Jamilloux Y, El Jammal T, Bert A, Sève P
Service de médecine interne, hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, 103, grande rue de la Croix Rousse, 69004 Lyon, France; Lyon Immunopathology FEderation (LIFE), Université Claude Bernard-Lyon 1, Lyon, France.
Service de médecine interne, hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, 103, grande rue de la Croix Rousse, 69004 Lyon, France.
Rev Med Interne. 2022 Jul;43(7):406-411. doi: 10.1016/j.revmed.2022.04.030. Epub 2022 May 31.
Sarcoidosis can develop into a chronic disease in about 30% of cases. When general treatment is indicated, corticosteroids are the first-line treatment. More than one third of patients treated with corticosteroids receive a steroid-sparing agent. Although methotrexate is the most commonly used sparing agent, synthetic antimalarials have been used for more than fifty years on the basis of small, randomised, therapeutic trials. Despite this low level of evidence, chloroquine or more often hydroxychloroquine are used in daily practice, particularly to treat skin, bone and joint sarcoidosis, as well as hypercalcemia and certain types of uveitis. This review summarises the state of knowledge on steroid-sparing therapy in sarcoidosis, particularly in its extra-pulmonary form. These data support the need for good quality therapeutic trials to validate the use of hydroxychloroquine in this specific indication.
约30%的结节病病例会发展为慢性病。当需要进行全身治疗时，皮质类固醇是一线治疗药物。接受皮质类固醇治疗的患者中，超过三分之一会使用类固醇节省剂。尽管甲氨蝶呤是最常用的节省剂，但基于小型随机治疗试验，合成抗疟药已被使用了五十多年。尽管证据水平较低，但氯喹或更常用的羟氯喹在日常实践中仍被使用，特别是用于治疗皮肤、骨骼和关节结节病，以及高钙血症和某些类型的葡萄膜炎。本综述总结了结节病，特别是肺外结节病的类固醇节省疗法的知识现状。这些数据支持需要进行高质量的治疗试验，以验证羟氯喹在这一特定适应症中的使用。
