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Sarcoidosis: federal clinical guidelines 2025

https://doi.org/10.18093/0869-0189-2026-36-3-389-413

Abstract

Sarcoidosis is a systemic inflammatory disease of unknown etiology characterized by the formation of noncaseating granulomas, multisystem organ involvement, and T-cell activation at the site of granulomatous inflammation with the release of various chemokines and cytokines. The prevalence of sarcoidosis is 3 – 25 cases per 100,000 population. The mainstay of sarcoidosis therapy is corticosteroids, immunosuppressants, and drugs that affect oxidative stress and tumor necrosis factor. The aim of the article was to introduce the latest procedures for the diagnosis and treatment of sarcoidosis of various localizations, agreed upon in the Russian Federation. The target audience for these clinical guidelines are general practitioners, internists, pulmonologists, phthisiologists, pathologists, radiologists, and rehabilitation physicians. Methods. Each recommendation statement for diagnostic and therapeutic measures is assessed using evidence levels ranging from 1 to 5 and a recommendation strength rating scale for categories A, B, and C. The clinical guidelines also contain commentary and explanations for these recommendations, algorithms for the diagnosis and treatment of idiopathic pulmonary fibrosis, and reference materials. Conclusion. These clinical guidelines provide an overview of current knowledge on the etiology and pathogenesis, clinical manifestations, diagnosis, and treatment of sarcoidosis. These clinical guidelines were approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation in 2025.

About the Authors

A. G. Chuchalin
Federal State Autonomous Educational Institution of Higher Education “N.I.Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation
Russian Federation

Alexander G. Chuchalin, Doctor of Medicine, Professor, Academician of Russian Academy of Sciences, Head of Department of Hospital Internal Medicine, Pediatric Faculty, Federal State Autonomous Educational Institution of Higher Education “N.I.Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation; Chairman of the Executive Board of Russian Respiratory Society

ul. Ostrovityanova 1, Moscow, 117513


S. N. Avdeev
Federal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
Russian Federation

Sergey N. Avdeev, Doctor of Medicine, Professor, Academician of Russian Academy of Sciences, Director of the National Medical Research Center for Pulmonology; Head of the Department of Pulmonology, N.V.Sklifosovsky Institute of Clinical Medicine, Federal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University); Chief Pulmonologist of the Ministry of Health of the Russian Federation

ul. Trubetskaya 8, build. 2, Moscow, 119991

SciProfiles: 741582;

Scopus Author ID: 7003292838


A. A. Vizel
Federal State Budgetary Educational Institution of Higher Education Kazan State Medical University of the Ministry of Health of the Russian Federation
Russian Federation

Aleksandr A. Vizel, Doctor of Medicine, Professor, Head of Department of Phthisiology and Pulmonology

ul. Butlerova 49, Kazan, 420012, Republic of Tatarstan

Author ID: 195447


Z. R. Aisanov
Federal State Autonomous Educational Institution of Higher Education “N.I.Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation
Russian Federation

Zaurbek R. Aisanov, Doctor of Medicine, Professor, Professor of Department of Pulmonology, Faculty of Additional Professional Education

ul. Ostrovityanova 1, Moscow, 117513

Author ID: 542371


O. P. Baranova
Federal State Budgetary Educational Institution of Higher Education “Pavlov First Saint Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation
Russian Federation

Olga P. Baranova, Candidate of Medicine, Senior Researcher, Research Institute of Interstitial and Orphan Lung Diseases, Scientific and Clinical Research Center, Associate Professor, Department of Pulmonology, Faculty of Postgraduate Education

ul. L’va Tolstogo 6 – 8, Saint-Petersburg, 197022


A. S. Belevskiy
Federal State Autonomous Educational Institution of Higher Education “N.I.Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation; The Moscow Research and Clinical Center for Tuberculosis Control of the Moscow Government Department of Health
Russian Federation

Andrey S. Belevskiy, Doctor of Medicine, Professor; Head of the Pulmonology Department, Faculty of Additional Professional Education Institute of Continuing Education and Professional Development, Federal State Autonomous Educational Institution of Higher Education “N.I.Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation

ul. Ostrovityanova 1, Moscow, 117513,

ul. Stromynka 10, Moscow, 107076


S. E. Borisov
The Moscow Research and Clinical Center for Tuberculosis Control of the Moscow Government Department of Health
Russian Federation

