[Sarcoidosis from an immunological perspective - experience-based diagnosis and treatment with targeted therapies]

This review summarizes the immunologic approach to systemic sarcoidosis and presents the use of novel, targeted therapies such as TNF-alpha inhibitors and Janus kinase (JAK) inhibitors. Sarcoidosis is a granulomatous multisystem disease with diverse clinical manifestations that requires differentiated diagnostic and therapeutic strategies. The recommendations presented here are based on extensive clinical experience and expert opinion from the certified sarcoidosis center of excellence at University Hospital Zurich. The article provides an overview of immunopathogenesis, immunoserologic and imaging diagnostic pathways, as well as an evaluation of established and novel therapeutic concepts. Practical guidance for the use of TNF-alpha and JAK inhibitors, for adverse effect management, and for therapy escalation is presented. A focus is also placed on the indication for consultation in difficult cases to support primary care physicians in the effective and individually tailored care of patients with systemic sarcoidosis.