Health condition · Clinically reviewed
Sarcoidosis, a multisystem granulomatous disease — modern care.
A multisystem inflammatory disease of unknown cause with non-caseating granulomas. Löfgren’s syndrome resolves spontaneously; other forms may need immunosuppression.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Checked against BTS, ERS and WASOG statements you can see at the end.
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Current for 2026
Reflects UK practice on tissue diagnosis, stepped immunosuppression, and cardiac sarcoid pathways.
Key facts
Sarcoidosis at a glance.
The essentials, in plain English — what it is, where it strikes, how it is diagnosed, and when treatment is actually needed.
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What it is
A multisystem inflammatory disease of unknown cause characterised by non-caseating granulomas in affected tissues.
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Where it hits
Pulmonary involvement in roughly 90% of cases — but skin, eyes, joints, heart and nervous system may all be affected.
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Löfgren’s syndrome
Arthritis, erythema nodosum and bilateral hilar lymphadenopathy — a distinctive presentation that resolves spontaneously in most.
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Most serious forms
Cardiac sarcoid and neurosarcoidosis are uncommon but life-changing — both need specialist care and low-threshold investigation.
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Diagnosis
Tissue confirmation of non-caseating granulomas is required in almost every case, most often via EBUS-guided nodal biopsy.
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First-line therapy
Oral steroids remain first-line when treatment is indicated — many patients need no treatment at all.
Why this guide matters
A multisystem disease that hides in plain sight.
Because sarcoidosis can involve almost any organ, the diagnosis is easy to miss and the treatment decision is nuanced. Three points shape everything else on this page.
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Tissue confirmation is the standard
Non-caseating granulomas on biopsy remain the diagnostic anchor — clinical patterns alone rarely suffice.
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Not all sarcoid needs treatment
Löfgren’s and other mild presentations often resolve without immunosuppression. Watchful monitoring is legitimate care.
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Cardiac and neuro forms are serious
Both are uncommon but potentially devastating — a low threshold for specialist assessment saves lives.
How the diagnosis is made
From first symptoms to a clear plan.
The steps a UK respiratory team will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
History and first imaging
Phase 2 · Confirming
Bloods and tissue biopsy
Phase 3 · Managing
Cardiac imaging and specialist clinic
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Recognising
Symptom + system history
A careful review of respiratory, skin, eye, joint, cardiac and neurological symptoms — sarcoidosis is a multisystem disease.
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Recognising
HRCT chest
High-resolution CT of the chest looking for hilar lymphadenopathy and parenchymal patterns — the commonest imaging finding.
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Confirming
Serum ACE
Angiotensin-converting enzyme — supportive rather than diagnostic. Neither sensitive nor specific enough to rule sarcoid in or out.
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Confirming
Calcium
Hypercalcaemia is a recognised complication of granulomatous disease and needs looking for and treating.
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Confirming
Endobronchial ultrasound + biopsy
EBUS-guided sampling of mediastinal nodes gives tissue confirmation of non-caseating granulomas — the diagnostic standard.
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Managing
Cardiac MRI + FDG-PET
Reserved for suspected cardiac sarcoid — arrhythmia, heart block or unexplained cardiomyopathy. Both imaging modalities complement each other.
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Managing
Multidisciplinary sarcoid clinic
Complex or multisystem disease is best managed in a specialist clinic with respiratory, cardiology, ophthalmology and neurology input.
Typical timeline: 4–12 weeks from first tests to a settled plan.
Symptoms
How sarcoidosis actually shows up.
Symptoms depend on which organs are involved. Here is what to look for and when to act.
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Respiratory symptoms
Dry cough and breathlessness — the commonest presentation, reflecting pulmonary involvement.
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Skin changes
Erythema nodosum on the shins, or lupus pernio — violaceous plaques on the nose and cheeks.
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Eye involvement
Uveitis — a red painful eye with blurred vision. Needs urgent ophthalmology to protect sight.
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Lymphadenopathy
Swollen lymph nodes, most often at the lung hila — often the first radiological finding.
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Joint symptoms
Ankle arthritis is classic in Löfgren’s syndrome — often with erythema nodosum and fever.
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Cardiac involvement
Arrhythmia, heart block, palpitations or unexplained cardiomyopathy — a red-flag presentation.
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Neurological symptoms
Cranial nerve palsy (especially facial), meningitis or spinal-cord involvement — neurosarcoidosis.
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Red flag: cardiac sarcoid
Arrhythmia, syncope or new heart block in known sarcoid — needs urgent cardiology assessment.
Treatment
How sarcoidosis is treated in the UK.
Observation for many, stepped immunosuppression for those who need it, and specialist care for organ-threatening disease.
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Observation
Many asymptomatic patients — including most with Löfgren’s syndrome — need no treatment, only monitoring.
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Oral prednisolone
First-line drug therapy when treatment is indicated — organ-threatening disease or troublesome symptoms.
