Evaluation of the practice management of physicians who have newly diagnosed patients with sarcoidosis

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Introduction. Sarcoidosis is a systemic granulomatosis of unknown etiology that is still difficult to diagnose at the primary health care stage, and initial prescriptions require knowledge of clinical guidelines. It is known that unreasonable practice management at the beginning of treatment significantly worsens the disease prognosis. The aim of the study was to evaluate the actions of doctors and their initial prescriptions for their patients who were subsequently diagnosed with the biopsy-confirmed sarcoidosis. Materials and Methods. We analyzed 1001 cases of histologically confirmed sarcoidosis: 634 (63.3%) women and 367 (36.7%) men who consulted a pulmonologist from 68 regions of Russia and neighboring countries. The methods of detection, primary diagnoses, and specialties of doctors who made initial prescriptions and conducted a diagnostic search were recorded, as well as the contents of such primary recommendations and prescriptions. Results and Discussion. The detection of sarcoidosis was associated with diagnostic investigations, the causes of which varied. Most often (in 417 cases, 41.74%), changes were detected during preventive fluorography, 250 patients (25.03%) sought help with respiratory complaints, while the remaining reasons for visits accounted for less than 10% each. 87 diagnoses were preliminarily made, among which the most common were tuberculosis (in 297 cases, 29.7%), sarcoidosis (in 161 cases, 16.1%), pneumonia (in 105 cases, 10.5%), and tumors– (in 88 cases, 8.8%). Only 237 patients (23.68%) were left under observation without treatment, while 515 patients were recommended to take vitamin E (51.45%) and 241 (24.08%) pentoxifylline (236 of them together with vitamin E). 210 patients (20.98%) were immediately prescribed systemic glucocorticosteroids (SGCS), 56 (5.59%) antibiotics, 50 (4.99%) anti-tuberculosis drugs, while the remaining prescriptions were less frequent than in 5% of cases. Frequency of SGCS prescription upon detection was more frequent in Löfgren’s syndrome (34.5% of cases versus 18.7% without this syndrome), which cannot be considered reasonable practice management. Conclusions. Despite the fact that most physicians are familiar with the key issues of diagnosis and initial therapy of sarcoidosis, in every fourth patient the practice management does not comply with clinical recommendations. Excessive administration of glucocorticosteroids in Löfgren’s syndrome has been observed, which may adversely affect the subsequent disease course.

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