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Monitoring disease activity in sarcoidosis

Monitoring disease activity in sarcoidosis
Patients with active disease
Every 3 to 4 months
ROS including fever, fatigue, weight loss, visual disturbance, dyspnea, cough, palpitations, abdominal pain, numbness, tingling, lightheadedness, syncope
PE including skin exam, palpation of lymph nodes, lung exam
Lab tests based on sites of disease activity and medications
Spirometry, diffusing capacity, ambulatory oximetry (or 6 minute walk)
Every 6 months
Ophthalmologic exam, if on hydroxychloroquine
Every 12 months
CBC and differential
Creatinine
Calcium
AST, ALT, Alkaline phosphatase
25 hydroxy vitamin D
1,25 dihydroxy vitamin D
EKG, sooner if palpitations, lightheadedness, syncope
Ophthalmologic exam (slit lamp, fundoscopic, tonometric), sooner if visual disturbance
Chest radiograph
As indicated by symptoms or other tests
HRCT
Echocardiogram
Holter monitoring
Urinalysis
TSH (association of thyroid autoimmunity and sarcoidosis)
Bone density when glucocorticoid therapy initiated and then every 3 years
MRI with gadolinium if neurologic symptoms (unless diabetic)
Patients with inactive disease for 2 or more (?) years
Every 12 to 18 months
ROS including fever, fatigue, weight loss, visual disturbance, dyspnea, cough, palpitations, abdominal pain, numbness, tingling, lightheadedness, syncope
PE including skin exam, palpation of lymph nodes, lung exam
Spirometry, diffusing capacity, ambulatory oximetry (or 6 minute walk)
CBC and differential
Creatinine
Calcium
Liver enzymes
1,25 dihydroxy vitamin D
EKG, sooner if palpitations, lightheadedness, syncope
Ophthalmologic exam, sooner if visual disturbance
ROS: review of systems; PE: physical exam; CBC: complete blood count; AST: aspartate aminotransferase; ALT: alanine aminotransferase; EKG: electrocardiogram; HRCT: high-resolution computed tomography; TSH: thyroid stimulating hormone; MRI: magnetic resonance imaging.
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