Dr. Yee notes two components of treatment. The first reduces active inflammatory processes that can lead to damage and is very much in the purview of rheumatologists. The second involves treating or mitigating the fibrosis that results from long-term inflammation, which can affect various organs. Antifibrotic medications are familiar to pulmonologists. Cardiologists who are heart failure specialists or electrophysiologists have pharmacologic and nonpharmacologic modalities to lessen the burden of damaged myocardium.
Rheumatologists are familiar with glucocorticoids, which reduce inflammation, and methotrexate, which modulates both immunity and inflammation. Rheumatologists have long used these drugs and others, notably tumor necrosis factor-alpha (TNF-α) inhibitors. The TNF-α inhibitors infliximab and adalimumab have been used to treat multiple diseases, including rheumatoid arthritis and uveitis, for 20 years, Dr. Yee adds.
“These trials show that more rheumatologists should participate in teams that manage sarcoidosis,” Dr. Yee emphasizes. “Rheumatologists should not be afraid of treatment to reduce the inflammation in sarcoidosis, even though they may not have learned much about it in medical school. We know more about prednisone and methotrexate than any other type of specialty. So I think these studies will help rheumatologists get even more comfortable with sarcoidosis.”
Deborah Levenson is a writer and editor based in College Park, Md.
References
- Baughman RP, Veleyre D, Korsten P, et al. ERS clinical practice guidelines on treatment of sarcoidosis. Eur Respir J. 2021 Dec 16; 58(6):2004079.
- Kahlmann V, Janssen Bonás M, Moore CC, et al. First-line treatment of pulmonary sarcoidosis with prednisone or methotrexate. N Engl J Med. 2025 July 17;393(3):231–242.
- Statement on sarcoidosis: Joint statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS board of directors and by the ERS executive committee, February 1999. Am J Respir Crit Care Med. 1999 Aug;160(2)736–755.
- Dhooria S, Sehgal IS, Agarwal R, et al. High-dose (40mg) versus low-dose (20mg) prednisolone for treating sarcoidosis: A randomised trial (SARCORT trial). Eur Respir J. 2023 Sep 9;62(3):2300198.
- Thillai M, Atkins CT, Crawshaw A, et al. BTS clinical statement on pulmonary sarcoidosis. Thorax. 2021 Jan;76(1):4–20.
