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Sarcoid

Important information for referring practitioners

When to refer:

  • To confirm diagnosis
  • For staging and treatment
  • Review and follow up

Sarcoid information

Sarcoid is a granulomatous disease which can affect any organ but most commonly involves the lungs. It is caused by antigen exposure in a genetically susceptible host resulting in granuloma formation with a marked Th1 cell-mediated immune response. The nature of the antigen is unknown. The severity and course of the disease varies widely between individuals. Most cases have a benign course. Most cases will be asymptomatic and are picked up on co-incidental CXR findings of bilateral hilar lymphadenopathy. The most common symptom is SOB.

Over 60% resolve within 2 years of diagnosis. Staging is important to identify those will a more serious prognosis and to help decide on treatment.

Factors associated with poorer prognosis

  • Age >40 yrs at onset
  • African American race
  • Requirement for steroids
  • Extra pulmonary involvement
  • Pulmonary involvement including:
    • Stage 3-4 disease
    • Pulmonary HT
    • Moderate or worse dyspnoea on presentation
    • Neutrophils in bronchoalveolar lavage

Treatment

The decision to treat is influenced by:

  • Natural course of disease i.e. most are self-limiting
  • Severity of symptoms
  • Duration
  • Organ involvement
  • Risks of therapy

Note: The decision to treat and the nature of treatment should be made at specialist level.

Lifestyle changes

  • Cease smoking
  • Regular exercise
  • Healthy diet

Medical management

  • Oral steroids (prednisolone)
  • Immunosuppresive agents
    • Methotrexate
    • Azathiaprine
    • Mycophenidate

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • Reason for referral
  • Symptoms
    • Duration
    • Severity
  • Relevant examination findings
    • Pleural effusion
  • Other relevant medical conditions
  • Medications
    • Include full medication list and allergies
  • Smoking history
  • FH or possible infectious source
  • Investigations
    • FBC, E/LFT, ESR
    • ACE level
    • CXR/HRCT and any other relevant imaging
    • Spirometry

Additional referral information (useful for processing the referral)

  • Gas transfer studies
  • Sputum culture (including TB culture)

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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