Primary care paradigm for management of sarcoidosis, Part 1.

Sarcoidosis is a systemic granulomatous disease of undetermined etiology in which the immune system is overstimulated. Management of the patient with sarcoidosis entails continuity of patient care far beyond disease, even into remission. Care is comprehensive, including all involved organ systems, coordination of specialty consultations and services, and diagnostic tests. Therapeutic decisions are the responsibility of the primary care practitioner. Prognosis of sarcoidosis is not uniformly good. Patients can die. Subacute sarcoidosis patients usually do not require pharmacologic therapy. Chronic sarcoidosis may require long-term treatment for years to indefinitely. Corticosteroids are still the drugs of choice and other therapy is now available. Health organizations and private nonprofit support groups are available for patient education and assistance. Close support must still come from the family unit. Sarcoidosis may occur in family members in different cohorts at all ages in life and in any racial or ethnic group. This article is the first in a two-part series on management of the patient with sarcoidosis in the 21 st century by the primary are provider. Applications of principles of family medicine are emphasized. Part 1 considers continuity, comprehensiveness, and coordination of care. Part 2 will complete coordination of care, and consider community, prevention, and family aspects of this disease.