Sergey E. Borisov , Doctor of Medicine, Professor, Deputy Director for Scientific and Clinical Work

ul. Stromynka 10, Moscow, 107076


I. A. Vasilieva
Federal State Autonomous Educational Institution of Higher Education “N.I.Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation; Federal State Budgetary Institution “National Medical Research Center for Phthisiopulmonology and Infectious Diseases” of the Ministry of Health of the Russian Federation
Russian Federation

Irina A. Vasileva, Doctor of Medicine, Professor, Head of the Phthisiology Department, Federal State Autonomous Educational Institution of Higher Education “N.I.Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation; Director, Federal State Budgetary Institution “National Medical Research Center for Phthisiopulmonology and Infectious Diseases” of the Ministry of Health of the Russian Federation; Chief Freelance Phthisiologist of the Ministry of Health of the Russian Federation

ul. Ostrovityanova 1, Moscow, 117513,

ul. Dostoyevskogo 4, build. 2, Moscow, 127473


I. Yu. Vizel
Federal State Budgetary Educational Institution of Higher Education Kazan State Medical University of the Ministry of Health of the Russian Federation
Russian Federation

Irina Yu. Vizel, Doctor of Medicine, Professor, Russian Academy of Natural Sciences, Professor, Department of Phthisiology and Pulmonology

49, Kazan, 420012, Republic of Tatarstan


I. V. Vasiliev
Russian Federation Healthcare Ministry Saint-Petersburg State Phthisiopulmonology Research Institute
Russian Federation

Igor V. Vasilev, Candidate of Medicine, Leading Researcher, Head of the Research Laboratory “Interventional Pulmonology”, Thoracic Surgeonъ

Ligovsky pr. 2 – 4, Saint-Petersburg, 191036


Yu. Yu. Garmash
The Moscow Research and Clinical Center for Tuberculosis Control of the Moscow Government Department of Health; Federal State Budgetary Educational Institution of Additional Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Health of the Russian Federation
Russian Federation

Yuliya Y. Garmash, Candidate of Medicine, Deputy Chief Physician for Medical Affairs, Phthisiologist, Clinic No.1, Pulmonologist, City Consultation and Diagnostic Center, The Moscow Research and Clinical Center for Tuberculosis Control of the Moscow Government Department of Health; Associate Professor, Department of Phthisiology, Faculty of Therapy, Federal State Budgetary Educational Institution of Additional Professional Education “Russian Medical Academy of Continuous Professional Education”, Ministry of Health of Russia

ul. Stromynka 10, Moscow, 107076,

ul. Barrikadnaya 2/1, Moscow, 123995


N. A. Geppe
Federal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
Russian Federation

Natal’ya A. Geppe, Doctor of Medicine, Professor, Head of Department of Pediatric Diseases, Therapeutic Faculty

ul. Trubetskaya 8, build. 2, Moscow, 119991


A. A. Zaitsev
Federal State Budgetary Educational Institution of Higher Education Russian Biotechnological University
Russian Federation

Andrey A. Zaicev, Doctor of Medicine, Professor, Head of the Department of Pulmonology (with a course of allergology), Medical Institute of Continuing Education

Volokolamskoye shosse 11, Moscow, 125080

Author ID: 217005


Yu. S. Zinchenko
Russian Federation Healthcare Ministry Saint-Petersburg State Phthisiopulmonology Research Institute
Russian Federation

Yulia S. Zinchenko, Candidate of Medicine, Senior Researcher, Head of the Research Laboratory for the Study of Chronic Nonspecific Lung Diseases

Ligovsky pr. 2 – 4, Saint-Petersburg, 191036


M. P. Kostinov
Federal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University); Federal State Budgetary Scientific Institution “I.I.Mechnikov Vaccine and Serum Research Institute” Ministry of Science and Higher Education of the Russian Federation
Russian Federation

