Inflammation imaging and treatment strategies in pulmonary and cardiac sarcoidosis

Sarcoidosis is an inflammatory disease, primarily affecting the lungs (pulmonary sarcoidosis) and lymph nodes. Although less common, the heart (cardiac sarcoidosis) can also be affected, sometimes leading to severe complications. Patients with sarcoidosis often experience a reduced quality of life and fatigue. In more severe cases, such as declining lung function or cardiac complications, corticosteroids like prednisone are commonly prescribed, despite their significant side effects.
This thesis focuses on nuclear imaging of inflammatory activity and new treatment strategies for sarcoidosis patients. To improve treatment decisions, a novel nuclear medicine technique was investigated, targeting inflammation by measuring an essential inflammatory mediator: Tumour Necrosis Factor (TNF)-α. Additionally, a pragmatic approach was developed to facilitate the preparation of radiopharmaceuticals, aiming for easier clinical implementation of innovative nuclear medicine techniques. Further studies addressed two important gaps in the evidence base on sarcoidosis treatment. The first examined the effects of anti-inflammatory therapy on quality of life and fatigue in pulmonary sarcoidosis patients. The second assessed the effectiveness of methotrexate as an alternative to corticosteroids in patients with cardiac sarcoidosis.
The research in this thesis demonstrates that anti-inflammatory therapy can effectively improve quality of life and reduce fatigue in sarcoidosis patients. Moreover, it confirms the role of methotrexate in cardiac sarcoidosis and illustrates the value of nuclear imaging in better characterising the inflammatory process in sarcoidosis patients.