Importantly

• What is the reason for suspicion of this diagnosis?
  • Checklist for medical examination here
• Where should the referral be sent (please see below)?

What type of specialist depends on the organ manifestations

• Joints mainly affected : Rheumatologist (Diakonhemmet's rheumatology department for Oslo patients with predominantly Arthritis)
  • Løfgren Syndrome: Ankles, hilus-glandular enlargements and erythema nodosum
• Pulmonary abnormalities mainly: Lung specialist
• Liver manifestation must be clarified: Gastroenterologist
• Cardiac disorders: Cardiologist
• Eye: Ophthalmologist
• Skin: Dermatologist

• Multiple organ affection: Referral for Oslo patients can be sent to: Department of Rheumatology, OUS Rikshospitalet, Postbox 4950 Nydalen, 0424 OSLO. The department also receives patients from the entire Health Region South East and other regions as far as capacity is concerned.

Disease history

• What typical organ symptoms?
• General condition is affected (night sweat / some fever, fatigue, weight loss)?

Medical examinations

• Enlarged lymph nodes by palpation
• Hepatosplenomegaly
• Heart failure and / or rhythm disturbance
• Auscultation of lungs
  • Crepitations
• X-ray examination or CT examination of lungs (Enlarged hilus glands or Interstitial pulmonary disease)
• Lung function tests
  • Preferably with DLCO / TLCO (gas diffusion)
• Auscultation of heart
• ECG (rhythm disturbances)

• Blood tests

  • Blood sedimentation rate (ESR) and CRP (moderate increase)
  • Leukocytes (Leukopenia among 5 - 10%)
  • ACE (angiotensin converting enzyme increased by generalized disease)
  • IgG (low among 80%)
  • Calcium (increased)
  • Alkaline phosphatase and liver enzymes (increased)

• Biopsies: Granulomas

Differential diagnosis

• Infection
• Malignancy
• Vasculitis diseases
• Connective Tissue Disease

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