Mikhail P. Kostinov, Doctor of Medicine, Professor, Corresponding Member of Russian Academy of Sciences; Head of the Department of Epidemiology and Modern Vaccination Technologies, Institute of Professional Education, Federal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University); Head of the Laboratory of Vaccine Prevention and Immunotherapy of Allergic Diseases, Federal State Budgetary Scientific Institution “I.I.Mechnikov Vaccine and Serum Research Institute”

ul. Trubetskaya 8, build. 2, Moscow, 119991,

Malyy Kazennyy per. 5A, Moscow, 105064


N. Y. Kravchenko
The Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department
Russian Federation

Natalia Yu. Kravchenko, Candidate of Medicine, Head of the Organizational and Methodological Department for Pulmonology and Allergology

ul. Sharikopodshipnikovskaya 9, room 5C, Moscow, 115088


M. M. Ilkovich
Federal State Budgetary Educational Institution of Higher Education “Pavlov First Saint Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation
Russian Federation

Mikhail M. Ilkovich, Doctor of Medicine, Professor, Head of the Pulmonology Department, Faculty of Postgraduate Education, Director, Research Institute of Interstitial and Orphan Lung Diseases

ul. L’va Tolstogo 6 – 8, Saint-Petersburg, 197022


O. V. Lovacheva
Federal State Budgetary Institution “National Medical Research Center for Phthisiopulmonology and Infectious Diseases” of the Ministry of Health of the Russian Federation
Russian Federation

Ol’ga V. Lovacheva, Doctor of Medicine, Professor, Chief Researcher, Department of Differential Diagnosis and Treatment of Tuberculosis and Co-Infections

ul. Dostoyevskogo 4, build. 2, Moscow, 127473


N. N. Makaryants
Moscow Regional Research and Clinical Institute (“MONIKI”)
Russian Federation

Natalya N. Makaryants, Doctor of Medicine, Head of the Pulmonology Department, Head of the Pulmonology Course at the Department of Therapy, Faculty of Advanced Medical Studies

ul. Shchepkina 61/2, Moscow, 129110


A. S. Malakhov
Federal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
Russian Federation

Aleksandr B. Malakhov, Doctor of Medicine, Professor at Department of Pediatric Diseases

ul. Trubetskaya 8, build. 2, Moscow, 119991


A. G. Malyavin
Federal State Budgetary Educational Institution of Higher Education “Russian University of Medicine” of the Ministry of Health of the Russian Federation
Russian Federation

Andrey G. Malyavin , Doctor of Medicine, Professor, Department of Phthisiology and Pulmonology, Medical Faculty

ul. Dolgorukovskaya 4, Moscow, 127006


D. V. Petrov
Federal State Budgetary Educational Institution of Higher Professional Education “Omsk State Medical University” of the Ministry of Health of the Russian Federation
Russian Federation

Dmitriy V. Petrov, Assistant Professor, Department of Propaedeutics of Internal Diseases

ul. Lenina 12, Omsk, 644099


E. N. Popova
Federal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
Russian Federation

Elena N. Popova, Doctor of Medicine, Professor, E.M.Tareev Clinic of Rheumatology, Nephrology, and Occupational Pathology

ul. Trubetskaya 8, build. 2, Moscow, 119991


V. V. Romanov
Federal State Budgetary Scientific Institution “Central Research Institute of Tuberculosis” of the Ministry of Science and Higher Education of the Russian Federation
Russian Federation

Vladimir V. Romanov, Doctor of Medicine, Professor, Head of the Department of Phthisiology

Yauzskaya alleya 2, Moscow, 107564


M. V. Samsonova
Federal State Budgetary Institution “Pulmonology Scientific Research Institute” under Federal Medical and Biological Agency of Russian Federation; State Budgetary Institution of Healthcare of the city of Moscow “Moscow Clinical Scientific and Practical Center named after A.S.Loginov of the Department of Healthcare of the City of Moscow”
Russian Federation

Mariya V. Samsonova, Doctor of Medicine, Head of Laboratory of Pathological Anatomy and Immunology, Federal State Budgetary Institution “Pulmonology Scientific Research Institute” under Federal Medical and Biological Agency of Russian Federation, Senior Researcher, Laboratory of Innovative Pathomorphology, State Budgetary Institution Moscow Clinical Scientific Center named after Loginov, Moscow City Department of Healthcare

