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Sarcoidosis

Is My Medication Hindering My Ability To Have Children?

06/02/2008

Question:

Thank you for hosting this website. It truly is helpful. For three years the sarcoidosis in my bone marrow continued to spread from my hands and feet to my arms, ribs, and legs. I have been treated with Prednisone, which made me worse. I am now taking hydroxychloroquine and Trental which help some of my symptoms but it does not appear to stop the spread. I see one Rheumatologist who now recommends Methotrexate. I have another rheumatologist who recommends anti TNF infusions two to three times per week. I perform surgery. I am 36, and would like to have children one day. I still work full time, but the fatigue and pain are taking its toll. I have concerns about methotrexate interfering with further fatigue and the potential to bear children. I have concerns about the anti TNF infusions as I may have to stop working.

Answer:

The progression of sarcoidosis of the bone marrow despite hydroxychloroquine and Trental is not surprising, and many patients do not tolerate prednisone at doses required to control sarcoidosis. As you have noted, methotrexate should be avoided in those who wish to bear children. Alternatively, sperm or ova can be preserved for the future. The anti-TNF drugs are a good alternative, and may be particularly useful for those with steroid-resistant disease. The protocol for Remicade infusions does not involve multiple dosing each week...usually we begin with every other week dosing and gradually increase the intervals between treatments to 6-8 weeks. This is an expensive treatment, but most insurance companies and even government programs cover it. If you feel well enough after treatment you may be able to go back to work.

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Response by:

Elliott D Crouser, MD Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University