title: The diagnostic pathway to sarcoidosis.
abstract: OBJECTIVE
  To examine the time from the first physician visit to the diagnosis of sarcoidosis.
  
  
  OBJECTIVE
  The time required to diagnose sarcoidosis is dependent on the initial symptoms, socioeconomic status, referral to a specialist, race, and severity of pulmonary involvement.
  
  
  METHODS
  Patients were recruited from the Case Control Etiology of Sarcoidosis Study (ACCESS) and had biopsy-confirmed sarcoidosis. Subjects were asked to recall the date of onset of symptoms of sarcoidosis, their first physician visit, number of physician visits, and types of physicians seen.
  
  
  RESULTS
  One hundred eighty-nine patients were enrolled. The diagnosis of sarcoidosis was made on the first physician visit in only 15.3% of cases. The presence of pulmonary symptoms was associated with prolonged time (> 6 months vs < or = 6 months, p = 0.02) until diagnosis, and the presence of skin symptoms with a shorter time (< or = 6 months vs > 6 months, p = 0.02) until diagnosis. Patients with pulmonary symptoms had more physician visits (mean +/- SEM) until the diagnosis was made compared to those without pulmonary symptoms (4.84 +/- 0.38 visits vs 3.15 +/- 0.24 visits, p = 0.0002). The mean baseline FEV(1) was greater in those diagnosed < or = 6 months from the first physician visit than those diagnosed > 6 months (87.3 +/- 1.52% predicted vs 81.2 +/- 2.5% predicted, p = 0.04). There was a significant delay in diagnosis (> 6 months vs < or = 6 months) from first physician visit with higher Scadding stages (stage 4 vs stage 2, or stage 3 vs stage 0 or 1, p = 0.04).
  
  
  CONCLUSIONS
  The diagnosis of sarcoidosis is often delayed and seems to be more a factor of disease presentation than patient or physician characteristics. The presence of pulmonary symptoms or higher radiographic stages is associated with a prolonged time until diagnosis. The presence of skin symptoms is associated with less delay in diagnosis. It is likely that the delay in diagnosis of pulmonary sarcoidosis relates to the fact that pulmonary symptoms and parenchymal involvement are nonspecific and are often regarded as manifestations of other pulmonary diseases.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston 29425, USA. judsonma@MUSC.edu
authors.forename: Marc A
authors.initials: MA
authors.lastname: Judson
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Thompson
authors.forename: David L
authors.initials: DL
authors.lastname: Rabin
authors.forename: Joanne
authors.initials: J
authors.lastname: Steimel
authors.forename: Genell L
authors.initials: GL
authors.lastname: Knattereud
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Lackland
authors.forename: Cecile
authors.initials: C
authors.lastname: Rose
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Rand
authors.forename: Robert P
authors.initials: RP
authors.lastname: Baughman
authors.forename: Alvin S
authors.initials: AS
authors.lastname: Teirstein
mesh_terms: D000328:Adult; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006297:Health Services Accessibility; D006801:Humans; D008168:Lung / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012507:Sarcoidosis / Q000175:diagnosis / Q000473:pathology; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis* / Q000473:pathology; D012871:Skin Diseases / Q000175:diagnosis / Q000473:pathology; D012959:Socioeconomic Factors