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Area of Science:

  • Immunology
  • Pulmonology
  • Radiology

Background:

  • Sarcoidosis is a multi-organ granulomatous disease with pulmonary involvement being most common.
  • Its pathogenesis involves genetic and environmental factors leading to immune dysregulation.
  • Accurate diagnosis is challenging due to variable presentation and the need to exclude other conditions.

Purpose of the Study:

  • To review the current understanding of sarcoidosis pathogenesis, diagnosis, and management.
  • To highlight the evolving role of imaging in sarcoidosis phenotyping.
  • To discuss current and future therapeutic strategies, emphasizing individualized care and minimizing corticosteroid use.

Main Methods:

  • Literature review of sarcoidosis pathogenesis, diagnosis, and treatment.
  • Analysis of current imaging techniques, including CT and radiomics.
  • Evaluation of established and novel therapeutic agents and treatment algorithms.

Main Results:

  • Imaging has advanced from chest X-ray to CT-based classification and radiomics for improved disease phenotyping.
  • Corticosteroids remain first-line, but methotrexate shows comparable efficacy with different side effect profiles.
  • Treatment decisions are complex, requiring individualization based on disease severity, organ damage risk, and quality of life.

Conclusions:

  • Sarcoidosis management is heterogeneous, necessitating revised treatment algorithms to minimize corticosteroid reliance.
  • Future research should focus on prognostic biomarkers and refined trial designs for better individualized care.
  • Developing evidence-based approaches and novel therapies is crucial for managing this complex disease.