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Sarcoidosis: clinical update

CORRESPONDENCE: U. Costabel, Ruhrlandklinik, Dept Pneumology/Allergology, Tueschener Weg 40, 45239, Essen, Germany. Fax: 49 2014334029

Keywords: bronchoalveolar lavage, CD4/CD8 ratio, corticosteroids, Löfgren's syndrome, sarcoidosis

Received: March 8, 2001
Many advances have been made regarding sarcoidosis in the past 2 decades. As a result, sarcoidosis is now defined as a multisystem disorder with a heightened cellular immune response at sites of disease activity in patients with a predisposition for sarcoidosis and a presumed exposure to as yet unknown transmissible environmental agents.

Recent International Consensus Statement recommendations regarding diagnosis and therapy have been published. The diagnosis of sarcoidosis is based on a compatible clinical and/or radiological picture, histological evidence of noncaseating granulomas and exclusion of other diseases capable of producing a similar histological or clinical picture.

Therapy is based on corticosteroids, although there are indications of valuable alternatives. Except for life- and sight-threatening organ involvement, it should be carefully considered whether the patient might benefit from treatment. For asymptomatic pulmonary sarcoidosis, a watch and wait approach is appropriate; treatment should mainly be considered if symptoms develop or lung function deteriorates.

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