What is your approach to therapy for pulmonary sarcoidosis resistant to methotrexate?

The first question I ask myself in any situation dealing with "refractory" sarcoidosis is "Am I sure active inflammation from sarcoidosis is the cause of their symptoms?". Oftentimes, I will see patients referred for refractory disease who end up having other causes of their symptoms. If I am confident it is sarcoidosis, then I would want to be sure they were on methotrexate long enough to see a therapeutic effect (at least 3 months in my opinion, others argue up to 6 months) and they were on at...