When should I consider referring a patient with SLE to a specialist, and what criteria should guide this decision?

Consider referring a patient with systemic lupus erythematosus (SLE) to a specialist (rheumatologist or relevant specialist) when:

• There is evidence of active or severe disease manifestations that require specialist assessment and management, such as organ involvement (e.g., renal, neurological, or severe hematological complications).
• The diagnosis is uncertain or complex, requiring specialist input for confirmation and further investigation.
• The patient has persistent or worsening symptoms despite initial management in primary care.
• Specialist monitoring is needed for immunosuppressive or biologic therapies that are beyond the scope of primary care.
• There is a need for multidisciplinary care due to systemic involvement or complications.

Referral criteria should be guided by:

• Clinical features suggestive of active systemic involvement or complications.
• Failure to respond to standard primary care management.
• Need for specialist diagnostic tests or treatments.
• Urgency based on severity of symptoms or risk of organ damage.

While the provided context does not explicitly detail SLE referral criteria, the principles for referral in systemic autoimmune diseases such as rheumatoid arthritis and spondyloarthritis emphasize early specialist assessment for persistent or severe disease, organ involvement, or diagnostic uncertainty, which are applicable to SLE management in UK practice ²,⁴,⁶.