Sarcoidosis

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United StatesATS/CHEST

Current

Diagnosis and Detection of Sarcoidosis: An Official ATS Clinical Practice Guideline

American Thoracic Society (ATS) · 2020

An ATS guideline covering how sarcoidosis is diagnosed and how extrapulmonary involvement is detected, offering 14 recommendations plus a best-practice statement.

The guideline addresses when lymph node sampling is needed, screening for extrapulmonary disease, and evaluation of suspected extrapulmonary involvement. source
ATS publishes an executive summary, online supplement and pocket guide alongside the full document. source

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EuropeERS (global: GOLD/GINA)

Current

ERS clinical practice guidelines on treatment of sarcoidosis

European Respiratory Society (ERS) · 2021

An ERS Task Force guideline on when and how to treat sarcoidosis, framed around reducing morbidity and mortality risk and protecting quality of life. It delivers 12 recommendations developed with GRADE.

Recommendations span pulmonary, cutaneous, cardiac and neurologic sarcoidosis as well as sarcoidosis-associated fatigue. source
The Task Force notes glucocorticoids remain first-line for symptomatic disease but that prolonged use carries toxicity, motivating steroid-sparing options. source

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US vs EU key differences

The two documents cover different halves of the problem: the ATS 2020 guideline is confined to diagnosis and detection (15 recommendations), while the ERS 2021 guideline addresses only treatment (12 recommendations from 8 PICO questions), so clinicians must pair them. source
The single strong recommendation in the ATS diagnostic guideline is for baseline serum calcium testing; baseline eye examination and baseline ECG in asymptomatic patients are only conditional, and routine baseline echocardiography or 24-hour Holter monitoring is advised against. source
The ERS treatment guideline keeps glucocorticoids as first-line for symptomatic disease with a suggested prednisone starting dose around 20 mg/day, positions methotrexate as the best-evidenced second-line agent, and reserves TNF-alpha inhibitors such as infliximab for refractory disease. source
Both sets rest on a weak evidence base: the ERS panel states that high or even moderate quality evidence for optimal sarcoidosis management is lacking, with every recommendation graded very low to low certainty. source

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