From the Guidelines
To test for sarcoidosis, a combination of clinical evaluation, imaging studies, and tissue biopsy is typically required, with the most recent and highest quality study recommending a thorough physical exam, medical history review, and imaging studies such as chest X-rays and high-resolution CT scans 1.
Diagnostic Approach
The diagnostic approach to sarcoidosis involves a combination of non-invasive and invasive methods. The following steps are recommended:
- Start with a thorough physical exam and medical history review to identify clinical features supportive of a diagnosis of sarcoidosis, such as bilateral hilar adenopathy, lupus pernio, uveitis, and erythema nodosum 1.
- Perform chest X-rays and high-resolution CT scans to look for characteristic lung changes, such as bilateral hilar adenopathy and perilymphatic nodules 1.
- Conduct blood tests, including complete blood count, serum calcium levels, liver function tests, and angiotensin-converting enzyme (ACE) levels, to assess for hypercalcemia, hypercalciuria, and abnormal vitamin D metabolism 1.
- Perform pulmonary function tests to assess lung capacity and function.
- Conduct a tissue biopsy, usually from the lungs or lymph nodes, to confirm the presence of granulomas, which is crucial for definitive diagnosis 1.
Additional Tests
Additional tests may be considered based on symptoms, such as:
- Eye exam for ocular involvement
- ECG or echocardiogram for cardiac sarcoidosis
- MRI for neurosarcoidosis
- Cardiac MRI or positron emission tomography with fluorodeoxyglucose imaging to diagnose cardiac sarcoidosis or follow response to therapy 1.
Importance of Early Diagnosis
Early and accurate diagnosis of sarcoidosis is essential for proper management and to prevent complications of this multisystem disorder. The prognosis of patients with symptomatic cardiac sarcoidosis has not been well characterized, but recent reports suggest substantially better outcomes with early diagnosis and treatment 1. Therefore, a thorough diagnostic approach, including clinical evaluation, imaging studies, and tissue biopsy, is recommended to diagnose sarcoidosis accurately and improve patient outcomes 1.
From the Research
Testing for Sarcoidosis
There are no research papers to assist in answering this question as the provided studies focus on the treatment of sarcoidosis rather than testing or diagnosis.
Treatment Indications
- The main indications of a systemic treatment include ophthalmologic, neurologic, cardiovascular, renal, laryngeal involvements, severe pulmonary manifestations, lupus pernio and marked hypercalcaemia 2
- Symptoms include pulmonary as well as extra-pulmonary manifestations of the disease 3
- Symptomatic patients with stage II-III pulmonary sarcoidosis, and many extrapulmonary manifestations of the disease, must be adequately treated 4
Treatment Options
- Glucocorticosteroids represent the "drugs of choice" for treatment of sarcoidosis 4
- Corticosteroids remain the mainstay of therapy 5
- Methotrexate, azathioprine, leflunomide and hydroxychloroquine are commonly prescribed second-line agents in sarcoidosis 6
- Tumor necrosis factor-alpha inhibitors infliximab and adalimumab and the experimental therapeutic rituximab are currently reserved for patients refractory to standard therapy 6