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Management of Systemic Lupus Erythematosus

11. REFERRAL

Timely referral to or consultation with rheumatologists is of utmost
importance for confirmation of diagnosis and early initiation of
treatment for SLE. Even though rheumatologists are the specialists who
primarily care for patients with SLE, co-management with specialists
in other disciplines (e.g. primary care physicians, nephrologists and
haematologists) is equally important.

Indications for referral to rheumatologist includes to confirm diagnosis,
assess disease activity and severity, provide general disease
management, manage organ involvement or life-threatening disease
and manage/prevent treatment toxicities. Other specific circumstances
that require referral include APS, pregnancy and perioperative
management. 129, level III

For moderate to severe organ involvement, patients with SLE will
require multidisciplinary care involving various subspecialties.

Indications for urgent referral are as listed below:
• for patients not diagnosed with SLE yet -
 clinical suspicion of SLE with major or multisystem organ
involvement
• for patients diagnosed with SLE -
 disease flare of major organ or multisystem organ involvement
 pregnancy (at booking)
 severe infection

Recommendation 16
• All cases with clinical suspicion of systemic lupus erythematosus
should be promptly referred to rheumatologists for confirmation of
the diagnosis and further management.

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