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Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
Evolving management of sarcoidosis in the real world
Daniel A Culver1, Manuel L Ribeiro Neto
1Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Purpose Of Review:
The management of sarcoidosis has relied mainly on glucocorticoids for over 80 years. Innumerable review articles, as well as all current guidelines, position systemic steroids as first line therapy for moderate and severe sarcoidosis. Despite accumulating evidence of short term (mostly overt) and long term (often unrecognized) toxicities of steroids, and the example of specialists treating diseases like rheumatoid arthritis and inflammatory bowel disease, the treatment paradigm for sarcoidosis has remained stubbornly affixed to steroids.
Recent Findings:
In 2025, there is now compelling evidence to relegate steroids to a lesser role in the management of sarcoidosis. Nonsteroid agents, especially methotrexate, can be used as first line therapy for many patients.
Summary:
As steroid use diminishes, the development and implementation of additional steroid-sparing agents will assume increased importance.
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