Adults
Suspected systemic lupus erythematosus (SLE)
Positive ANA with lupus-type clinical features or lupus-specific antibodies.
What to look for
- Positive ANA (usually 1:80 or higher by HEp-2 IFA; the entry criterion in the 2019 EULAR/ACR classification)
- Photosensitive or malar rash, discoid lesions, oral or nasal ulcers, non-scarring alopecia
- Inflammatory arthritis, serositis (pleurisy, pericarditis), fevers
- Cytopenias (leukopenia, lymphopenia, thrombocytopenia, hemolysis)
- Proteinuria or hematuria, low complements, anti-dsDNA or anti-Sm antibodies
What to do
- Send ANA titer and pattern, anti-dsDNA, ENA panel (Sm, RNP, SSA/Ro, SSB/La), C3/C4, CBC with differential, metabolic panel, urinalysis with microscopy and urine protein-to-creatinine ratio.
- Add antiphospholipid antibodies (lupus anticoagulant, anticardiolipin, anti-β2-glycoprotein I) if there is a history of thrombosis or pregnancy loss.
- Nephritis, pulmonary hemorrhage, neuropsychiatric features or severe cytopenias are emergent.
- Rheumatology may advise starting hydroxychloroquine early, since the 2025 ACR guideline recommends it for nearly everyone with SLE. Avoid starting glucocorticoids unless there is organ threat.
About this urgency level
Early specialist assessment changes outcomes. Send the usual workup with the referral, but don't hold the referral while waiting for results.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.