Table 1.

Examples of sarcoidosis manifestations and risk stratification

Low-risk sarcoidosis	Intermediate-risk sarcoidosis	High-risk sarcoidosis • Factors warranting intensive treatment
Lofgrens syndrome
Nodal sarcoidosis
Scar sarcoidosis
(Ankle) arthritis	Osseous sarcoidosis
Uncomplicated or local cutaneous involvement		Lupus Pernio (known to warrant long-term treatment)
	Uncomplicated uveitis	Chronic or severe uveitis  • Loss of vision
	Mild hypercalcemia hypercalciuria with nefrocalcinosis	Severe hypercalcemia (known to warrant long-term treatment)
	Possible cardiac sarcoidosis	Probable or definite cardiac sarcoidosis  • Large extent of involvement on CMR or FDG-PET  • Rhythm or function abnormalities
	Parenchymal sarcoidosis without impaired PFT	Progressive fibrosing pulmonary sarcoidosis  • Impaired pulmonary function  • High inflammatory burden and signs of fibrosis on FDG-PET/CT
		Central nervous system sarcoidosis  • Spinal cord involvement  • Hydrocephalus
	Hepatic sarcoidosis

Simplified stratification of sarcoidosis examples into risk categories. Risk of organ damage or mortality are taken into account. Low-risk sarcoidosis can be managed by watchful waiting and screening for organ involvement. Intermediate-risk sarcoidosis should be managed case-by-case, some patients warrant systemic treatment following current guidelines with a step-up regime. High-risk sarcoidosis warrants systemic treatment and could potentially benefit from a more aggressive ‘top-down’ or ‘hit-hard’ regimen with a more upfront use of steroid sparing agents or in some cases even biologicals. CMR Cardiac Magnetic Resonance Imaging; FDG, fluorodeoxyglucose; PFT, pulmonary function test.