Orekhovyy bul’var 28, build. 10, Moscow, 115682,

Shosse Entuziastov 86, Moscow, 111123


I. V. Sivokozov
Federal State Budgetary Scientific Institution “Central Research Institute of Tuberculosis” of the Ministry of Science and Higher Education of the Russian Federation
Russian Federation

Ilya V. Sivokozov, Doctor of Medicine, Leading Researcher, Head of the Endoscopy Department, Head of the Center for Diagnostics and Rehabilitation of Respiratory Diseases

Yauzskaya alleya 2, Moscow, 107564


I. P. Solovyova
Federal State Autonomous Educational Institution of Higher Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
Russian Federation

Irina P. Solovieva, Doctor of Medicine, Professor, Head of the Laboratory of Pathological Anatomy

ul. Trubetskaya 8, build. 2, Moscow, 119991


A. A. Starshinova
Federal State Budgetary Institution “V.A.Almazov National Medical Research Center” of the Ministry of Health of the Russian Federation
Russian Federation

Anna  А. Starshinova, Doctor of Medicine, Head of the Scientific Research Department, Professor, Department of Faculty Therapy with a Clinic

ul. Akkuratova 2, Saint-Petersburg, 197341


I. E. Stepanyan
Federal State Budgetary Scientific Institution “Central Research Institute of Tuberculosis” of the Ministry of Science and Higher Education of the Russian Federation
Russian Federation

Igor’ E. Stepanyan, Doctor of Medicine, Professor, Leading Researcher of the Department of Differential Diagnosis of Tuberculosis and Extracorporeal Treatment Methods, Advisor to the Director

Yauzskaya alleya 2, Moscow, 107564

Author ID: 443264


S. A. Terpigorev
Federal State Budgetary Institution “National Medical and Surgical Center named after N.I.Pirogov” of the Ministry of Health of the Russian Federation
Russian Federation

Stanislav A. Terpigorev, Doctor of Medicine, Head of the Department of Internal Medicine at the Institute for Advanced Medical Studies

ul. Nizhnyaya Pervomayskaya 70, Moscow, 105203


V. V. Tinkova
Federal State Autonomous Educational Institution of Higher Education “N.I.Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation; Federal State Budgetary Institution “National Medical Research Center for Phthisiopulmonology and Infectious Diseases” of the Ministry of Health of the Russian Federation
Russian Federation

Valentina T. Tinkova, Candidate of Medicine, Deputy Chief Physician for Medical Affairs, National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Russian Ministry of Health; Associate Professor of Phthisiology Department, Federal State Autonomous Educational Institution of Higher Education “N.I.Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation

ul. Ostrovityanova 1, Moscow, 117513,

ul. Dostoyevskogo 4, build. 2, Moscow, 127473


I. N. Trofimenko
Irkutsk State Medical Academy of Postgraduate Education – a Branch Campus of the Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuing Professional Education” of the Ministry of Health of the Russian Federation
Russian Federation

Irina N. Trofimenko, Doctor of Medicine, Assistant Professor, Head of Department of Clinical Allergology and Pulmonology

mkr Yubilejnyy 100, Irkutsk, 664079


I. E. Tyurin
Federal State Budgetary Educational Institution of Additional Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Health of the Russian Federation
Russian Federation

Igor’ E. Tyurin, Doctor of Medicine, Professor, Head of Department of Radiology

ul. Barrikadnaya 2/1, Moscow, 123995


L. Ya. Frantsuzevich
Federal State Autonomous Educational Institution of Higher Education “N.I.Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation; Federal State Budget Educational Institution of Higher Education M.V.Lomonosov Moscow State University of the Government of the Russian Federation
Russian Federation

