Treatments for<unk>  vary greatly depending on the patient. At least half of patients require no systemic therapy. Most people (>75%) only require symptomatic treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin. For those presenting with lung symptoms, unless the respiratory impairment is devastating, active pulmonary<unk>  is observed usually without therapy for two to three months; if the inflammation does not subside spontaneously, therapy is instituted. Major categories of drug interventions include glucocorticoids, antimetabolites, biologic agents especially monoclonal anti-tumor necrosis factor antibodies. Investigational treatments include specific antibiotic combinations and mesenchymal stem cells. If drug intervention is indicated, a step-wise approach is often used to explore alternatives in order of increasing side effects and to monitor potentially toxic effects. Corticosteroids, most commonly prednisone or prednisolone, have been the standard treatment for many years. In some people, this treatment can slow or reverse the course of the disease, but other people do not respond to steroid therapy. The use of corticosteroids in mild disease is controversial because in many cases the disease remits spontaneously. Antimetabolites Antimetabolites, also categorized as steroid-sparing agents, such as azathioprine, methotrexate, mycophenolic acid, and leflunomide are often used as alternatives to corticosteroids. Of these, methotrexate is most widely used and studied. Methotrexate is considered a first-line treatment in neurosarcoidosis, often in conjunction with corticosteroids. Long-term treatment with methotrexate is associated with liver damage in about 10% of people and hence may be a significant concern in people with liver involvement and requires regular liver function test monitoring. Methotrexate can also lead to pulmonary toxicity (lung damage), although this is fairly uncommon and more commonly it can confound the leukopenia caused by<unk> . Due to these<unk> fety concerns it is often recommended that methotrexate is combined with folic acid in order to prevent toxicity. Azathioprine treatment can also lead to liver damage. However, the risk of infection appears to be about 40% lower in those treated with methotrexate instead of azathioprine. Leflunomide is being used as a replacement for methotrexate, possibly due to its purportedly lower rate of pulmonary toxicity. Mycophenolic acid has been used successfully in uveal<unk> , neurosarcoidosis (especially CNS<unk> ; minimally effective in<unk>  myopathy), and pulmonary<unk> . Immunosuppressants As the granulomas are caused by collections of immune system cells, particularly T cells, there has been some success using immunosuppressants (like cyclophosphamide, cladribine, chlorambucil, and cyclosporine), immunomodulatory (pentoxifylline and thalidomide), and anti-tumor necrosis factor treatment (such as infliximab, etanercept, golimumab, and adalimumab). In a clinical trial cyclosporine added to prednisone treatment failed to demonstrate any significant benefit over prednisone alone in people with pulmonary<unk> , although there was evidence of increased toxicity from the addition of cyclosporine to the steroid treatment including infections, malignancies (cancers), hypertension, and kidney dysfunction. Likewise chlorambucil and cyclophosphamide are seldom used in the treatment of<unk>  due to their high degree of toxicity, especially their potential for causing malignancies. Infliximab has been used successfully to treat pulmonary<unk>  in clinical trials in a number of cases. Etanercept, on the other hand, has failed to demonstrate any significant efficacy in people with uveal<unk>  in a couple of clinical trials. Likewise golimumab has failed to show any benefit in those with pulmonary<unk> . One clinical trial of adalimumab found treatment response in about half of subjects, which is similar to that seen with infliximab, but as adalimumab has better tolerability profile it may be preferred over infliximab. Specific organ treatments Ursodeoxycholic acid has been used successfully as a treatment for cases with liver involvement. Thalidomide has also been tried successfully as a treatment for treatment-resistant lupus pernio in a clinical trial, which may stem from its anti-TNF activity, although it failed to exhibit any efficacy in a pulmonary<unk>  clinical trial. Cutaneous disease may be successfully managed with antimalarials (such as chloroquine and hydroxychloroquine) and the tetracycline antibiotic, minocycline. Antimalarials have also demonstrated efficacy in treating<unk> -induced hypercalcemia and neurosarcoidosis. Long-term use of antimalarials is limited, however, by their potential to cause irreversible blindness and hence the need for regular ophthalmologic screening. This toxicity is usually less of a problem with hydroxychloroquine than with chloroquine, although hydroxychloroquine can disturb the glucose homeostasis. Recently selective phosphodiesterase 4 (PDE4) inhibitors like apremilast (a thalidomide derivative), roflumilast, and the less subtype-selective PDE4 inhibitor, pentoxifylline, have been tried as a treatment for<unk> , with successful results being obtained with apremilast in cutaneous<unk>  in a small open-label study. Pentoxifylline has been used successfully to treat acute disease although its use is greatly limited by its gastrointestinal toxicity (mostly nausea, vomiting, and diarrhea). Case reports have supported the efficacy of rituximab, an anti-CD20 monoclonal antibody and a clinical trial investigating atorvastatin as a treatment for<unk>  is under-way. ACE inhibitors have been reported to cause remission in cutaneous<unk>  and improvement in pulmonary<unk> , including improvement in pulmonary function, remodeling of lung parenchyma and prevention of pulmonary fibrosis in separate case series'. Nicotine patches have been found to possess anti-inflammatory effects in<unk>  patients, although whether they had disease-modifying effects requires further investigation. Antimycobacterial treatment (drugs that kill off mycobacteria, the causative agents behind tuberculosis and leprosy) has also proven itself effective in treating chronic cutaneous (that is, it affects the skin)<unk>  in one clinical trial. Quercetin has also been tried as a treatment for pulmonary<unk>  with some early success in one small trial. Because of its uncommon nature, the treatment of male reproductive tract<unk>  is controversial. Since the differential diagnosis includes testicular cancer, some recommend orchiectomy, even if evidence of<unk>  in other organs is present. In the newer approach, testicular, epididymal biopsy and resection of the largest lesion has been proposed. Symptoms People with<unk>  may have a range of symptoms that do not correspond with objective physical evidence of disease but that still decrease quality of life. Physical therapy, rehabilitation, and counseling can help avoid deconditioning, and improve social participation, psychological well-being, and activity levels. Key aspects are avoiding exercise intolerance and muscle weakness. Low or moderate-intensity physical training has been shown to improve fatigue, psychological health, and physical functioning in people<unk>  without adverse effects. Inspiratory muscle training has also decreased severe fatigue perception in subjects with early stages of<unk> , as well as improving functional and maximal exercise capacity and respiratory muscle strength. The duration, frequency, and physical intensity of exercise needs to accommodate impairments such as joint pain, muscle pain, and fatigue. Neurostimulants such as methylphenidate and modafinil have shown some effectiveness as an adjunct for treatment of<unk>  fatigue. Treatments for symptomatic neuropathic pain in<unk>  patients is similar to that for other causes, and include antidepressants, anticonvulsants and prolonged-release opioids, however, only 30 to 60% of patients experience limited pain relief.
Sarcoidosis
Cat-scratch disease
Melioidosis
Tuberculosis
Gamasoidosis
Sporotrichosis
Milk-alkali syndrome
Amyloidosis