{"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":"2026-07-30T11:28:23","modified_gmt":"2026-07-30T10:28:23","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 class=\"wp-block-paragraph\">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 class=\"wp-block-paragraph\">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 &#8211; rash<\/li>\n\n\n\n<li>Swollen joints<\/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 aligncenter\"><table class=\"has-fixed-layout\"><tbody><tr><td>Haematological &nbsp;<\/td><td>Anaemia, leukopenia or thrombocytopenia<strong><\/strong><\/td><\/tr><tr><td>Inflammatory markers<\/td><td>CRP, ESR- may be raised <strong>\u00a0<\/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\/\" target=\"_blank\" rel=\"noreferrer noopener\">Connective Tissue Disease (ANA) Testing \u2013 RefHelp<\/a><\/td><td>ANA, anti dsDNA positive, extractable nuclear antigen (ENA) positive<\/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>\u00a0if concerned about muscle weakness See <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/myositis\/\" id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology\/myositis\/\" target=\"_blank\" rel=\"noreferrer noopener\">Myositis<\/a> page <strong>\u00a0<\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>M.A &amp; H.B\/S.R &#8211; 29-7-26<\/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 class=\"wp-block-paragraph\">Consider referral ONLY 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<p class=\"wp-block-paragraph\">ANA is positive in 1\/20 healthy individuals.&nbsp; A positive ANA is also associated with many non rheumatic diseases such as autoimmune thyroid disease, primary biliary cirrhosis, certain viral infections (EBV, CMV, hepatitis B&amp;C), inflammatory bowel disease and lymphoproliferative diseases.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is more likely to be positive with age.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>If the positive ANA is an isolated finding, then the patient does not need a rheumatology review.<\/strong><\/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\n\n\n<li>Patients with Raynaud\u2019s with weekly positive ANA and a negative dsDNA, ENA and no evidence of digital ischemia\/ulcers or other CTD signs and symptoms.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">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<h4 class=\"wp-block-heading\">Initial management<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">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 class=\"wp-block-paragraph\"><a href=\"https:\/\/www.arthritis-uk.org\/information-and-support\/understanding-arthritis\/conditions\/\" target=\"_blank\" rel=\"noreferrer noopener\">Types of arthritis | Arthritis UK<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.rheumatology.org.uk\/improving-care\/specialist-advice-referral-and-triage\" target=\"_blank\" rel=\"noreferrer noopener\">Specialist advice, referral and triage<\/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 Inflammatory markers CRP, ESR- may be raised &nbsp; Immunology: Check immunology only if high index of suspicion. CTD diagnosis is<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4395,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","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 Inflammatory markers CRP, ESR- may be raised &nbsp; Immunology: Check immunology only if high index of suspicion. CTD diagnosis is","_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":13,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3819\/revisions"}],"predecessor-version":[{"id":29264,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3819\/revisions\/29264"}],"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}]}}