Advances in Sarcoidosis

Sarcoidosis is a systemic granulomatous disease influenced by genetic and environmental factors, resulting in a wide range of phenotypic variation. Accordingly, it often represents a diagnostic and therapeutic challenge. In recent years, evidence has notably accelerated across both diagnostic and therapeutic domains. EBUS-guided cryobiopsy has shown promising diagnostic improvement supported by randomized controlled trial data, while quantitative FDG-PET/CT biomarkers, novel radiotracers targeting somatostatin receptors and vascular adhesion protein 1, and multiparametric cardiac MRI have expanded the precision and prognostic value of imaging. Preclinical proteomic signatures and electronic nose technology suggest a future of earlier, less invasive detection. The 2025 WASOG Position Paper marked a paradigm shift in corticosteroid use, arguing against the traditional corticosteroid-centered model of sarcoidosis treatment. The PREDMETH trial supports methotrexate as a first-line alternative to prednisone in pulmonary sarcoidosis. Emerging targeted therapies-JAK inhibitors, PDE-4 inhibitors, and SGLT-2 inhibitors in sarcoid cardiomyopathy-provide preliminary but promising evidence of efficacy. Collectively, these advances outline a trajectory toward more precise, less toxic, and increasingly personalized management of sarcoidosis.