As sarcoidosis may be self-limiting and remit spontaneously, a first challenge in its management is to decide whether pharmacological treatment can be postponed and possibly avoided without any significant impact on quality of life, organ damage or prognosis.

Systemic glucocorticosteroids are the drug of first choice in the treatment of sarcoidosis. Once started, there is a >50% chance of long-term treatment. Prolonged use of prednisone at >10 mg/day or equivalent is not advised due to frequent severe side effects.

Antimetabolites and biologics are useful additions to corticosteroids in refractory sarcoidosis or as steroid-sparing options. Methotrexate is the most commonly used antimetabolite. Infliximab is the biologic most commonly used in sarcoidosis management.

Eye, nervous system and heart involvement in sarcoidosis may have major clinical consequences and require prompt aggressive management. Other common effects of sarcoidosis, such as fatigue and small fibre neuropathy, may not respond well to conventional sarcoidosis treatments.

Comorbidities are common in sarcoidosis and, except for osteoporosis, are usually treated as in the general population.

Irrespective of treatment, the clinician needs to organize regular follow-ups to monitor remissions, flares, progression, complications, toxicity and relapses in order to promptly adjust treatment.