Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown etiology having some features of autoimmune diseases. It most often affects the lungs and intrathoracic nodes, less often the skin and eyes and the nervous system, but basically it can affect most organs in the human body.
During diagnosis, we assess clinical manifestations, radiological findings and the histological findings - in particularly presence of non-caseifying granulomas. There is a need of restraint on the part of treatment, because in many cases, especially in the earlier radiological stages, it is a self-healing disease.
However, if a decision is made to initiate treatment, systemic corticosteroids are usually indicated in the first line. Treatment is initiated with 0.5 mg/kg prednisone per day, gradually reduced to 10 mg/day and should last for at least six months.
If the disease progresses despite to this therapy, second-line treatment is used, in which an immunosuppressant is added to prednisone. There is no binding consensus which drug to prefer, but methotrexate is most often recommended.
If two medications of the 2nd line fail, biological treatment is appropriate. The TNF-α (tumor necrosis factor alpha) antibody infliximab is currently well established, but a good therapeutic response has been observed with other TNF-α blockers as well as with other drugs involved in the cytokine network.