Sarcoidosis: An Update for the Primary Care Physician

Oluranti A. Aladesanmi, MD, MPH

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In This Article

Evidence of Delayed Diagnosis

Judson and colleagues[13] studied the time from the first physician visit to the diagnosis of sarcoidosis in a subset of 189 patients enrolled in the ACCESS study. Patients had to recall the date of onset of symptoms, their first physician visit, number of physician visits, and types of physicians seen. Only 15.3% of patients had the diagnosis of sarcoidosis made after the first physician visit, almost 50% of patients required 4 or more physician visits, and 1 patient in the study required 23 physician visits before the diagnosis was made.

Patients who presented to their physicians with pulmonary symptoms or had higher Scadding chest x-ray stages were less likely to be diagnosed within 6 months. Patients diagnosed more than 6 months after the onset of symptoms or after their first physician visit had a lower FEV1 but not FVC than those diagnosed within 6 months after symptom onset or physician visit. These findings imply that sarcoidosis was not usually in the differential diagnoses of patients with airflow obstruction or pulmonary infiltrates on their chest radiograph.

It was suggested that common diagnoses such as asthma, bronchitis, and reactive airway disease, which may be treated empirically, tend to delay the diagnosis of sarcoidosis, and the finding of nonspecific parenchymal involvement on chest x-ray would prompt suspicion for other pulmonary diseases such as pneumonia, other interstitial lung diseases, etc. The Stage 0 and 1 chest x-rays may be accompanied by extrapulmonary involvement such as skin involvement, allowing early diagnosis by biopsy, unlike stage 2, 3, and 4 chest x-rays with accompanying pulmonary symptoms, which may need further evaluation with a chest computed tomography scan and transbronchial biopsy.

It is worth noting that the patient's race, gender, and whether the first visit was to a generalist or specialist had no effect on the time between first physician visit and diagnosis in this study.

The take-home point for the primary care physician is to obtain a chest x-ray early in the diagnostic evaluation of a patient who presents with pulmonary symptoms (cough, wheezing, chest pain, and dyspnea), and/or extrapulmonary signs or symptoms compatible with sarcoidosis and to include it in the list of differential diagnoses early.

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