Background: Sarcoidosis is a multisystem granulomatous disease with a heterogeneous clinical course and often requires systemic glucocorticoids and steroid-sparing agents. However, treatment selection varies widely in real-world practice. Relapses contribute to morbidity and frequently necessitate treatment intensification.

Objectives: In this study, we aimed to characterize treatment choices in sarcoidosis within a multicenter real-world cohort and to report relapse data—including relapse frequency and time to relapse from diagnosis.

Methods: We conducted a retrospective, multicenter cohort study across five tertiary centers including patients with sarcoidosis.Sarcoidosis diagnosis followed the ATS 2020 clinical practice guideline and was based on a compatible clinical presentation, demonstration of non-necrotizing granulomatous inflammation in tissue when available, and exclusion of alternative causes of granulomatous diseas. Demographics, comorbidities, coexisting rheumatic/autoimmune diseases, clinical manifestations/organ involvement during follow-up. Scadding stage, biopsy status, baseline laboratory parameters, and treatments were recorded. Relapse was defined as the first episode of sarcoidosis-related clinical and/or radiologic worsening requiring treatment escalation; time to first relapse was calculated from the date of diagnosis.

Results: A total of 179 patients were included (female 59.8%). Median age at diagnosis was 41 (IQR 32–51) years and median follow-up was 36 (IQR 12–96) months. The most frequent comorbidities were hypertension (22.9%) and diabetes mellitus (21.8%). Among coexisting rheumatic/autoimmune diseases, the two most common were spondyloarthritis (6.1%) and psoriasis (3.4%). Pulmonary involvement was present in 96.1%. Dyspnea (40.2%) and cough (38.0%) were most common symptoms. The clinical profile was dominated by rheumatology-relevant manifestations, particularly musculoskeletal (42.5%) and cutaneous (34.6%) involvement. Ocular involvement occurred in 12.3% (uveitis 8.9%). Scadding stage was available in 170/179 (95.0%): stage 0 6.5%, I 53.5%, II 35.9%, III 1.8%, IV 2.4%. Biopsy was performed in 69.8%. Systemic glucocorticoids were used in 97 patients (54.2%); the most common steroid-sparing agents were methotrexate (n=51, 28.5%), hydroxychloroquine (n=25, 14.0%), and azathioprine (n=21, 11.7%). Anti-TNF therapy was used in 10 patients (5.6%) (infliximab n=5, 2.8%; adalimumab n=5, 2.8%). Tofacitinib was used in 1 patient (0.6%). Relapse data were available for 97 patients; 28/97 (28.9%) experienced ≥1 relapse. Median time to first relapse was 42 (IQR 15–93) months from diagnosis. At first relapse, pulmonary involvement was most frequent (15/28, 53.6%), followed by cutaneous involvement (6/28, 21.4%), arthritis (3/28, 10.7%), uveitis (2/28, 7.1%), hypercalcemia (2/28, 7.1%) and neurologic involvement (1/28, 3.5%). During the first relapse (n=28), 13 patients (46.4%) were receiving no treatment; treatments used at relapse were low-dose glucocorticoids (prednisone-equivalent ≤7.5 mg/day) in 7 (25.0%), colchicine in 3 (10.7%). Relapse while receiving any DMARD (hydroxychloroquine, methotrexate, or azathioprine) occurred in 4/28 patients (14.3%). Two patients developed delayed major organ involvement not present at baseline: cardiac involvement at 120 months and popliteal artery aneurysm at 34 months after diagnosis.

Conclusions: In this rheumatology cohort, sarcoidosis showed a marked musculoskeletal–cutaneous phenotype with predominantly early radiographic stages. Relapse occurred at a median of 42 months from diagnosis, most commonly with pulmonary and cutaneous involvement, and was frequently observed when patients were not receiving systemic therapy or were on low-intensity regimens. Both rare relapse development under conventional immunosuprresives and delayed major organ involvement supports the need for long-term intensive treatment during follow-up of sarcoidosis patients.

REFERENCES: NIL.

Acknowledgments: NIL.

Disclosure of Interests: None declared.