{"id":3819,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/connectivetissuedisease\/"},"modified":"2025-05-23T14:49:39","modified_gmt":"2025-05-23T13:49:39","slug":"connectivetissuedisease","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/connectivetissuedisease\/","title":{"rendered":"Lupus and Connective Tissue Disease"},"content":{"rendered":"\n<p>This may cover a wide range of complex autoimmune conditions mainly looked after by rheumatologist. They include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Systemic Lupus Erythematosus<\/li>\n\n\n\n<li>Mixed connective tissue disease\/ Undifferentiated CTD<\/li>\n\n\n\n<li>Systemic Sclerosis\/Scleroderma<\/li>\n\n\n\n<li>Sjogren\u2019s Syndrome<\/li>\n\n\n\n<li>Polymyositis\/ Dermatomyositis<\/li>\n\n\n\n<li>Vasculitis<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">History<\/h3>\n\n\n\n<p>Patients may present with a variety of symptoms including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Photosensitive skin rash\/ malar rash<\/li>\n\n\n\n<li>Polyarthritis or polyarthralgia<\/li>\n\n\n\n<li>Serositis- unexplained pleurisy\/ pericarditis<\/li>\n\n\n\n<li>Unexplained muscle pain and weakness<\/li>\n\n\n\n<li>Unexplained dyspnoea<\/li>\n\n\n\n<li>Raynaud&#8217;s<\/li>\n\n\n\n<li>Unexplained Seizures, focal neurological defects, psychosis<\/li>\n\n\n\n<li>Mouth ulcers<\/li>\n\n\n\n<li>Dry eyes, dry mouth<\/li>\n\n\n\n<li>Hair loss<\/li>\n\n\n\n<li>Recurrent miscarriages or unexplained thrombosis<\/li>\n\n\n\n<li>Constitutional symptoms- unexplained fever or weight loss<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Examination<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Skin rash <\/li>\n\n\n\n<li>Synovitis <\/li>\n\n\n\n<li>Mouth ulcers <\/li>\n\n\n\n<li>Scarring alopecia <\/li>\n\n\n\n<li>Sclerodactyly (tightening and thickening of skin over digits) <\/li>\n\n\n\n<li>Raynaud&#8217;s with digital ulceration <\/li>\n\n\n\n<li>Telangiectasia <\/li>\n\n\n\n<li>Pleural or pericardial effusion<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Investigations<\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td>Haematological &nbsp;<\/td><td>Anaemia, leukopenia or thrombocytopenia<strong><\/strong><\/td><\/tr><tr><td>&nbsp;Inflammatory markers<strong><\/strong><\/td><td>CRP,ESR- may be raised <strong>&nbsp;<\/strong><\/td><\/tr><tr><td>Immunology: <strong>Check immunology only if high index of suspicion. CTD diagnosis is based on history<\/strong> &#8211; <strong><em>Please see <\/em><\/strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/immunology\/ana-testing\/\">Connective Tissue Disease (ANA) Testing \u2013 RefHelp<\/a><\/td><td>ANA , anti dsDNA positive, extractable nuclear antigen (ENA) positive<strong><\/strong><\/td><\/tr><tr><td>Urine dipstick and renal function <strong>&nbsp;<\/strong><\/td><td>&nbsp;Proteinuria, renal impairment<strong><\/strong><\/td><\/tr><tr><td>CK<strong><\/strong><\/td><td>&nbsp;if concerned about muscle weakness See <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology\/myositis\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology\/myositis\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Myositis<\/strong><\/a> page <strong>&nbsp;<\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong>M.A &amp; H.B\/S.R 25-01-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">When to refer:<\/h4>\n\n\n\n<p>Consider referral in patients <strong>with symptoms and signs<\/strong>. <\/p>\n\n\n\n<h4 class=\"wp-block-heading\">&nbsp;When not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>1\/3<sup>rd<\/sup> of healthy people may have a positive ANA and do not need referral.<\/li>\n\n\n\n<li>Patients with weakly positive ANA and no other symptoms<\/li>\n\n\n\n<li>Patients with arthralgia that have a positive ANA and a negative dsDNA (with no other signs or symptoms)<\/li>\n\n\n\n<li>Patients with Raynaud&#8217;s that have a positive ANA and a negative dsDNA,ENA (with no other signs or symptoms)<\/li>\n\n\n\n<li>Patients with generalised pain or fatigue that have a positive ANA and a negative dsDNA (with no other signs or symptoms)<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>SCI Gateway &gt; Rheumatology &gt; WGH<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">Initial management<\/h3>\n\n\n\n<p>Treat on a symptomatic basis pending clinic review<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><a href=\"https:\/\/versusarthritis.org\/about-arthritis\/conditions\/\">https:\/\/versusarthritis.org\/about-arthritis\/conditions\/<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>This may cover a wide range of complex autoimmune conditions mainly looked after by rheumatologist. They include: History Patients may present with a variety of symptoms including: Examination Investigations Haematological &nbsp; Anaemia, leukopenia or thrombocytopenia &nbsp;Inflammatory markers CRP,ESR- may be raised &nbsp; Immunology: Check immunology only if high index of suspicion. CTD diagnosis is based<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4395,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[615],"class_list":["post-3819","page","type-page","status-publish","hentry","category-connectivetissuedisease"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/rheumatology\/connectivetissuedisease\/\" rel=\"tag\">Connective Tissue Disease<\/a>","rttpg_excerpt":"This may cover a wide range of complex autoimmune conditions mainly looked after by rheumatologist. They include: History Patients may present with a variety of symptoms including: Examination Investigations Haematological &nbsp; Anaemia, leukopenia or thrombocytopenia &nbsp;Inflammatory markers CRP,ESR- may be raised &nbsp; Immunology: Check immunology only if high index of suspicion. CTD diagnosis is based","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3819","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3819"}],"version-history":[{"count":10,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3819\/revisions"}],"predecessor-version":[{"id":24126,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3819\/revisions\/24126"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4395"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3819"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3819"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}