ATS GUIDELINES Bundle

3 Diagnosis Screening for Extrapulmonary Disease ➤ For patients with sarcoidosis who do not have ocular symptoms, the ATS suggests a baseline eye examination to screen for ocular sarcoidosis (conditional recommendation, very low-quality evidence). ➤ For patients with sarcoidosis who have neither renal symptoms nor established renal sarcoidosis, the ATS suggests baseline serum creatinine testing to screen for renal sarcoidosis (conditional recommendation, very low-quality evidence). ➤ For patients with sarcoidosis who have neither hepatic symptoms nor established hepatic sarcoidosis, the ATS suggests baseline serum alkaline phosphatase testing to screen for hepatic sarcoidosis (conditional recommendation, very low-quality evidence). ➤ For patients with sarcoidosis who have neither hepatic symptoms nor established hepatic sarcoidosis, the ATS makes no recommendation for or against baseline serum transaminase testing. ➤ For patients with sarcoidosis who do not have symptoms or signs of hypercalcemia, the ATS recommends baseline serum calcium testing to screen for abnormal calcium metabolism (strong recommendation, very low-quality evidence). ➤ If assessment of vitamin metabolism is deemed necessary in a patient with sarcoidosis, such as to determine if vitamin replacement is indicated, the ATS suggests measuring both 25- and 1,25- OH vitamin levels before vitamin replacement (conditional recommendation, very low-quality evidence). ➤ The ATS suggests that patients with sarcoidosis undergo baseline complete blood cell count testing to screen for hematological abnormalities (conditional recommendation, very low-quality evidence). ➤ For patients with extracardiac sarcoidosis who do not have cardiac symptoms or signs, the ATS suggests performing baseline ECG to screen for possible cardiac involvement (conditional recommendation, very low-quality evidence). ➤ For patients with extracardiac sarcoidosis who do not have cardiac symptoms or signs, the ATS suggests NOT performing routine baseline transthoracic echocardiography (TTE) or 24-hour ambulatory ECG (Holter) monitoring to screen for possible cardiac involvement (conditional recommendation, very low-quality evidence). Remarks: The panel recognizes the low risks attendant to the use of TTE or Holter to screen for cardiac sarcoidosis. Thus, these tests should be considered on a case-by-case basis.

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