Diagnosis and treatment of sarcoidosis: a literature review

Alisa Pozniak1

1Faculty of Medicine, Vilnius University, Vilnius, Lithuania


Background. Sarcoidosis is a granulomatous disease of unknown etiology that can damage any organ but predominantly affects the lungs and intrathoracic lymph nodes. The disease most often occurs in non-smoking women aged 30 to 50 years. The incidence varies from 5 to 64 cases per 100 000 population in different countries.

Aim: to review the diagnosis and treatment of sarcoidosis.

Methodology: literature sources were selected from PubMed database following dates from 2016 to 2022 using keywords and their combinations: granuloma, sarcoidosis, positron emission tomography/computed tomography (PET/CT), tumor necrosis factor alpha (TNF-α ) inhibitors, Janus kinase (JAK) inhibitors.

Results. Sarcoidosis is characterized by nonspecific symptoms. Chest radiography,  bronchoalveolar lavage (BAL) fluid and granulomas without necrosis, detected in the biopsy of the affected organ are used to diagnose the disease. Magnetic resonance imaging (MRI) or PET/CT is used to assess the spread of the disease. First-line drugs are glucocorticosteroids. Second-line drugs are methotrexate or azathioprine in combination with glucocorticosteroids. TNF-α inhibitors may be used for third-line therapy. JAK inhibitors have emerged as a promising new treatment approach.

Conclusions. The diagnosis of sarcoidosis is based on instrumental tests. Most patients do not need treatment, only monitoring. Glucocorticosteroids, methotrexate and azathioprine are widely used in treatment. There is still a lack of high-quality clinical trials of TNF-α inhibitors and JAK inhibitors use in clinical practice.

Keywords: granuloma, sarcoidosis, PET/CT, TNF-α inhibitors, JAK inhibitors.