A young male with pulmonary sarcoidosis with high level of ACE responded well to oral steroid, he is still on maintenance dose of steroid (tab Prednisolone 10 mg OD) with normal ACE level. Should I stop steroid now, and how to follow up?
it is advised to taper steroid over 6 months to avoid relapse if there is no evidence of relapse and follow up parameters keeping with improvement you can stop unless there is extrapulmonary involvement or vital organ affection, if relapse occurred restart with 20 mg then taper and maintain patient on least effective dose that maintain stability
follow up by clinical, 6MWD, pao2, spirometric data also any investigation that was abnormal at time of diagnosis could be of value like ACE or calcium but the clinical and functional will be more predictors of improvement and stability
refer to this article for ttt and followup
http://erj.ersjournals.com/content/28/3/627.full.pdf
To my knowledge, ACE level is not an indication for therapy. For pulmonary involvement (stages II, III), progressive disease manifested by diminishing VT and increasing pulmonary shadowing is the sole indication. The minimal dose sustaining maximum improvement and gradually tapered down is an appropriate strategy.
Dear Bhupen!
By us, in HUngary indicated systematic steroid therapy if pulmonary involvement (noduli, fibrosis etc) is great or extrapulmonal/ extrathoracical lymphadenomegalia, or other organ: oculi, heart is ill. In this cases we start with 30-40 mg metilprednisolon, and quicqly reduce to8-12 mg. The treatment period is 6 month. We follow the patient two years, after the theapy, (X-ray, CT, sometimes ACE-level, dermatology signs).
So I think reduce the therapy 8 mg, and follow .Attention :Has the patient latent TBC?
- Badges
- Science topic
- Similar topics
- Chemistry
- Pharmacology
- Medical Pharmacology
- Clinical Pharmacology