Sarcoidosis: An Update for the Primary Care Physician

Oluranti A. Aladesanmi, MD, MPH

In This Article


Observation would be appropriate in asymptomatic patients with mild disease, provided they are monitored periodically for evidence of clinical and radiologic progression.


Corticosteroids should be initiated when clinically necessary, and collaborative care with other subspecialists, including pulmonologists, rheumatologists, ophthalmologists, cardiologists, gastroenterologists, or dermatologists, may be necessary.

A recent systematic review of evidence from randomized, controlled trials for the effect of corticosteroids in sarcoidosis provided only limited guidance to physicians.[16] Because of the lack of evidence of sustained benefit and the potential adverse effects of corticosteroids, their use should be restricted to those patients in whom careful clinical assessment with monitoring of chest radiographs and lung function confirm a clear need for treatment.

Corticosteroids are usually effective and are indicated for progressive pulmonary disease, threatening critical organ involvement such as the eye, and central nervous system and cardiac involvement. After 6 months to 2 years, they should be withdrawn with careful patient monitoring. Chest x-rays may improve in patients with Stage 2 or 3 disease. Inhaled steroids may be useful for confirmed bronchial hyperreactivity.


Noncorticosteroids may be effective. Antimalarials are used for skin, bone, and joint involvement; methotrexate and azathioprine are steroid-sparing or steroid-replacing agents for serious organ involvement when steroid therapy is ineffective or not tolerated. Other agents include anti-TNF-alpha inhibitors such as pentoxyfylline, thalidomide, etanercept, and remicade, which have recently shown successes.[17]


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