Laine Ya. Frantsuzevich, Assistant Professor, Department of Pulmonology, Faculty of Continuing Professional Education, Institute of Continuing Education and Professional Development, Federal State Autonomous Educational Institution of Higher Education “N.I.Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation; Assistant Professor, Department of Internal Medicine, Faculty of Fundamental Medicine, Medical Scientific and Educational Institute, Federal State Budget Educational Institution of Higher Education M.V.Lomonosov Moscow State University, The Government of the Russian Federation

ul. Ostrovityanova 1, Moscow, 117513,

Leninskye gory 1, build. 40, Moscow, 119992


A. L. Chernyaev
Federal State Budgetary Institution “Pulmonology Scientific Research Institute” under Federal Medical and Biological Agency of Russian Federation; Avtsyn Research Institute of Human Morphology of Federal State Budgetary Scientific Institution “Petrovsky National Research Centre of Surgery”
Russian Federation

Andrey L. Cherniaev, Doctor of Medicine, Professor, Head of the Department of Fundamental Pulmonology, Federal State Budgetary Institution “Pulmonology Scientific Research Institute” under Federal Medical and Biological Agency of Russian Federation; Leading Researcher, Laboratory of Clinical Morphology, Avtsyn Research Institute оf Human Morphology оf Federal State Budgetary Scientific Institution “Petrovsky National Research Centre оf Surgery”

Orekhovyy bul’var 28, build. 10, Moscow, 115682,

ul. Tsyurupy 3, Moscow, 117418


E. I. Shmelev
Federal State Budgetary Scientific Institution “Central Research Institute of Tuberculosis” of the Ministry of Science and Higher Education of the Russian Federation
Russian Federation

Evgeny I. Shmelev, Doctor of Medicine, Professor, Chief Researcher of the Department of Differential Diagnostics

Yauzskaya alleya 2, Moscow, 107564


N. M. Shmeleva
State Budgetary Healthcare Institution Moscow “Consultative and Diagnostic Center No.6 Moscow City Department of Healthcare”
Russian Federation

Natalya M. Shmeleva, Candidate of Medicine, Pulmonologist

Dmitrovskoe shosse 107G, Moscow, 127247


N. A. Esaulova
Ural Federal Research Institute of Phthisiology and Pulmonology – a Branch of National Medical Research Center for Phthisiology, Pulmonology and Infectious Diseases of the Ministry of Health of the Russian Federation
Russian Federation

Natalia A. Esaulova, Candidate of Medicine, Head of the Department of Differential Diagnosis of Tuberculosis

ul. 22-go Parts’ezda 50, Ekaterinburg, 620039


P. K. Yablonskiy
Russian Federation Healthcare Ministry Saint-Petersburg State Phthisiopulmonology Research Institute; Federal State Budgetary Educational Institution of Higher Education “St. Petersburg State University” of the Government of the Russian Federation
Russian Federation

Petr K. Yablonskiy, Doctor of Medicine, Professor, Head of Russian Federation Healthcare Ministry Saint-Petersburg State Phthisiopulmonology Research Institute; Vice-Rector for Medicine, Federal State Budgetary Educational Institution of Higher Education “St. Petersburg State University”, Government of the Russian Federation

Ligovsky pr. 2 – 4, Saint-Petersburg, 191036,

Universitetskaya naberezhnaya 7 – 9, Saint-Petersburg, 199034

Author ID: 196793


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For citations:

Chuchalin A.G., Avdeev S.N., Vizel A.A., Aisanov Z.R., Baranova O.P., Belevskiy A.S., Borisov S.E., Vasilieva I.A., Vizel I.Yu., Vasiliev I.V., Garmash Yu.Yu., Geppe N.A., Zaitsev A.A., Zinchenko Yu.S., Kostinov M.P., Kravchenko N.Y., Ilkovich M.M., Lovacheva O.V., Makaryants N.N., Malakhov A.S., Malyavin A.G., Petrov D.V., Popova E.N., Romanov V.V., Samsonova M.V., Sivokozov I.V., Solovyova I.P., Starshinova A.A., Stepanyan I.E., Terpigorev S.A., Tinkova V.V., Trofimenko I.N., Tyurin I.E., Frantsuzevich L.Ya., Chernyaev A.L., Shmelev E.I., Shmeleva N.M., Esaulova N.A., Yablonskiy P.K. Sarcoidosis: federal clinical guidelines 2025. PULMONOLOGIYA. 2026;36(3):389-413. (In Russ.) https://doi.org/10.18093/0869-0189-2026-36-3-389-413

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