1) In patients with pulmonary sarcoidosis, should glucocorticoid treatment be used versus no immunosuppressive treatment? |
For untreated patients with major involvement from pulmonary sarcoidosis believed to be at higher risk of future mortality or permanent disability from sarcoidosis, we recommend the introduction of glucocorticoid treatment to improve and/or preserve FVC and QoL. (Strong recommendation, low quality of evidence.)
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2) In patients with pulmonary sarcoidosis, should one add immunosuppressive treatment or remain on glucocorticoid treatment alone? |
For patients with symptomatic pulmonary sarcoidosis believed to be at higher risk of future mortality or permanent disability from sarcoidosis who have been treated with glucocorticoids and have continued disease or unacceptable side-effects from glucocorticoids, we suggest the addition of methotrexate to improve and/or preserve FVC and QoL. (Conditional recommendation, very low quality of evidence.) For patients with symptomatic pulmonary sarcoidosis believed to be at higher risk of future mortality or permanent disability from sarcoidosis who have been treated with glucocorticoids or other immunosuppressive agents and have continued disease, we suggest the addition of infliximab to improve and/or preserve FVC and QoL. (Conditional recommendation, low quality of evidence.)
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3) In patients with cutaneous sarcoidosis, should glucocorticoid treatment be used versus no immunosuppressive treatment? |
For patients with cutaneous sarcoidosis and cosmetically important active skin lesions which cannot be controlled by local treatment, we suggest oral glucocorticoids be considered to reduce skin lesions. (Conditional recommendation, very low quality of evidence.)
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4) In patients with cutaneous sarcoidosis, should one add other immunosuppressive treatment when treatment with glucocorticoids has not been effective? |
For patients with cutaneous sarcoidosis who have been treated with glucocorticoids and/or other immunosuppressive agents and have continued cosmetically important active skin disease, we suggest the addition of infliximab compared to no additional treatment to reduce skin lesions. (Conditional recommendation, low quality of evidence.)
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5) In patients with clinically relevant cardiac sarcoidosis, should glucocorticoids with or without other immunosuppressives versus no immunosuppression be used? |
For patients with evidence of functional cardiac abnormalities, including heart block, dysrhythmias or cardiomyopathy, we recommend the use of glucocorticoids (with or without other immunosuppressives). (Strong recommendation, very low quality of evidence.)
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6) In patients with neurosarcoidosis, should immunosuppressive treatment be used versus no immunosuppressive treatment? |
For patients with clinically significant neurosarcoidosis, we recommend treatment with glucocorticoids. (Strong recommendation, very low quality of evidence.) For patients with neurosarcoidosis that have been treated with glucocorticoids and have continued disease, we suggest the addition of methotrexate. (Conditional recommendation, very low quality of evidence.) For patients with neurosarcoidosis that have been treated with glucocorticoids and a second-line agent (methotrexate, azathioprine, mycophenolate mofetil) and have continued disease, we suggest the addition of infliximab. (Conditional recommendation, very low quality of evidence.)
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7) In patients with sarcoidosis-associated fatigue, should immunosuppressants, neurostimulants, exercise or other treatments be used versus no treatment for fatigue? |
In patients with sarcoidosis who have troublesome fatigue, we suggest a pulmonary rehabilitation programme and/or inspiratory muscle strength training for 6–12 weeks to improve fatigue. (Conditional recommendation, low quality of evidence.) In patients with sarcoidosis who have troublesome fatigue that is not related to disease activity, and after consideration of a pulmonary exercise or rehabilitation programme, we suggest the use of d-methylphenidate or armodafinil for 8 weeks to test its effect on fatigue and tolerability. (Conditional recommendation, low quality of evidence.)
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8) In sarcoidosis patients with small-fibre neuropathy, should immunosuppressants or intravenous immunoglobulin be prescribed versus no treatment? |
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