When Kristen Mathias, M.D., M.H.S., joined the multidisciplinary faculty team of the Johns Hopkins Sarcoidosis Center in August 2025, center co-director Michelle Sharp, M.D., M.H.S., could barely contain her excitement.

As a research and clinical fellow, Mathias had brought her expertise in rheumatology to the Sarcoidosis Center for three years. Now, as a newly minted instructor, she would be a permanent member of the team.

“From a patient care perspective, Kristen is one of the best physicians I’ve ever had the privilege of mentoring and working with,” says Sharp, an associate professor of medicine in the division of pulmonary and critical care medicine. “She exhibits an amazing degree of competence, knowledge and kindness, and is always focused on keeping the patient at the center.”

Moreover, Mathias’ expertise in rheumatology has been key to the translational research unfolding at the Sarcoidosis Center, Sharp notes. “Having this bright, rising star from Rheumatology, who is so adept at bringing in her understanding of and experience in treating autoimmune disorders such as scleroderma, lupus and myositis, is really helping us to reframe our approach to treating patients with sarcoidosis,” Sharp says.

That kind of reframing is crucially needed for sarcoidosis, a poorly understood inflammatory disease that affects more than 1 million people around the world and can attack any organ in the body, often with devastating consequences.

For her part, Mathias says she is honored to bring a rheumatologist’s perspective to the team and is excited to move the needle on this condition. “Sarcoidosis is a complex, immune-mediated disease that affects multiple organs and often responds to immunosuppressive therapies, much like many of our established rheumatic conditions,” she explains.

“Yet despite these striking similarities, sarcoidosis continues to lag behind in the development of safe, effective treatments. That’s why now is an ideal time for rheumatologists and pulmonologists to come together — to advance a collaboration that can drive meaningful advances in patient care.”

Sharp concurs, “Kristen’s new role in the Sarcoidosis Center represents a beautiful marriage in our clinical program. I am overwhelmed by the generosity the Division of Rheumatology has shown by their willingness to collaborate and help bring forward a disease that has been neglected around the world.”

Addressing Gaping Disparities

There is no known cure for sarcoidosis, which is characterized by the growth of clumps of immune cells called granulomas in various parts of the body. Symptoms arise from the inflammation spurred by these granulomatous infiltrates over time. They can damage organs — such as the lungs, heart, kidneys, eyes and skin — as well as bones and joints.

Cruelly, sarcoidosis most often strikes people in the prime of life, between the ages of 20 and 50.

Mathias is working with Sharp and other colleagues at the Sarcoidosis Center to make the scientific case for a multidisciplinary approach to diagnosing and treating the disease, and to gain a clearer understanding of its clinical heterogeneity. To do that, Mathias is leading efforts to harness data science by bringing the Sarcoidosis Center onto the Precision Medicine Analytics Platform (PMAP) at Johns Hopkins.

She believes that data-intensive investigations will, in particular, offer insights into gaping disparities in treatment and health outcomes for Black patients in the United States, who are disproportionately affected by the disease. In a recent study published in CHEST Pulmonology, Mathias and colleagues found that after diagnosis of sarcoidosis,

the time for referral to a specialized sarcoidosis clinic, in seeking tertiary care consultation, was significantly longer for Black individuals (nine years) than for white patients (five years).

This lag is crucial to address, Mathias notes, since Black individuals have a higher incidence of sarcoidosis, and tend to have more severe disease with higher rates of hospitalization. Moreover, “Earlier detection and treatment in sarcoidosis is key to preserving organ function,” she says.

Sparing the Steroids

At the present time, glucocorticoids, agents that act on the glucocorticoid axis (a class of steroid hormones), are the only U.S. Food and Drug Administration-approved treatment for patients with sarcoidosis. But these immunosuppression drugs, also referred to as corticosteroids, can cause a host of serious side effects, including osteoporosis, diabetes and cardiovascular problems. These drug-induced adverse events arising from steroid therapy are also referred to as “secondary Cushing’s disease.” The risk and severity of these side effects generally increase with longer duration and higher doses of treatment, Mathias notes.

Thus, in one important area of her research, Mathias is investigating the early use of steroid-sparing therapies, including biologics. While steroids affect the whole body in reducing inflammation, biologics are much more targeted, zeroing in on specific proteins involved in inflammation.

“In other rheumatic diseases, appropriate steroid stewardship has been a big priority. We need to start that conversation with sarcoidosis,” says Mathias. “Up until this point, there’s been this idea that steroids are the most powerful and direct way to treat the disease, but more and more, data are coming in to suggest that is not true — that steroid use is associated with so many toxicities.”

Mathias, who earned a master of health science degree in clinical investigation from Johns Hopkins Bloomberg School of Public Health during her fellowship training, also sees patients in the Division of Rheumatology’s Scleroderma Center. She notes that steroid-sparing therapies, including biologics, have long been used effectively to treat patients with scleroderma. The insights she’s gained with these patients are informing her efforts to plan clinical trials to test steroid-sparing strategies for sarcoidosis.

