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.

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. greater 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

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 by the Western Locality on behalf of NEW Devon CCG.

Publication date: February 2017
Updated: October 2018

 

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