Abstract
Sarcoidosis is an enigmatic, multisystem inflammatory disorder characterized by the
formation of non-necrotizing granulomas in affected organs. Sarcoidosis may be self-limited
or spontaneously resolve in up to two-thirds of individuals, but 10% to 30% develop
a more chronic syndrome requiring long-term treatment. Most individuals will require
treatment at some point during the course of the disease. Currently, guidelines recommend
treatment in those at risk of future morbidity or organ dysfunction to preserve the
quality of life. Careful identification of those likely to benefit from treatment
is critical, as current agents are cumbersome to monitor and all have adverse effects.
There is a lack of validated prognostic markers to identify those at risk for poor
outcomes, but identifying characteristic manifestations of severe disease early can
assist with treatment planning. While corticosteroids have been central to the treatment
of sarcoidosis, newer data have challenged the current treatment paradigm of steroids
as first-line agents. Recent and ongoing clinical trials may provide evidence for
individualized approaches centered on shared decision-making with patients, as balancing
the benefits of treatment must always be weighed with the potential for toxicity.
This paper will provide an update on current treatment paradigms, new therapeutic
strategies, and potential novel agents on the horizon while highlighting the existing
challenges and barriers to progress.
Keywords
sarcoidosis - corticosteroids - steroid-sparing agents - methotrexate - TNF inhibitors
- health-related quality of life
