A structured primary care–led triage and referral pathway for systemic lupus erythematosus: Operational criteria and referral outcomes from a real-world rheumatology practice

ObjectiveTo describe the operational criteria and characterize the referral outcomes of a structured primary care-led clinical triage pathway for systemic lupus erythematosus (SLE), implemented by a family physician with postgraduate training in rheumatology.MethodsWe conducted a retrospective observational study including 148 adult patients with confirmed SLE managed between January 2025 and January 2026 at SERVIMED IPS, Colombia. The structured triage pathway was in active clinical use throughout the study period. For the purposes of this analysis, patients were classified into a four-level triage framework with predefined clinical and laboratory criteria for each management tier (continued primary care, programmed referral, prioritized referral, and urgent referral) by applying those criteria retrospectively to documented clinical and laboratory records. Primary outcomes included time to rheumatology assessment and indications for referral.ResultsOf 148 patients (84.5% female; median age 38 years), 93 (62.8%) required rheumatology consultation (38 programmed, 55 prioritized) and 19 (12.8%) required urgent referral. Median time to rheumatology assessment was 22 days (IQR 15-31) for prioritized and 49 days (IQR 38-62) for programmed referrals. Urgent referrals were evaluated within a median of 2 days (IQR 1-3). Newly diagnosed patients were more frequently classified at Level 3 than established patients (56.5% vs 28.4%). Triage reclassification occurred in a minority of cases. SLEDAI-2K was available in 92 patients (median 6, IQR 4-10).ConclusionsA structured primary care-led triage pathway with explicit operational criteria provides a descriptive framework for risk-stratified referral to rheumatology care for patients with SLE in resource-constrained settings. The observed referral times are preliminary descriptive findings that warrant prospective comparative evaluation. Formal inter-rater reliability assessment and independent validation studies are needed before broader implementation recommendations can be made.