·         Background/Purpose: Sarcoidosis is characterized by a variable clinical presentation. DMARDs and biologics have been used for resistant and/or organ-threatening disease. We analyzed the cases of sarcoidosis in a tertiary medical center in northern New England. 

·         Methods: This was a retrospective review of the medical charts of patients who presented to Dartmouth-Hitchcock Medical Center from 2005-2010. Data were extracted from the electronic medical records using ICD-9 code. Patients with biopsy-proven non-caseating granuloma or Lofgren’s syndrome were included. Patients were divided into those requiring either no treatment or steroids alone (non-immunosuppression (Non-IMS) group) and those requiring immunosuppressive medication beyond steroid (IMS group).

·         Results: 402 charts were reviewed and 120 patients met the inclusion criteria. Comparison was made with data from the ACCESS study (736 patients, Baughman et al., 2001). See table1. In addition, Comparison was made between IMS and Non-IMS group in the study. Of 29 patients in the IMS group, 82.7% had 2 or more organs involved (P<0.0005). 68.9% were followed by Rheumatology service in IMS group (P<0.0001).  Eye (P<0.003), Musculoskeletal (P<0.0004) and nervous system (P<0.030) involvement often required IMS. The average ACE level (Unit/L) was 66.8 in IMS and 48.3 in Non IMS group (P<0.0339). See Table 2.

·         Conclusion: We have characterized a unique sarcoidosis population in rural northern New England, mainly Caucasian with more musculoskeletal, skin and kidney involvement and less lung involvement compared to existing data. 24% of our patients required treatment beyond steroid (IMS group). The use of IMS was associated with the number of organs involved (>=2), and the specific organ involvement (eye, musculoskeletal, nervous system) at the time of diagnosis. We also observed a trend toward higher ACE levels in patients requiring the use of IMS. Rheumatologists followed most patients on IMS treatment, perhaps due to familiarity with these agents and/or seeing more complicated cases in their clinic.