
Back on a higher dose of prednisone. I am having more trouble breathing and with fatigue. OH FOR JOY...
I was just looking at an interesting study, with a reasonable sample size. If their conclusions have been substantiated by other similar studies, I am past the point of not return. It seems that the best results are with NEVER giving steroids to someone diagnosed with sarcoidosis!
The following was the published abstract from the journal CHEST (v. 111):
Over a 4-year calendar period, 337 patients with sarcoidosis were prospectively enrolled in a registry. One hundred eighteen patients were assigned to a spontaneous remission group when symptoms resolved without treatment, and 103 were assigned to an induced remission group when symptoms resolved following corticosteroid therapy and successful discontinuation. In 116 patients assigned to a recalcitrant group, therapy could not be stopped for 1 month or more owing to severity of symptoms or lack of compliance. We defined relapse as a recurrence of symptoms of sufficient
severity to warrant treatment with corticosteroids, following a remission without treatment lasting greater than 1 month.
Intervention: Patients who were judged to be sufficiently symptomatic to preclude observation without treatment or who failed to respond to conservative treatment with topical or inhaled corticosteroids or nonsteroidal anti-inflammatory agents were treated with systemic corticosteroids at a target dose of 20 mg prednisone per day for 1 year. (I am already out of the ballpark here as I was started at 50 mg a day)
Measurements and results: We observed a 74% relapse rate in the induced remission group, but only an 8% relapse rate in the spontaneous remission group (p<0.01).
Conclusions: Relapse occurred frequently in patients with sarcoidosis who had been treated with corticosteroids, and rarely occurred in patients who had not been treated with corticosteroids in the past. The striking difference in relapse rate between treated and untreated patients suggests that patients with disease that would later be severe and protracted were almost unerringly identified early in their course. One explanation is that severe presenting symptoms portend a protracted and recurrent course; an alternative explanation is that corticosteroids contributed to the prolongation of the disease by delaying resolution.