How to treat nodular disease

  Treatment I. Principles of treatment 1. Patients with stage I or II nodular disease who are asymptomatic and have normal lung function generally do not require special treatment, but need to be followed up.  2, acute inflammatory manifestations (such as fever, polyarthritis, erythema nodosum, can be given first non-steroidal anti-inflammatory agents (NSAIDs, treatment; if symptoms are obvious and NSAIDs treatment is ineffective, glucocorticoids can be used.  3. For intrapulmonary or extrapulmonary nodular disease with obvious symptoms or progressive development, glucocorticoids should be preferred. For anterior uveitis, glucocorticoids can be used locally, but for posterior uveitis, systemic medication should be used.  4. Severe cases of glucocorticoid resistance or patients with progressive exacerbation can use immunosuppressive agents (methotrexate or azathioprine), but reasonable dosing principles should be followed and treatment monitoring should be performed.  Second, the treatment drugs 1, glucocorticoid treatment should be individualized. Usually prednisone 20-40mg/day is applied, and after 1-3 months, the dosage is slowly reduced to 5-10mg/day according to the treatment response, and then the treatment is maintained for 6-12 months. The relapse rate is 16-74% after discontinuation.  2.Alternative therapy can be considered for immunosuppressants in patients who are ineffective in glucocorticoid therapy or have severe side effects, but attention should be paid to the monitoring of therapeutic response and toxic reactions.  I. Azathioprine at a dose of 100-150 mg/day.  II. The dose of methotrexate is 10-20mg/week.  III. Chloroquine is indicated for skin and mucosal nodular disease at a dose of 500mg/day, which is changed to 250mg/day after 2 weeks for 5 and a half months, followed by 6 months of rest.  3. Treatment of complications If complicated by infection, bronchiectasis, and hemoptysis, corresponding anti-infection and hemostatic treatment is required. For hemoptysis, selective arteriography and embolization can be considered after determining the site of bleeding by bronchoscopy.  4. Follow-up nodular disease stage I is reviewed every 6 months, and other stages are reviewed every 3-6 months for at least 3 years until X-ray normalization for 2 years. Especially for patients in remission from hormone therapy, follow-up should be strengthened.