This may cover a wide range of complex autoimmune conditions mainly looked after by rheumatologist. They include:
- Systemic Lupus Erythematosus
- Mixed connective tissue disease/ Undifferentiated CTD
- Systemic Sclerosis/Scleroderma
- Sjogren’s Syndrome
- Polymyositis/ Dermatomyositis
- Vasculitis
History
Patients may present with a variety of symptoms including:
- Photosensitive skin rash/ malar rash
- Polyarthritis or polyarthralgia
- Serositis- unexplained pleurisy/ pericarditis
- Unexplained muscle pain and weakness
- Unexplained dyspnoea
- Raynaud’s
- Unexplained Seizures, focal neurological defects, psychosis
- Mouth ulcers
- Dry eyes, dry mouth
- Hair loss
- Recurrent miscarriages or unexplained thrombosis
- Constitutional symptoms- unexplained fever or weight loss
Examination
- Skin rash
- Synovitis
- Mouth ulcers
- Scarring alopecia
- Sclerodactyly (tightening and thickening of skin over digits)
- Raynaud’s with digital ulceration
- Telangiectasia
- Pleural or pericardial effusion
Investigations
| Haematological | Anaemia, leukopenia or thrombocytopenia |
| Inflammatory markers | CRP,ESR- may be raised |
| Immunology: Check immunology only if high index of suspicion. CTD diagnosis is based on history | ANA , anti dsDNA positive, extractable nuclear antigen (ENA) positive |
| Urine dipstick and renal function | Proteinuria, renal impairment |
| CK | if concerned about muscle weakness See Myositis page |
M.A & H.B/S.R 25-01-24
When to refer:
Consider referral in patients with symptoms and signs.
When not to refer:
- 1/3rd of healthy people may have a positive ANA and do not need referral.
- Patients with weakly positive ANA and no other symptoms
- Patients with arthralgia that have a positive ANA and a negative dsDNA (with no other signs or symptoms)
- Patients with Raynaud’s that have a positive ANA and a negative dsDNA,ENA (with no other signs or symptoms)
- Patients with generalised pain or fatigue that have a positive ANA and a negative dsDNA (with no other signs or symptoms)
Initial management
Treat on a symptomatic basis pending clinic review
