Sarcoidosis Medical Slides

Present the five stages with spontaneous remission rates: Stage 0 (normal CXR, extrapulmonary only), Stage I (bilateral hilar lymphadenopathy — 60-80% spontaneous remission), Stage II (BHL + pulmonary infiltrates — 50-60% remission), Stage III (pulmonary infiltrates without BHL — 30% remission), Stage IV (pulmonary fibrosis — 0% remission). Emphasize that staging is prognostic, not sequential — patients do not necessarily progress through stages.

Present the HRS 2014 expert consensus recommendations: screen all patients with unexplained AV block (especially age <60), ventricular tachycardia, or new-onset cardiomyopathy. Screening tools: ECG, echocardiography, and if abnormal → cardiac MRI (late gadolinium enhancement) or FDG-PET (focal uptake after 12-18 hour fast to suppress physiologic myocardial uptake). The 2014 JMHW criteria vs HRS criteria — HRS has higher sensitivity by incorporating advanced imaging.

Present clear indications for treatment: organ-threatening disease (cardiac, neurologic, sight-threatening ocular, severe hypercalcemia), progressive pulmonary impairment (FVC decline >10% or DLCO decline >15%), disabling symptoms. First-line: prednisone 20-40 mg/day tapered over 6-12 months. Early steroid-sparing for: anticipated >6 months therapy, relapse on taper, significant steroid side effects. Reference methotrexate as preferred steroid-sparing agent (10-15 mg/week) per 2020 ERS guidelines.