What are the indications for referral to a specialist in cases of sarcoidosis?

Indications for referral to a specialist in cases of sarcoidosis include:

• Any suspected sarcoidosis diagnosis in adults (age 18 and over) should be referred to an appropriate secondary care physician based on the organ system(s) involved for further assessment and treatment by a specialist.
• Urgency of referral depends on clinical judgement; for example, urgent cardiology referral is indicated if cardiac involvement such as arrhythmia or impaired cardiac function is suspected.
• If ocular involvement is suspected, baseline assessment by an optician or ophthalmologist should be recommended or arranged depending on symptom severity.
• People with involvement of more than one organ system may require multidisciplinary team input coordinated by a specialist.
• Active treatment and specialist management are indicated in cases of dangerous disease or unacceptable loss of quality of life.
• All people receiving active treatment for sarcoidosis should be managed in secondary care.
• Ongoing specialist monitoring is required for most people, especially those with stage II to IV pulmonary sarcoidosis or significant extrapulmonary involvement.

Referral is also warranted if new or worsening symptoms develop after discharge from specialist care.

Investigations such as bronchoscopy, tissue biopsy, CT, PET, MRI, and echocardiogram (if cardiac involvement suspected) are used to confirm diagnosis and assess severity, guiding referral decisions.

Primary care should refer suspected sarcoidosis cases promptly to secondary care for diagnosis and management.

References: NICE CKS