Matt Lander, MD, on Sarcoidosis: Is Corticosteroid Treatment the Best Option?

Cardiac sarcoidosis doesn't have an approved treatment according to the US Food and Drug Administration Guidelines, but corticosteroids are the first-line intervention approved for sarcoidosis, which almost always starts in the lungs.

In an interview with HCPLive, Matthew Lander, MD from the Division of Advanced Heart Failure and Transplantation Cardiology, Cardiovascular Institute, Allegheny Health Network (AHN), said that around 90% of sarcoidosis cases involve the lungs, according to the literature.

While sarcoidosis is a rare disease, it's much less likely to be found in the heart. However, Lander acknowledged that while the number of cases might be lower than in other forms of sarcoidosis, the outcomes are more severe.

"The reason (cardiac sarcoidosis) is so important is, actually a larger proportion of patients with sarcoid have a cardiac morbidity, or even mortality later on," he explained, "suggesting that, while the cardiac involvement historically has been felt to be only in the 10, 15, maybe 20% range, I think there's a lot of us that think that's probably because we just haven't found it."

When considering treatment options, it's crucial to understand how the disease is presenting in a patient because corticosteroid treatment has effects that shouldn't be taken lightly. Prescribing corticosteroids or methotrexate can be done by almost any practitioner, but Lander suggested the best approach is to connect with a specialist unless the entirety of the patient's disease is understood.

"We also have to remember that there are limitations to these imaging studies and that the gold standard is always going to be some type of tissue diagnosis," he said. "Once we've seen those granulomas under the microscope and pathology, we're going to feel a lot more comfortable about the treatment."