The prognosis is better for patients who have adenopathy without radiologic evidence of pulmonary disease. The most reliable indicator of a favorable outcome of sarcoidosis is onset with erythema nodosum. Pulmonary fibrosis leading to cardiorespiratory failure is the most common cause of death, followed by pulmonary hemorrhage from aspergilloma. Abnormal ACE activity, gallium scanning, and other laboratory tests are useful in assessing symptoms, but abnormal test results alone do not justify therapy. No available drugs have consistently prevented pulmonary fibrosis.
Corticosteroids accelerate clearance of symptoms, physiologic disturbances, and x-ray changes.
However, little difference is demonstrable in long-term outcome between treated and untreated patients, and relapse is common when treatment ends. Inhaled corticosteroids may provide palliation of mild or moderate respiratory symptoms. After 8 wk of methotrexate, the corticosteroid can be reduced and then often discontinued. Serial blood counts and liver enzyme tests should be performed every 6 wk. Although immunosuppressive drugs are often more effective in refractory cases, relapse is frequent after their cessation.