Table 5.
Best Practice Recommendations for Detection of Delayed Onset of Extrapulmonary Sarcoidosis Manifestations after Negative Baseline Screening
| Test Parameter | Routine Testing for New Sarcoidosis Involvement | New Conditions Triggering a Specific Testing for Extrapulmonary Sarcoidosis Involvement |
|---|---|---|
| Calcium | Annually | Kidney stones |
| Acute or acute on chronic renal failure | ||
| Creatinine | Annually | — |
| Alkaline phosphatase | Annually | — |
| Eye exam | None | Change in vision |
| • Floaters | ||
| • Blurry | ||
| • Visual field loss | ||
| Eye pain, photophobia, or redness (sustained) | ||
| Cardiac testing (see Questions 9) | None | Chest pains |
| Palpitations | ||
| Near syncope/syncope | ||
| Sustained bradycardia or tachycardia | ||
| Dyspnea out of proportion to lung disease | ||
| New ECG findings | ||
| Pulmonary hypertension testing (see Question 10) | None | Clinical signs of pulmonary hypertension (see main text) |
Approximately 23% of patients with sarcoidosis will develop a new disease manifestation within 3 years of baseline evaluation. Annual testing is recommended for calcium, creatinine, and alkaline phosphatase, because these manifestations are often asymptomatic. In contrast, routine testing is not recommended for ocular or heart sarcoidosis, unless the patient presents with related symptoms, as above.