Medical Care:
" Colchicine or azathioprine can be used for systemic manifestations, such as severe ulcers or skin disease. Antileprosy drugs, dapsone and thalidomide, and the immune modulator levamisole may be useful.
" Joint involvement may respond to prednisone, local corticosteroid injections, and nonsteroidal anti-inflammatory drugs (NSAIDs). Colchicine, sulfasalazine, and interferon-alpha also are used. Levamisole and azathioprine may be alternatives.
" Ocular disease is a feared complication. Treatment involves topical drops (ie, both mydriatic and corticosteroid drops). Successful immunosuppression is achieved with azathioprine, systemic corticosteroids, cyclosporine, chlorambucil, tacrolimus, or cyclophosphamide.
" Erythema nodosum is a special circumstance and may be treated with colchicine or dapsone.
" Central nervous system disease usually is treated with prednisone (or prednisolone), chlorambucil, or cyclophosphamide.
" Gastrointestinal lesions usually are treated with corticosteroids, sulfasalazine, or thalidomide.
" Thrombotic events are treated with anticoagulants.
" Vasculitis is treated with immunosuppressive medication, such as cyclophosphamide. Anticoagulants may increase the mortality in patients with pulmonary vasculitis.
" Tumor necrosis factor (TNF) antagonists, such as etanercept or infliximab may be effective.
Surgical Care:
" Gastrointestinal perforations and subsequent peritonitis need surgical treatment.
" Aneurysms may require resection, as may ischemic tissues affected by vasculitis or thrombosis.
" Surgical excision has been performed for endocardial fibrosis.
" Ventricular aneurysms and coronary thrombosis may be amenable to surgery.
" Glaucoma, cataracts, or retinal detachment may require surgery, and neurosurgery may correct some central nervous system aneurysms or clots.
Diet:
" No general dietary recommendations exist.
" Patients with severe bowel involvement are advised to follow the recommendations of gastroenterologists for patients with inflammatory bowel disease.
Activity: Activity is suggested as tolerated and may be limited due to systemic symptoms or arthritis