Valeyre D
Service de pneumologie, hôpital Avicenne, Bobigny.
Rev Prat. 1994 Oct 1;44(15):2059-63.
The treatment of sarcoidosis remains empirical. In severe cases, it is based on systemic corticosteroid therapy which is highly effective on granulomatous lesions and immune and metabolic disorders. Its limitations are its purely "suspensive" effect, its lack of efficacity on fibrous lesions and its side effects. It is widely accepted in the case of poorly tolerated, recent sarcoidosis and respiratory or extrarespiratory involvement, modification of the general status, or hypercalcaemia. In these cases, its therapeutic effect is spectacular. Corticosteroid treatment is also indicated in most chronic forms having development of fibrosis. Complementary examinations, especially CT scan of the chest, can be useful in treatment decision. Failure or contraindication of corticosteroids suggests the use of synthetic antimalarial drugs or methotrexate. Local corticosteroids are useful in treatment of ophthalmologic or skin localisations.
结节病的治疗仍基于经验。在严重病例中，治疗以全身糖皮质激素疗法为基础，该疗法对肉芽肿性病变以及免疫和代谢紊乱高度有效。其局限性在于它纯粹是“缓解性”作用，对纤维性病变缺乏疗效且有副作用。在难以耐受的近期结节病、有呼吸或呼吸外受累、一般状况改变或高钙血症的情况下，它被广泛接受。在这些情况下，其治疗效果显著。糖皮质激素治疗在大多数已发展为纤维化的慢性病例中也有指征。辅助检查，尤其是胸部CT扫描，对治疗决策可能有用。糖皮质激素治疗失败或存在禁忌时，建议使用合成抗疟药或甲氨蝶呤。局部糖皮质激素对眼科或皮肤局部病变的治疗有用。
