A sarcoidosis patient may be refractory to corticosteroid therapy. This may be because corticosteroids are ineffective in relieving the sarcoidosis patient's symptoms/dysfunction or because the clinician has determined that the risks of corticosteroids outweigh their benefits. Interestingly, when corticosteroids truly fail to improve a sarcoidosis patient's condition, it is very rarely because of failure of the drug as an anti-granulomatous agent; rather, it is usually because the patient's symptoms were unrelated to active sarcoid granulomas. In this manuscript, we review the causes of corticosteroid refractory sarcoidosis. The clinician should consider these causes when confronted with a sarcoidosis patient who is either not responding to corticosteroids, developing corticosteroid side-effects, or is at significant risk of developing such side-effects. We believe that determining the cause of corticosteroid refractory sarcoidosis may aid the clinicians in optimizing the care of sarcoidosis patients and clinical researchers in appropriately stratifying patients for clinical trials.

结节病患者可能对皮质类固醇激素治疗无效。这可能是因为皮质类固醇不能有效缓解结节病患者的症状/功能障碍，或者是因为临床医生已确定皮质类固醇的风险大于其益处。有趣的是，当皮质类固醇激素不能真正改善结节病患者的病情时，很少因为抗粒状药物的作用而失败。相反，通常是因为患者的症状与活动性结节肉芽肿无关。在本文中，我们回顾了皮质类固醇难治性结节病的病因。当结节病患者对皮质类固醇无反应，出现皮质类固醇副作用时，临床医生应考虑这些原因。或有产生此类副作用的重大风险。我们认为确定皮质类固醇难治性结节病的病因可能有助于临床医生优化结节病患者的护理，并帮助临床研究人员对患者进行适当分层以进行临床试验。