The sarcoidosis granuloma is formed by a distinct conglomeration of multinucleated giant cells and epithelioid macrophages surrounded by a rim of CD4+ T cells ( 1). Herein, we review the indications for treatment, pharmacotherapy, treatment duration, side effects, adjunct non-pharmacologic therapies, and outcomes for patients. Treatment is directed at alleviating organ dysfunction, preventing irreversible scarring, and improving quality of life. Lung and thoracic lymph nodes are most often involved, but any organ can be affected, with multi-system involvement having a worse prognosis. The disease is diagnosed by a constellation of radiographic, clinical and histopathologic findings it is most often defined by the presence of noncaseating granulomatous inflammation that occurs in the absence of infection, exposures, malignancy, or alternative immune-related disease. Sarcoidosis is a systemic disease of unknown etiology that can cause organ dysfunction and diminished quality of life. Future treatment approaches may also include personalized decisions based on pharmacogenomics and sarcoidosis phenotype, as well as patient-centered approaches to manage immunosuppression, symptom control, and treatment of comorbid conditions. Discovery of new therapies will depend on research into pathogenesis of antigen presentation and granulomatous inflammation. In this review, a multidisciplinary treatment approach is summarized, addressing immunuosuppressive drugs, managing complications of chronic granulomatous inflammation, and assessing treatment toxicity.
REVIEWS OF JIM FINK OPTIONS EXPERT TRIAL
Clinical trials guiding evidence for treatment are lacking due to the rarity of disease, heterogeneous clinical course, and lack of prognostic biomarkers, all of which contribute to difficulty in clinical trial design and implementation. Current treatment options focus on interruption of granuloma formation and propagation. Treatment is indicated to protect organ function and decrease symptomatic burden. Sarcoidosis is a systemic disease of unknown etiology defined by the presence of noncaseating granulomatous inflammation that can cause organ damage and diminished quality of life. Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Iowa, Iowa City, IA, United States.
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