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Suspected Connective Tissue Disease (CTD)

SUSPECTED CONNECTIVE TISSUE DISEASE

Includes suspected SLE, Systemic Sclerosis, Poly/Dermatomyositis/Sjorgens/Mixed connective tissue disease

Consider referral if multiple of the following symptoms:

·         Arthritis

·         Serositis- pericarditis/ pleurisy

·         Neuro- seizures/ psychosis

·         Haematological- lymphopenia, haemolytic anaemia, thrombocytopenia

·         Renal- proteinuria/haematuria

·         Skin- malar rash, discoid rash, photosensitivity

·         Oral ulcers

·         Raynauds phenomenon  (hyperlink to raynauds page)

·         Inflammatory myalgia/ proximal muscle weakness

·         Dry eyes/ dry mouth

·         Distal skin thickening/swollen fingers/distal finger ulcers

Who to refer to?

Referral to the most appropriate speciality depends on the predominant system involved:

Photosensitivity/ rash only - Dermatology

Proteinuria/haematuria/renal impairment-Urgent Renal

Arthritis/ -Rheumatology

Investigations required pre referral:

1)      Urinalysis

2)      FBC,( if anaemic check reticulocyte count),  CRP, ESR, U&E, LFTS, Bone,  AutoAb, Consider checking complement if SLE suspected

3)      CK if querying polymyositis

4)      CXR if possible polymyositis/or Respiratory system involvement

Do not give empirical oral steroids prior to referral

 

Useful information( including images)

Dermatomyositis :https://www.dermnetnz.org/topics/dermatomyositis/

SLE/Systemic sclerosis: https://www.dermnetnz.org/cme/systemic/connective-tissue-diseases/

References:

Arthritis research UK, Overview of management SLE, Spring 2013

2013 ACR/EULAR Classification for scleroderma

Uptodate-diagnosis of dermatomyositis/polymyositis- Aug 2017

Personal communication with Dr Hutchinson, Consultant Rheumatologist-RCHT, Aug 2017