American Medical Association Family Medical Guide - American Medical Association [640]
Treatment
Polymyalgia rheumatica frequently disappears by itself after a year or longer. With treatment, symptoms are usually relieved within 48 hours. Depending on the severity of symptoms, the doctor may recommend taking nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, or naproxen, or he or she may prescribe low doses of corticosteroid drugs, which are very effective in relieving symptoms. To produce the best results, corticosteroids must be taken for 6 months to 2 years.
Sarcoidosis
Sarcoidosis is a chronic inflammatory condition in which small areas of inflamed tissue (called granulomas) form in organs or other tissues in the body. Although sarcoidosis usually affects the lungs and the lymph nodes (infection-fighting glands), it can also affect the heart, nervous system, muscles, joints, liver, kidneys, skin, or eyes. Most doctors think that sarcoidosis is an autoimmune disorder, in which the immune system mistakenly produces antibodies (infection-fighting proteins) that attack the body’s own tissues. The disorder most often affects black adults between ages 20 and 40, which indicates a genetic component.
Symptoms
Many people who have sarcoidosis do not have symptoms. When symptoms occur, they can vary according to the organs or tissues that are affected. In many cases, a red, itchy rash develops on the face, arms, and legs. You may also have a fever, fatigue, loss of appetite, and weight loss. Arthritislike swelling and pain sometimes occur, especially in the hands and feet. If your lungs are affected, you may have a persistent dry cough, shortness of breath, or mild chest pain. Damage to the heart can cause chest pain, an abnormal heartbeat (see page 580), or heart failure (see page 570). The lymph nodes or liver can become enlarged. You may experience weakness or pain in your muscles or joints. If your nervous system is affected, you may have trembling, loss of balance and coordination, paralysis, hearing loss, or seizures. The condition sometimes causes dry, watery eyes and impaired vision. If your kidneys are affected, you may develop kidney stones (see page 814).
Diagnosis
Doctors base a diagnosis of sarcoidosis on the symptoms, a health history, and a physical examination. Your doctor will probably order a chest X-ray to examine your lungs, and lung function tests (see page 647) to evaluate your lung capacity (the amount of air you can inhale in a single breath) and the ability of your lungs to transfer oxygen to the blood. He or she may recommend blood tests to measure the levels of calcium, angiotensin-converting enzyme (a substance in the blood that narrows blood vessels), and specific antibodies. People who have sarcoidosis usually have excess amounts of these substances in their blood.
You may also have a procedure called bronchoscopy (see page 661), in which the doctor uses a long, flexible viewing tube to look inside your lungs. During this procedure, he or she may perform a biopsy, in which a sample of the affected tissue is removed for examination under a microscope. Because tuberculosis causes similar symptoms, your doctor may perform a tuberculin skin test (see page 663) to rule out tuberculosis as a possible cause of your symptoms.
Treatment
In many cases, sarcoidosis does not require treatment and clears up on its own within a few years. For mild, arthritislike symptoms, your doctor may recommend taking over-the-counter nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, or naproxen to relieve pain and inflammation in the joints. If you have mild respiratory symptoms, your doctor may monitor your lungs for several months with chest X-rays and lung function tests to determine whether the condition is improving or worsening.
If your symptoms are persistent or severe, or if the condition worsens, your doctor will probably prescribe corticosteroid medications such as prednisone to reduce inflammation, relieve shortness of breath or joint pain, and suppress the abnormal activity of your immune system. He or she may also recommend supplemental oxygen