ArticleSarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG2026
Advances in management of sarcoidosis-associated fatigue: A narrative review.
Article in Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
aimSarcoidosis-associated fatigue (SAF) occurs in approximately 30% to 90% of patients. While previous reviews examined select medications, these omitted nonpharmacological and emerging treatments that could significantly improve fatigue for individuals with sarcoidosis. Limited guidance exists for excluding alternative causes of fatigue and selecting between treatment options for these patients. This narrative review synthesized pharmacological and nonpharmacological interventions for SAF and interpreted evidence strength to guide clinical decision-making.
methodsPubMed was queried in December 2025 for clinical trials, reviews, and meta-analyses published within the last 10 years. This yielded 41 results which were supplemented by manual review of bibliographies, clinical guidelines, and a search of the Cochrane Library. Evidence was interpreted and analyzed for quality using a modified GRADE-informed approach.
resultsTreatment of active disease with prednisone or methotrexate improves systemic inflammation but may paradoxically worsen fatigue with chronic use. Stimulants (e.g., dexmethylphenidate, armodafinil) display low-quality evidence for improving SAF and side effects may be prohibitive for some patients. TNF-α inhibitors (e.g., infliximab) have very low-quality evidence with few studies and negative findings. Pulmonary rehabilitation and exercise training show low-to-moderate quality evidence with few adverse effects but lack specific implementation protocols.
conclusionsDiagnosis of SAF requires exclusion of alternative causes which may be challenging. Active disease should be treated appropriately while monitoring for adverse effects. Despite low-to-moderate quality evidence for most interventions, nonpharmacological approaches (e.g., pulmonary rehabilitation, exercise) are recommended as first-line therapy given favorable risk-benefit profiles. Larger, well-designed RCTs are needed given the substantial disease burden.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.