Adults
Connective tissue disease with organ-threatening features
Lupus, scleroderma, myositis or APS with a dangerous complication: kidney, lung, brain, blood or muscle failure.
What to look for
- Diffuse alveolar hemorrhage in SLE
- Rapidly progressive ILD, especially anti-MDA5 dermatomyositis (often with skin ulcers and little weakness)
- Scleroderma renal crisis: new severe hypertension and acute kidney injury, sometimes with microangiopathic hemolysis. Risk is highest in early diffuse SSc, with anti-RNA polymerase III, and with high-dose glucocorticoids.
- Severe lupus nephritis (nephrotic-range proteinuria, active sediment, rising creatinine) or neuropsychiatric lupus (seizures, psychosis, myelitis)
- Severe cytopenias such as hemolytic anemia or platelets below about 30,000
- Myositis with dysphagia, aspiration risk, respiratory muscle weakness or myocarditis
- Catastrophic antiphospholipid syndrome: thrombosis in several organs over days
What to do
- Emergency or inpatient evaluation is often needed. Contact rheumatology directly.
- Suspected scleroderma renal crisis: start an ACE inhibitor promptly (captopril is commonly used), admit, and avoid high-dose glucocorticoids.
- Suspected rapidly progressive ILD: urgent HRCT and admission. Early combination immunosuppression is usually needed.
About this urgency level
Call rheumatology directly. Many of these need the emergency department or admission, and treatment often starts before the specialist visit.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.