Which specialist should evaluate a patient with sarcoidosis?

From the Guidelines

A pulmonologist should be the primary specialist to evaluate a patient with sarcoidosis, as the lungs are affected in over 90% of cases. However, since sarcoidosis is a multisystem inflammatory disorder that can affect various organs, other specialists may need to be involved depending on which organs are affected. If there is cardiac involvement, a cardiologist should be consulted; for skin manifestations, a dermatologist; for eye involvement, an ophthalmologist; for neurological symptoms, a neurologist; and for liver or spleen involvement, a gastroenterologist. Rheumatologists may also manage sarcoidosis, particularly in complex cases with multiple organ involvement. The choice of specialist depends on the predominant organ system affected and the severity of the disease. A multidisciplinary approach is often necessary for comprehensive management, with the pulmonologist typically coordinating care since lung involvement is most common. Early specialist referral is important for proper diagnosis through tissue biopsy, appropriate imaging studies, and development of a tailored treatment plan, as recommended by the European Respiratory Society guidelines 1.

Some key points to consider in the management of sarcoidosis include:

• The need for a multidisciplinary approach to manage the various organ systems that can be affected by the disease 1
• The importance of early specialist referral for proper diagnosis and development of a tailored treatment plan 1
• The use of glucocorticoids as a first-line treatment for pulmonary sarcoidosis, with the addition of other immunosuppressive agents as needed 1
• The consideration of cardiac involvement and the need for cardiologist consultation in these cases 1
• The importance of monitoring for disease progression and adjusting treatment accordingly, with the goal of minimizing risk of disability and loss of quality of life 1

Overall, the management of sarcoidosis requires a comprehensive and individualized approach, taking into account the specific organ systems affected and the severity of the disease. By prioritizing early specialist referral, multidisciplinary care, and tailored treatment planning, patients with sarcoidosis can receive optimal management and improve their quality of life, as supported by the most recent and highest quality study 1.

From the Research

Sarcoidosis Diagnosis and Management

The diagnosis and management of sarcoidosis typically involve a multidisciplinary approach, given the disease's systemic nature and potential to affect various organs.

• A pulmonologist is often the primary referral physician for diagnosis and management, as the lungs are frequently involved in the disease 2.
• The diagnosis of sarcoidosis requires a compatible clinical and radiologic presentation, pathologic evidence of noncaseating granulomas, and the exclusion of other diseases with similar findings 3.
• The treatment for sarcoidosis depends on the severity of symptoms, organ involvement, and disease progression, with corticosteroid therapy being the mainstay of treatment for significantly symptomatic or progressive pulmonary disease 3, 4.

Specialist Evaluation

Given the complexity and variability of sarcoidosis, evaluation by a specialist is crucial for accurate diagnosis and effective management.

• A pulmonologist, due to the frequent involvement of the lungs, is typically the specialist who evaluates patients with suspected sarcoidosis 2.
• In cases where other organs are involved, such as the heart or nervous system, consultation with cardiologists or neurologists may also be necessary.
• The involvement of a multidisciplinary team, including rheumatologists, dermatologists, or other specialists, may be required for comprehensive care, depending on the organs affected and the severity of the disease 2, 4.

Treatment Approach

The treatment approach for sarcoidosis is tailored to the individual patient's needs, considering factors such as symptom severity, organ involvement, and potential side effects of treatments.

• Oral glucocorticoids, such as prednisone, are commonly used as first-line treatment for symptomatic patients with parenchymal infiltrates and abnormal pulmonary function test results 5, 6.
• For patients who do not respond to glucocorticoids or experience adverse effects, immunosuppressive agents or biologic agents may be considered as second- or third-line therapy 5, 6, 4.