Do you continue methotrexate while starting TNFi therapy in patients with refractory pulmonary sarcoidosis?   

No clear data to do this in an EBM fashion in my opinion. I keep the baseline anti-inflammatory agents the same for the initial two doses of infliximab and once they are on regular dosing, I decrease the other agent/s. After steady-state, I would still keep a low dose of prednisone (2.5 or 5 mg dail...

If a TNF inhibitor is started for treating sarcoidosis, then the next step is to try to de-escalate other immunosuppression medications. If a patient has reasons to try to taper off prednisone (such as difficult to control diabetes), then the dose of TNF inhibitor can be adjusted (increase infusion ...

Mostly agree with these answers. Significant morbidity and mortality are related to prolonged glucocorticoid use in sarcoidosis. And this is disproportionately experienced by stratification of race and also low SES. Leaving a person with sarcoidosis on glucocorticoids as a maintenance treatment is ...