Sarcoidosis

¹ Utrecht, The Netherlands

The diagnosis of sarcoidosis can nearly always be established by an assessment of the clinical picture in combination with the histologic features of a biopsy specimen.

Knowledge of the natural course of the disease is required in determining the indication for corticosteroid therapy.

The majority of patients with sarcoidosis of the lungs require no treatment. If the need to prevent the occurrence or progression of fibrosis calls for therapy, then the latter must adhere to a strictly formulated regimen.

Two therapeutic regimens are discussed. The general recommendation favors regimen 1, which calls for corticosteroid medication during a five-year period. Regimen 2 is used whenever the standard regimen is considered too rigorous, e.g. in the treatment of patients over age 45 or if the indication for therapy is questionable.

Careful management of patients with sarcoidosis nearly always succeeds in preventing the occurrence or progression of fibrosis. An insufficiently high dosage or premature discontinuation of treatment often leads to recurrence, prolongation of therapy and the occurrence of irreversible fibrosis.

The number of patients unnecessarily treated with corticosteroids can be limited by a careful study of the natural course of the disease. This requires the use of a classification in stages with the aid of an atlas.