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Methotrexate
Steroid-sparing agent for those needing longer-term treatment or intolerant of steroid side effects.
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Hydroxychloroquine
Useful for cutaneous sarcoid and sarcoid arthritis — well tolerated and often steroid-sparing.
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Azathioprine
Another steroid-sparing immunosuppressant — used when methotrexate is unsuitable or ineffective.
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TNF inhibitor
Infliximab or adalimumab for refractory disease — specialist-led, most often in neurosarcoidosis or severe cutaneous disease.
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ICD for cardiac sarcoid
An implantable cardioverter defibrillator is considered in cardiac sarcoid at risk of ventricular arrhythmia.
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Ophthalmology-led uveitis care
Topical or systemic steroid drops with slit-lamp follow-up — vision preservation depends on prompt specialist input.
What this guide is based on
The sources behind every claim on this page.
UK and international specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or respiratory team knows your history and can tell you which parts apply to you. If in doubt, ask for a review.
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British Thoracic Society. Clinical statement on pulmonary sarcoidosis.
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European Respiratory Society. Guidelines on treatment of sarcoidosis.
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World Association for Sarcoidosis and Other Granulomatous Disorders (WASOG). Organ assessment instrument.
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Sarcoidosis UK. Patient information and support resources.
Red flags
When sarcoidosis needs urgent attention.
Most sarcoidosis is stable and manageable. These are the situations where you should act promptly.
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Cardiac sarcoid arrhythmia
Palpitations, syncope, new heart block — call for urgent cardiology assessment and cardiac MRI.
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Neurosarcoidosis
New cranial nerve palsy, meningitis or spinal-cord signs — urgent neurology referral.
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Hypercalcaemia
Thirst, confusion, kidney injury — check calcium and treat promptly. Avoid vitamin D supplements without advice.
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Uveitis with vision loss
A red painful eye with blurred vision — same-day ophthalmology assessment. Do not wait.
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Löfgren’s vs progressive disease
Löfgren’s usually resolves; other presentations may progress. Get the classification right early.
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Post-steroid adrenal insufficiency
Prolonged steroid therapy needs a slow taper and steroid-sick-day rules — do not stop suddenly.
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Post-methotrexate cytopenia
Regular blood monitoring is essential — bone marrow and liver toxicity are the main concerns.
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Pregnancy planning
Methotrexate and other immunosuppressants need review before conception — plan with your specialist.
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Post-transplant sarcoid recurrence
Sarcoidosis can recur in transplanted lungs — new symptoms need prompt specialist review.
Living with it
A long-term condition, but usually a manageable one.
Four things that make the biggest difference day to day — monitoring, vaccines, vitamin D awareness, and good patient support.
A quiet reminder
New symptoms deserve a fresh look.
Sarcoidosis can affect new organs at any point. Palpitations, vision changes, cranial nerve symptoms or unexplained fatigue all warrant a review.
- 01 Monitoring
Regular review matters
Even asymptomatic disease needs periodic review — lung function, imaging and bloods as agreed with your specialist.
- 02 Vaccines
Stay up to date on vaccinations
Flu and COVID jabs are recommended, particularly if you are on immunosuppression. Discuss live vaccines with your team.
- 03 Vitamin D
Be careful with vitamin D
Granulomas can convert vitamin D unpredictably — avoid high-dose supplements without checking your calcium.
- 04 Support
Sarcoidosis UK is a good resource
Patient information, local support groups and up-to-date treatment summaries — free and independent.
Frequently asked
Everything we get asked about sarcoidosis.
Quick answers on diagnosis, Löfgren’s syndrome, treatment thresholds, cardiac and neurological involvement.
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What is sarcoidosis?
A multisystem inflammatory disease of unknown cause. Small collections of inflammatory cells — non-caseating granulomas — form in affected organs, most often the lungs and lymph nodes.
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How is sarcoidosis diagnosed?
By a combination of clinical picture, imaging (usually HRCT chest) and tissue confirmation of non-caseating granulomas, most often via endobronchial-ultrasound-guided biopsy of mediastinal nodes.
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What is Löfgren’s syndrome?
A distinctive presentation with arthritis (often the ankles), erythema nodosum and bilateral hilar lymphadenopathy — usually with fever. It carries a good prognosis and typically resolves spontaneously.
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Does sarcoidosis always need treatment?
No — many patients, including most with Löfgren’s syndrome, need only monitoring. Treatment is reserved for organ-threatening disease or symptoms that significantly affect quality of life.
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What does cardiac sarcoid look like?
Arrhythmias, heart block, syncope or unexplained cardiomyopathy in a person with sarcoidosis — investigated with cardiac MRI and FDG-PET. It is uncommon but potentially life-threatening.
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Can sarcoidosis affect the brain or nerves?
Yes — neurosarcoidosis is uncommon but serious. Cranial nerve palsies (especially facial), meningitis, seizures and spinal-cord involvement can all occur, and need specialist neurology care.