Systemic Autoimmune Disease

Scope

Autoimmune disease (aka 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.

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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. greater 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

Patient Information

Long-term Condition Self-Management Programme

GPs and patients can refer to Improving Lives Plymouth for patient support with any long-term physical or low level mental health condition. The service helps people to better manage their condition and to achieve a better quality of life.

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: February 2017
Updated: October 2018

Referral