What criteria should I use to refer a patient with suspected SLE to a specialist for further evaluation and management?

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

• Refer any patient with clinical features suggestive of systemic autoimmune disease, such as unexplained persistent synovitis, multisystem involvement, or characteristic symptoms (e.g., rash, photosensitivity, oral ulcers, serositis, renal involvement, neurological symptoms) to a rheumatologist or specialist with expertise in connective tissue diseases.
• Urgent referral is warranted if there is evidence of organ involvement or rapidly progressive symptoms that may indicate active systemic disease requiring prompt specialist assessment and management.
• Do not delay referral for specialist opinion based on initial blood tests; investigations such as ANA, anti-dsDNA, complement levels, and other autoantibodies may be performed but should not postpone referral if clinical suspicion is high.
• Referral should be considered when there is diagnostic uncertainty or when initial management in primary care is insufficient to control symptoms or prevent disease progression.

These criteria align with the general principles of referring patients with suspected systemic autoimmune diseases, including SLE, for specialist evaluation to ensure timely diagnosis and management, as specific UK NICE guidelines for SLE referral are not detailed in the provided context but are consistent with referral principles for inflammatory rheumatological conditions ¹,².