Please select the option that best describes you:
Topics:
General Internal Medicine • Rheumatology • Sarcoidosis • Pulmonology • Diffuse Parenchymal Lung Disease
How do you approach a patient with sarcoidosis who cannot tolerate steroids and who is developing ILD?
Do you use TNF-i or MMF?
Answer from: at Community Practice
As with most questions about sarcoidosis, clear understanding of the relevant clinical context should first be established. While interstitial lung disease (ILD) is a common manifestation of sarcoidosis, it often can be safely monitored without treatment, and so radiologically identified sarcoid ILD...
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Answer from: at Academic Institution
I agree with Dr. @Yee’s comments and approach. However, I submit that all persons with proven pulmonary sarcoidosis have an interstitial component, regardless of stage or disease severity. Bronchoalveolar lavage in stage I cases with normal-appearing lung parenchyma and lung function demonstra...
Answer from: at Academic Institution
I will preface by saying that I'm not a specialty expert like Dr. @Yee and Dr. @Perez above. However, if you are seeing such a patient for a new diagnosis of pulmonary sarcoidosis AND have decided that they warrant treatment, one could also consider methotrexate (MTX) as a first agent!Its non-i...
Answer from: at Academic Institution
Dr. @Perez and @Yee have provided excellent information already. There are now several choices in treating sarcoidosis beyond steroids. My first choice would be methotrexate. A recent NJEM open-label non-inferiority study compared methotrexate and prednisone in sarcoidosis lung disease and foun...
Answer from: at Community Practice
I would start mtx to goal dose 8tabs weekly, steroid sparing, if no disease control, then add to DMARD MTX Humira vs Remicade based on infusion vs SC preference. Try to find a lab to monitor ACE, inflammation markers, and CK. Baseline EKG, HRCT, and PFT are reasonable.