She has also embarked on studies to measure the damage caused by long-term, cumulative exposure to steroid therapies among patients with sarcoidosis. “Our findings could provide extra motivation for the field to adopt steroid-sparing alternatives,” she says.

Improved Treatment Through Teamwork

During her time as a fellow within the Sarcoidosis Center at Johns Hopkins, Mathias saw firsthand how important it is for patients to receive care from a multidisciplinary team of clinicians, which is often not the norm since there are a limited number of multidisciplinary centers across the country.

“By the time patients come to us, they have seen as many as 10 specialists without a definitive diagnosis. They are frustrated and exhausted,” says Mathias. “After bouncing around from doctor to doctor, without getting definitive answers, many feel uncertain, overwhelmed and depressed.” (See sidebar, “Cause for Distress.”)

At Johns Hopkins, these patients are evaluated by a wide-ranging team of specialists, all in one place, whose work on their behalf is closely coordinated. In addition to rheumatology, the center’s multidisciplinary team includes expertise in pulmonology, cardiology and neurology. Ad hoc specialists are available in dermatology, ophthalmology, radiology and pathology.

Mathias explains that the team meets weekly to review individual patient cases. They discuss imaging tests — such as CTs and MRIs — and go over the patient’s lab reports, clinical history and pathology reports. Together, they decide whether a diagnosis of sarcoidosis is warranted. If it is, they decide together on a treatment plan, which sometimes involves further diagnostic testing and, if organ damage is particularly severe, referral to organ transplant specialists. Often, the team prescribes use of immunosuppressive drugs.

To find out whether the multidisciplinary team approach makes a difference in outcomes, Mathias, Sharp and colleagues undertook a study to analyze the impact of the formalized multidisciplinary sarcoidosis team at Johns Hopkins, which was formed in 2019. The study examined 321 documented team discussions involving 207 patients between 2020 and 2023. The results were published in Annals of the American Thoracic Society Letters in September 2025.

“We found that the team approach improved overall diagnostic certainty for sarcoidosis and for organ involvement,” Mathias reports. What’s more, it altered the use of immunosuppression management in 123 out of 171 cases (72%), she reports. Oral glucocorticoid-sparing agents were introduced in 31 of the 171 cases, and biologic agents were initiated in 34 of the 171 cases.

“Our findings suggest that multidisciplinary discussions may provide the confidence to pursue more timely and aggressive treatment in patients who do not tolerate or respond to first- and second-line therapies,” Mathias notes.

Tapping into Precision Medicine

Looking ahead, Mathias and others in the Johns Hopkins Sarcoidosis Center believe the key to more targeted treatment in sarcoidosis will lie in the ability to sort patients into different subsets and follow their disease trajectory.

In that pursuit, the Precision Medicine Analytics Platform (PMAP) at Johns Hopkins Medicine will prove invaluable. PMAP is a large-scale data repository that exists in the cloud and includes clinical EMR data, open notes, imaging data, genomic and molecular data, wearable data, and operational and financial data (for value creation).

“PMAP provides a data pipeline that we can query with clinical questions and look at data for specific patient cohorts, both within our center and within the Johns Hopkins Health system at large,” Mathias says. “Ideally we can get a better handle on clinical heterogeneity to better identify patient phenotypes. For example, with PMAP, we can start to address the question: Why do some patients with sarcoidosis develop musculoskeletal manifestations, such as inflammatory arthritis and myopathy, while others do not?

More targeted understanding of each patient’s immunologic dysregulation will enable researchers to develop more effective treatments for different phenotypes, she explains.

“As rheumatologists, we are comfortable with clinical heterogeneity in a way that is unique among internal medicine specialists,” says Mathias. She notes that while other centers within the Division of Rheumatology have been tapping into the power of PMAP for several years, the Sarcoidosis Center is new to the game, with IRB approval coming through this past summer. Mathias has been central to that effort.

That work and other opportunities she’s pursued were key to her decision to remain at Johns Hopkins after she completed her fellowship training in rheumatology, Mathias says.

“Johns Hopkins offers a really unique environment because there is so much motivation to innovate, and if you want to make something happen, you don’t get institutional pushback but instead the response is: ‘How can we help you?!’”

Related Reading

• Delays in Referral to Multidisciplinary Care for Black Individuals With Sarcoidosis,
  CHEST Pulm. 2025 Jun;3(2):100125
• Patient Uncertainty in Sarcoidosis, Chest, 2025, PMID 40609858,
  Chest. 2025 Jul 1:S0012-3692(25)00807-4
• Working Together in Sarcoidosis, AnnalsATS, September 2025, PMID 40479550
  Ann Am Thorac Soc. 2025 Sep;22(9):1436-1439