Systemic Autoimmune Disease

Scope

Autoimmune disease (also known as Connective Tissue Disorders / CTD) may be considered in cases of systemic illness, often with widespread joint pains and evidence of involvement of another body system.

Assessment

Signs and Symptoms

Clinical clues

  • Pleurisy / Pericarditis
  • Raynauds - of recent onset in particular
  • Muscle Weakness
  • Photosensitivity
  • Sicca symptoms not easily explained by drugs / age

Test clues

  • Raised P.Viscosity & CRP
  • Cytopenias in particular lymphopenia
  • Markedly elevated Creatine Kinase (i.e. more than 1000)
  • Low C3 C4 complement levels
  • Proteinuria / Haematuria

Please don't give empirical steroids prior to referral

Investigations

  • FBC UE LFT BONE PVisc CRP
  • ANA – lab will do ENA & dsDNA if strong positive and good clinical information
  • Blood Pressure
  • Urinalysis
  • Consider complement (C3 & C4 if there is a strong suspicion of autoimmune disease)

Referral

Referral Criteria

The most appropriate specialist to look after patients with Systemic Autoimmune Disease depends on the predominant system involved e.g.

  • proteinuria / haematuria / renal dysfunction – nephrology
  • photosensitivity – dermatology
  • joints / muscles – rheumatology
  • multisystem involvement – rheumatology are happy to discuss / help

Please don't give empirical steroids prior to referral

Supporting Information

Pathway Group

This guideline has been signed off by the Eastern Locality on behalf of NEW Devon CCG.

Publication date: July 2016

 

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