Cardiac Sarcoidosis Randomized Trial

Who can take part

• (i) Cardiac sarcoidosis presenting with one or more of the following clinical findings:
• advanced conduction system disease (defined as Mobitz II AV block or third degree AV block)
• significant sinus node dysfunction (defined as average HR less than 40bpm when awake and/or sustained atrial arrhythmias)
• non- sustained or sustained ventricular arrhythmia
• left ventricular dysfunction (LVEF < 50%)
• right ventricular dysfunction (RVEF < 40%); AND; (ii) No alternative explanation for clinical features; AND; (iii) Nuclear Imaging within six-months of enrollment consisting of FDG-PET scan with FDG uptake suggestive of active CS and myocardial perfusion imaging; AND ONE OR BOTH OF FOLLOWING; (iv) Positive biopsy for Sarcoid (either EMB or extra-cardiac); (v) CT Chest showing features consistent with pulmonary sarcoidosis and/or mediastinal and/or hilar lymphadenopathy

Who cannot take part

• Currently taking Methotrexate or Prednisone for another health condition
• Pregnancy (all women of child bearing age and potential will have a negative BHCG test before enrollment)
• Women of childbearing age who refuse to use a highly effective and medically acceptable form of contraception throughout the study
• Current or recent (within two months) non-topical treatment for sarcoidosis
• Current Oral/IV treatment of duration greater than 5 days
• Intolerance or contra-indication to Methotrexate or Prednisone
• Patient does not meet all of the above listed inclusion criteria
• Patient is unable or unwilling to provide informed consent
• Patient is included in another randomized clinical trial
• Patient has a contraindication to PET imaging or is unlikely to tolerate due to severe claustrophobia
• Breastfeeding
• Patients for whom the investigator believes that the trial is not in the interest of the patient