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Referral
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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.
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
- 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 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
Pathway Group
This guideline has been signed off on behalf of NHS Devon.
Publication date: July 2016
