What criteria should I use to determine whether to refer a patient with suspected lupus to a specialist?

Criteria for referral of a patient with suspected systemic lupus erythematosus (SLE) to a specialist:

• Refer any patient with clinical features suggestive of SLE, such as persistent unexplained multisystem symptoms including fatigue, joint pain or swelling, skin rashes (especially malar rash), photosensitivity, oral ulcers, serositis, renal involvement, neurological symptoms, or haematological abnormalities.
• Consider urgent referral if there is evidence of organ involvement (e.g., renal impairment, neurological symptoms) or if the diagnosis is unclear and requires specialist immunological assessment.
• Do not delay referral for specialist opinion pending blood test results if clinical suspicion is high, as early diagnosis and management are critical to prevent organ damage.
• Initial investigations in primary care (e.g., ANA testing) may support suspicion but should not delay referral if clinical features strongly suggest SLE.

In summary, refer patients with suspected SLE promptly to rheumatology or relevant specialists when clinical features suggest multisystem autoimmune disease, especially if organ involvement is suspected or diagnosis is uncertain.

Note: Although the provided UK guidelines do not explicitly detail SLE referral criteria, the principles for referral of suspected systemic autoimmune diseases align with early specialist assessment for persistent multisystem symptoms and organ involvement, as emphasised in rheumatology referral guidelines ².