of the increased compliance [93].…”