Sarcoidosis

[Guest]

I diagnosed Sarcoid apx. 10 months ago. I am still having to use inhalers a nebulizer as well as suplemented oxygen every day. I am taking 60mgs. of Prednisone a day am now having problems skin lesions as well. diagnosis came from a biopsy of lymp nodes in my chest have returned to nomal size now , I am still battleing CPOD. Can lend any advise may help me? Do fill methotrexate may be better me than prednisone?

[Guest]

Methotrexate is used in patients who are intolerant to the side effects of sarcoidosis or in patients who are not responding sufficiently to steroids. It is difficult to say what your breathing problems are due to without an examination, review of PFT's and radiographs. Methotrexate is considered a viable option in someone with persistent symptoms still on high dose steroids. The shortness of breath can be due to many different things, including deconditioning, weight gain, progressive sarcoidosis, other respiratory ailments. A difficult problem often time is what to do with the steroids in a person who has sarcoid and has remained stable with shortness of breath but not improved over a period of time. When does one feel that the lung impairment is pernament and that nothing more can be gained by prolonged high dose steroids, but the defect is not going to progress. The answer to that question needs to be done on an individual basis with close follow up of the symptoms and objective measures as one weans the steroids after prolonged use. Further complicating this is the fact that people who are on high dose steroids often feel poor nonspecifically when weaing steroids. Often times with prolonged high dose if the lung function is remaining stable then tapering and watching for decline is a reasonable thing. Progression of lung decline is a reason to consider methotrexate. Sometimes stability, with significant impairment over a period of time with high dose steroids is another reason.