Symptomatic sarcoidosis is usually treated with glucocorticoids; however, glucocorticoids are associated with significant morbidity. Because low dose methotrexate has been successful in treating other inflammatory diseases, methotrexate was used in patients with persistent, symptomatic sarcoidosis. Fifteen patients with either progressive advancing disease or severe side effects with prednisone were treated with methotrexate for at least 6 months. In 13 of 14 evaluable cases there was symptomatic improvement. In 12 of 14 patients there was significant improvement in objective parameters, including a greater than 15% increase in the vital capacity (5 patients), improvement in chest roentgenogram (6 patients), or a greater than 50% reduction in skin lesions (4 patients) or liver function tests (2 patients). In five patients the disease relapsed as methotrexate was being withdrawn; all patients responded to reinstitution of the drug.