Sarcoidosis: Management

Key points

• Sarcoidosis: a multisystem disorder of unknown cause with non-caseating granulomas; commoner in young adults and people of African descent.
• Indications for corticosteroids: symptomatic chest X-ray stage 2 or 3 disease (asymptomatic, stable stage 2-3 with only mildly abnormal lung function does not need treatment).
• Also treat: hypercalcaemia, and eye, cardiac or neurological involvement.
• First-line is oral corticosteroids (with bone protection); steroid-sparing agents (methotrexate, azathioprine) for chronic disease.
• Lofgren syndrome (erythema nodosum, bilateral hilar lymphadenopathy, arthralgia, fever) is an acute presentation with a good prognosis that usually resolves without treatment.