What is included in long-term monitoring of patients with sarcoidosis?

Updated: Jul 30, 2018
  • Author: Joseph F Merola, MD, MMSc; Chief Editor: Dirk M Elston, MD  more...
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Answer

Follow-up care should be frequent for the first 2 years after diagnosis. Patients with stage I disease can receive follow-up care twice yearly, whereas patients with more advanced lung disease should be seen more frequently. All patients should be monitored for at least 3 years after discontinuation of therapy.

During follow-up care, patients should have a history with a review of systems and should undergo physical examination, chest radiography, and pulmonary function tests to evaluate for active or insidiously progressive disease. A baseline electrocardiogram is of use to assess for cardiac involvement and for future comparison if symptoms develop. Baseline laboratory examination may include calcium and vitamin D levels as calcium dysregulation with hypercalcemia may occur. In general, an angiotensin-converting enzyme (ACE) level has limited usefulness as a diagnostic test for sarcoidosis.

Ophthalmologic assessment is needed initially—generally annually in all patients and more frequently in those with ocular involvement. Therapeutic use of hydroxychloroquine (Plaquenil) may also warrant more frequent, detailed ophthalmologic examinations.

A large review by Ji et al of the Swedish Hospital Registry noted an elevated risk of skin cancer (especially squamous cell carcinoma), non-Hodgkin lymphoma, and leukemia in hospitalized patients with sarcoidosis, extending beyond the first year after hospitalization. Therefore, close follow up for malignancies is recommended. [44]


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