From the Guidelines
Anasarca in sarcoidosis patients should be managed by treating the underlying sarcoidosis with corticosteroids, such as prednisone, and diuretics like furosemide, with careful monitoring of kidney function, electrolytes, and cardiac status. Anasarca and sarcoidosis are distinct medical conditions that can sometimes be related, with sarcoidosis occasionally leading to anasarca if it causes significant cardiac or renal dysfunction [ 1 ]. Sarcoidosis is a multisystem inflammatory disorder characterized by the formation of granulomas in various organs, most commonly the lungs and lymph nodes. The decision to treat an individual sarcoidosis patient depends on two major factors: risk for death or organ failure and impairment of quality of life (QoL) [ 1 ].
Key Considerations
- The European Respiratory Society (ERS) clinical practice guidelines on treatment of sarcoidosis emphasize the importance of treating symptomatic disease [ 1 ].
- Corticosteroids like prednisone are commonly used to treat sarcoidosis, with a typical starting dose of 20-40mg daily for 1-3 months, then gradually tapering [ 1 ].
- Diuretics such as furosemide (20-80mg daily) can help reduce fluid retention in anasarca [ 1 ].
- Monitoring kidney function, electrolytes, and cardiac status is essential during treatment to prevent complications [ 1 ].
- In severe cases, additional immunosuppressants like methotrexate (10-25mg weekly) or azathioprine (50-200mg daily) may be needed to control the underlying sarcoidosis [ 1 ].
Treatment Approach
- The treatment approach should be individualized based on the presence of symptomatic disease and the risk of organ failure or death [ 1 ].
- The use of anti-inflammatory therapy, such as corticosteroids, can help prevent progression to irreversible disease [ 1 ].
- The treatment of sarcoidosis-associated fatigue (SAF) and small-fibre neuropathy (SFN)-associated symptoms is also a high priority [ 1 ].
From the Research
Sarcoidosis Overview
- Sarcoidosis is a multisystem granulomatous disease with nonspecific clinical manifestations that commonly affects the pulmonary system and other organs including the eyes, skin, liver, spleen, and lymph nodes 2.
- The disease usually presents with persistent dry cough, eye and skin manifestations, weight loss, fatigue, night sweats, and erythema nodosum 2.
Treatment of Sarcoidosis
- Corticosteroids are the drug of choice for the treatment of sarcoidosis, and they work quickly 3.
- However, because of the potential toxicities of corticosteroids, alternative medications often need to be considered, such as cytotoxic agents, hydroxychloroquine, and cyclosporine 3, 4.
- Immunosuppressives such as methotrexate, azathioprine, leflunomide, and mycophenolate have all been reported as effective in sarcoidosis 5.
- Biologics and other agents are third-line therapy, with monoclonal antibodies directed against tumor necrosis factor having been shown to be particularly effective for advanced disease 5.
Anasarca and Sarcoidosis
- There is no direct evidence in the provided studies that links anasarca to sarcoidosis.
- However, sarcoidosis can cause a range of symptoms, including weight loss, fatigue, and night sweats, which may be related to anasarca 2.
- Further research is needed to determine the relationship between anasarca and sarcoidosis.
Corticosteroid Dosage
- Current guidelines recommend 20-40 mg·day-1 of oral prednisolone for treating pulmonary sarcoidosis 6.
- A randomised trial (SARCORT trial) found that high-dose (40 mg·day-1) prednisolone was not superior to a lower dose (20 mg·day-1) in improving outcomes or health-related quality of life in sarcoidosis, and was associated with similar adverse effects 6.