Sarcoidosis guidelines update

Sarcoidosis continues to be a challenging disease for which the indication for treatment is still unclear. The measurements of treatment response are too heterogeneous and single endpoints may not be reliable (enough). There are still many questions to be answered, and for the time being, international guidelines aim to fill in the gaps as much as possible/clinically feasible.

The ATS guidelines (last update in 2020) state that the diagnosis of sarcoidosis is not standardised, but based on 3 major criteria: a compatible clinical presentation, the histological finding of non-necrotising granulomatous inflammation in ≥1 tissue samples, and the exclusion of alternative causes of granulomatous disease [1]. Due to a lack of substantial evidence, the guidelines currently offer only 1 strong recommendation (i.e. for baseline serum calcium testing), whilst 13 conditional recommendations are made [1]. The ERS guidelines (2021) present 12 recommendations for 7 PICOs (patients, intervention, comparison, and outcomes) and state that the major reasons for treating sarcoidosis are to lower morbidity and mortality risk and/or to improve the quality of life [2,3].

1. Crouser ED, et al. Am J Respir Crit Care Med. 2020 Apr 15;201(8):e26-e51.
2. Baughman RP, et al. Eur Respir J. 2021 Dec 16;58(6):2004079.
3. Bock K. Essentials from the European Respiratory Society (2021) and the American Thoracic Society (2020) clinical practice guidelines on the diagnosis and treatment of sarcoidosis. Nordic Lung Congress 2022, 01–03 June, Copenhagen, Denmark.

 

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Posted on 17 August, 202216 August, 2022