FROM THE DESK OF DR C. EVERETT KOOP

By Ed Edelson
HealthScoutNews Reporter

Tuesday, March 12 (HealthScoutNews) --


Corticosteroid drugs can help patients with a severe form of sarcoidosis, the inflammatory disease that is in many ways a medical puzzle.

"This is the first time that anyone has attempted to carry out a proper systematic review of all the data about corticosteroid treatment of the condition," says Paul W. Jones, head of physiological medicine at St. George's Hospital in London. He reports his finding in tomorrow's issue of the Journal of the American Medical Association.

Sarcoidosis is a disease of unknown origin that can affect many organs of the body. It usually occurs in people aged 20 to 40, is more common and more severe in blacks, and affects twice as many women as men. Its principal feature is the appearance of small areas of inflamed cells called granulosa, which can develop on the skin or in the respiratory system. In many cases, the disease disappears as mysteriously as it came.

Symptoms include shortness of breath, a cough, a rash, red bumps on the face, arms or shins, weight loss, fever and night sweats. In his study, Jones sifted through 150 reported trials of steroid therapy, each of which included a control group that received a placebo, to determine the effect of treatment on relieving those symptoms.

"It is one condition in which it is very important to have a control group," Jones says. "The problem with studying treatment of sarcoidosis is that it is not uncommon for there to be spontaneous recovery." His review shows that "if people are given an oral corticosteroid, there is greater improvement in the treatment group than in the control group after a year."
The study confirms the rightness of current sarcoidosis treatment, says Dr. Jack Lieberman, a recognized authority on the condition. Specifically, steroid therapy is recommended for the more severe cases, known as Stage 2 or Stage 3.

"The patient should not be treated unless there are severe symptoms," Lieberman says. "Most Stage 1 patients don't have to be treated because they have no symptoms."

However, there still is an unanswered question about steroid treatment, Jones says.

"What this study doesn't tell us is whether giving steroids will have any long-term benefits," he says. "If the steroids are stopped and the patients are followed for another year or so, would the benefit be maintained?" That question is likely to go unanswered, Jones says, because an answer would require a carefully controlled trial.

"It's highly improbable that such a trial would be carried out," he says. "Steroids do have a beneficial effect, so designing a placebo control study would be quite risky."

What To Do
"The review does clarify who will benefit from treatment," Jones says. "Steroids should be used only in more severe cases."
A complete rundown on sarcoidosis is offered by the National Heart, Lung, and Blood Institute and the American Lung Association.

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