Clinical Review

Sarcoidosis

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b3206 (Published 28 August 2009) Cite this as: BMJ 2009;339:b3206
  1. Owen J Dempsey, consultant chest physician1,
  2. Edward W Paterson, specialist registrar in respiratory medicine1,
  3. Keith M Kerr, professor of pulmonary pathology2,
  4. Alan R Denison, clinical senior lecturer3
  1. 1Department of Respiratory Medicine, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN
  2. 2Aberdeen University Medical School, Foresterhill, Aberdeen AB25 2ZD
  3. 3Aberdeen Biomedical Imaging Centre, University of Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZD
  1. Correspondence to: O J Dempsey owen.dempsey{at}nhs.net
  • Accepted 16 May 2009

Summary points

  • Sarcoidosis is a multisystem granulomatous disease of unknown cause, typically affecting young and middle aged adults

  • Three thousand new cases are diagnosed each year in the United Kingdom

  • Any organ can be affected—mostly lungs, skin, and eyes—and patients often feel tired and generally unwell

  • Most patients do not need systemic treatment, and disease often regresses spontaneously, especially in those presenting with erythema nodosum

  • A minority have potentially life threatening progressive organ dysfunction; these patients need active management including oral corticosteroids

Around 3000 new cases of sarcoidosis are diagnosed each year in the United Kingdom.1 General practitioners play a key role in the early recognition of the most common clinical presentations of this multifaceted disease, and they usually direct initial assessment and specialist referral. Although prognosis is excellent for most patients, a minority will develop life threatening complications and may need potentially toxic treatments. Most patients are young and understandably alarmed at having sarcoidosis, which can be difficult to explain and understand. This review provides a summary of the management of sarcoidosis and includes updates from the recently revised British Thoracic Society (BTS) guidelines.2

Sources and selection criteria

We searched for papers published between 1966 and March 2009 using appropriate index terms and the National Library of Medicine’s computerised search service (providing access to Medline, PreMedline, and other related databases). We also consulted Cochrane database systematic reviews and used our personal archive of references.

What is sarcoidosis and who gets it?

Sarcoidosis is a multisystem granulomatous disease of unknown cause, first described in 1877.3 Although sarcoidosis may occur at any age, it is usually seen in adults under the age of 50. It is slightly more common in women and certain racial groups, such as African-Americans and Scandinavians. Estimates of incidence and prevalence vary widely. In a well conducted five year study from a health maintenance organisation in the …

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