This is a complex topic. In general I would probably carefully monitor an asymptomatic patient in whom I had established this diagnosis rather than initiate therapy
I think it's important to monitor such a patient (CT thorax and pulmonary function) at regular intervals for signs of progressive disease and for other conditions (such as an interstitial lung disease) that can develop in these individuals. Likewise, the emergence of a dominant nodule or lymphadenopathy on chest CT would be a cause for concern (and biopsy if appropriate).
I have had experience with one patient who had the unfortunate tetrad of SS, pulmonary amyloidosis, pulmonary MALT lymphoma and lymphocytic interstitial pneumonitis. Although the MALT lymphoma was in remission, the patient required several courses of prednisone for the LIP. For various reasons, methotrexate was not an option for that individual and so there wasn't much improvement in what we believed to be amyloid-related nodules.
Dear Wanis H Ibrahim, an interesting question and difficult to answer without knowing the full details. You mention that the patient is asymptomatic. What are the lung function, exercise tolerance, any hypoxia on exercise, quality of life indices and most importantly the patient's wishes? It would be important to be able to monitor the anatomy, physiology , co-morbid conditions etc. serially to establish objective measures of any deterioration before embarking on complex treatment which has it's own morbidity. Hope this helps.
Dear Avijit. Thank you very much for your response. In fact the patient's PFT result an oxygen saturaion were normal
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