Contemporary management of sarcoidosis.

Sarcoidosis is a heterogeneous multisystem granulomatous disease with a highly variable clinical course ranging from spontaneous resolution to progressive organ dysfunction and life-threatening complications. Treatment decisions are guided by symptom burden, organ involvement, risk of irreversible damage, and overall impact on patient health-related quality of life. Corticosteroids remain the cornerstone of therapy; however, concerns regarding long-term cumulative toxicity and limited effects on disease progression have driven increasing interest in steroid-sparing and targeted therapeutic approaches. Recent clinical trial data evaluating earlier use of methotrexate and evolving steroid-sparing strategies reflect a changing treatment paradigm in selected patients with sarcoidosis.This review provides an updated overview of contemporary sarcoidosis management, integrating current guideline recommendations, recent clinical trial data, steroid-sparing approaches, biologic therapies, antifibrotic treatment, and emerging targeted therapies. In addition, current challenges in disease monitoring, treatment selection, and future directions toward personalized medicine are discussed.