Sarcoidosis is a multisystem condition characterised by non-necrotising granulomatous inflammation, with pulmonary involvement in approximately 90% of cases [1]. While its cause remains unknown, it is thought to result from unidentified antigens driving immune dysregulation and granuloma formation [2]. Sarcoidosis is characterised by a broad spectrum of disease manifestations, from asymptomatic pulmonary lymphadenopathy, chronic fatigue and arthralgias, to life-threatening complications of pulmonary fibrosis, pulmonary hypertension and cardiac involvement [3].

With global trends demonstrating increasing burden of disease and disease-adjusted life years (DALY), current treatment approaches need to be reassessed [4]. Wells’ Law states that sarcoidosis should be treated either when symptoms cause a significantly impaired quality of life or when there is evidence of dangerous, life- or organ-threatening manifestations [5]. While danger is best evaluated by the treating physician, only patients can truly gauge the degree to which sarcoidosis affects their quality of life. Keeping this distinction in mind is essential when communicating with patients: the physician will primarily guide treatment decisions on danger, while the patient will naturally have a much greater input in treatment initiated for quality of life purposes. The principle behind Wells’ Law is also reflected in international guidelines on the treatment of sarcoidosis, where the importance of not using a ‘one size fits all’ approach is underpinned 6, 7. The challenge lies in identifying which patients will require treatment, at what intensity and for how long Figure 1. We provide an overview of the current evidence for sarcoidosis treatments and analyse the circumstances where less may indeed be more. Additionally, as outlined in a recent review of pulmonary and extra-pulmonary disease, there is also a need for a multidisciplinary approach when managing patients with pharmacological and nonpharmacological treatment 8•, 9•.