SarcoidosisRefer

• Prednisolone (symptomatic lung, heart, eye or nerve disease, or high calcium), Methotrexate + Folic acid (steroid-sparing), Naproxen (Löfgren: fever, erythema nodosum, ankle arthritis)

• Exclude TB first: In India granulomas are TB until proven otherwise — AFB, GeneXpert and culture on tissue or BAL before steroids (ERS 2021)
• Screen every patient: ECG, eye examination, calcium, creatinine, LFT, PFT with DLCO (ERS 2021)

First visit

• Chest X-ray and HRCT — Hilar lymph nodes and lung involvement.
• Tissue biopsy with AFB, NAAT and culture — Exclude TB before steroids — in India granulomas are TB until proven otherwise.
• Serum calcium, creatinine, LFT — Organ involvement.
• ECG — Heart block (cardiac sarcoid).

Only if indicated

• PFT with DLCO — Lung disease, to stage and follow.
• Eye examination — Every patient, for uveitis.
• Echo / cardiac MRI — Abnormal ECG or palpitations.

Follow-up and monitoring

• Calcium, PFT, chest imaging — Every 3–6 months on treatment.