From guidelines to reality: how do physicians really manage sarcoidosis?

Guidelines exist for the diagnosis, treatment, and follow-up of sarcoidosis; however, considerable variation in clinical practice remains. This study aimed to evaluate the approaches of pulmonologists in Turkey to the management of patients with sarcoidosis through a survey. A web-based survey consisting of 26 questions regarding diagnostic and therapeutic approaches and follow-up strategies in patients with sarcoidosis was sent to the email groups of specialists. The study was designed as a multicenter project and targeted only pulmonology physicians. The responses provided by the participating physicians were analyzed statistically. Ninety-seven pulmonologists participated in the survey. Stage I–II sarcoidosis was most frequently encountered, and endobronchial ultrasound was the preferred diagnostic modality across all stages. Routine evaluations commonly included laboratory tests, thoracic imaging, and pulmonary function testing. Systemic therapy was rarely initiated in stage I–II disease but was routinely used in stage III–IV disease, with glucocorticoids as first-line treatment and methotrexate as the most common second-line agent. Antifibrotic therapy was considered by approximately one-third of physicians for stage IV sarcoidosis. Follow-up intervals were generally 3–6 months for untreated patients and 3 months for treated patients. There are individual and institutional variations in the diagnosis, treatment, and follow-up of sarcoidosis in Turkey, particularly in diagnostic methods and treatment duration. Considering the well-recognized environmental and racial differences in disease presentation, our findings highlight the need for a national diagnostic and treatment guideline for sarcoidosis.