🧩 Blair Compass Clinical Decision Support

Autoimmune CDSM

“I think this might be autoimmune. What do I do next?” A fast, colorful, PCP-friendly workflow for rash, joint pain, positive ANA, inflammatory arthritis, myositis clues, and rheumatology referral decisions.

Blair Compass PCP support tool. Designed to support structured evaluation and documentation, not replace clinical judgment or specialist evaluation.
🚀 2-minute workflow🧪 Cost-conscious labs🧮 SLE + RA + DM + Sjögren calculators🎯 Teaching quiz📋 Chart note generator🤝 Companion Guide: MCTD & patient scripts
map

🧩 Autoimmune Disorder Suspected

Common PCP symptoms→Autoimmune disorder NEC / UCTD possible→Branch by pattern
SLE is the “great masquerader.” It can first look like fatigue, eczema, viral illness, anemia, arthritis, pleurisy, edema, kidney disease, psych symptoms, or “just not feeling well.” Use the pathway to avoid anchoring too early.
🦋
SLE / LupusButterfly rash, oral ulcers, cytopenias, proteinuria, low complements, dsDNA/Smith, neuropsych
🖐️
RA / Inflammatory arthritisMCP/PIP/wrist synovitis, morning stiffness, anti-CCP/RF, ESR/CRP
👁️💪
Dermatomyositis / MyositisGottron papules/sign, heliotrope rash, weakness, dysphagia, CK/aldolase
💧
Sjögren / siccaDry eyes, dry mouth, parotid swelling, SSA/SSB
🌈
MCTD / overlapRNP, Raynaud’s, swollen hands, myositis/arthritis overlap
⚠️
Mimics / red flagsInfection, drug eruption, psoriasis/eczema, thyroid, malignancy, drug-induced lupus
Fast promise

Built to reduce cognitive load

  • Progressive disclosure: default view is short; “why” lives in flip cards.
  • Pattern recognition: emoji/color branch cards make rare clues memorable.
  • Forced MUST DOs: exam checklist prevents missed Gottron, heliotrope, strength, urine, neuropsych clues.
  • Cost ladder: minimum → cost-conscious → expanded → full panel.
  • Copy output: generates note, patient message, and referral rationale.
Quick pathway

🚦 Stepwise PCP workflow

Red flags first

No red flags selected yet.

History screen

Exam MUST DOs

Pick branch and order labs

Use the lab ladder, then run the calculator that fits the pattern. If no branch is clear, document autoimmune disorder NEC / undifferentiated connective tissue disease concern and start with first-pass labs.

Refer

Rheumatology referral is indicated for SLE-specific antibodies, renal findings, cytopenias, inflammatory arthritis, suspected Gottron/heliotrope rash, elevated CK/aldolase, low complements, APS concern, or progressive systemic symptoms.

Live pattern nudge

Branch hint

Start checking boxes.
Suggested branch will appear here.
🤝 MCTD, overlap, UCTD, or unclear picture? The Autoimmune Companion Guide covers MCTD recognition, overlap syndromes, the UCTD framing, and ready-to-paraphrase patient scripts (including the "this may take time" conversation).
🧠 Why neuropsych is included
SLE can involve the nervous system. The 2019 SLE classification neuropsychiatric domain includes delirium, psychosis, and seizure. Clinically, cognitive dysfunction, mood/anxiety symptoms, headache, and peripheral nervous system issues may also occur, but attribution is complex.
Don't miss

💧 Sjögren

Sjögren is the autoimmune disease most likely to be misattributed to aging, medications, or anxiety. Ask directly - patients often do not volunteer dryness as a symptom.

Symptoms to ask about

  • Daily, persistent, troublesome dry eyes > 3 months
  • Recurrent sand/gravel sensation in the eyes
  • Tear substitutes used > 3×/day
  • Daily dry mouth > 3 months
  • Needs liquids to swallow dry food

Beyond the dry triad

  • Bilateral parotid swelling (often recurrent/episodic)
  • Dental caries out of proportion to hygiene
  • Vaginal dryness/dyspareunia not otherwise explained
  • Fatigue, arthralgia, Raynaud's, peripheral or small-fiber neuropathy, cytopenias (esp. leukopenia)
  • Increased B-cell lymphoma risk (~5–10× general population) - persistent parotid swelling warrants attention
First-pass workup: CBC, CMP, ANA + anti-SSA/Ro, anti-SSB/La, RF, ESR/CRP, urinalysis. Ophthalmology for Schirmer / ocular staining. SPEP if cryoglobulin/lymphoma concern. Rheumatology when anti-SSA positive or objective dry findings + systemic features.
Run the formal 2016 ACR/EULAR classification.
Don't miss

🩸 MCTD

The patient who looks like "early lupus with weird hands" may actually be MCTD. Easy to miss because anti-U1-RNP is not routinely ordered.

Recognition pattern

  • Raynaud's phenomenon
  • Puffy or swollen hands
  • Arthralgia / arthritis
  • Proximal weakness or dysphagia (myositis spectrum)
  • Dyspnea / cough (ILD or pulmonary hypertension risk)
  • Esophageal dysmotility / reflux

Antibody pattern that should redirect you

  • High-titer speckled ANA (often ≥1:1280)
  • Anti-U1-RNP positive - the defining antibody
  • Anti-dsDNA and anti-Smith typically negative (helps distinguish from SLE)
Add to the workup: anti-U1-RNP (often part of the ENA panel). PFTs with DLCO + echocardiogram if dyspnea or fibrotic findings - pulmonary hypertension is the leading cause of MCTD mortality.
🤝 Open MCTD Companion Guide Criteria orientation tool + overlap syndromes + patient scripts.
Lab ladder

🧪 Cost-conscious labs with “why”

TierTestWhyBranch
For ANA already positive: practical minimum next labs often become CBC w/diff, CMP, UA microscopy, urine protein/creatinine ratio, anti-dsDNA, anti-Smith, and CK.
2019 EULAR/ACR

🦋 SLE calculator

Entry criterion: ANA ≥1:80 at least once. Classification generally requires ≥10 points and at least one clinical criterion. Use only if each item is best explained by SLE.
Current SLE weighted score
0
ANA entry not selected.
2010 ACR/EULAR

🖐️ RA calculator

Apply only when definite clinical synovitis is present in at least one joint and there is no better alternative explanation. A score of 6/10 or higher supports research classification and does not replace diagnosis.
Current RA score
0
Below classification threshold.
2016 ACR/EULAR

💧 Sjögren calculator

2016 ACR/EULAR classification criteria for primary Sjögren's syndrome (Shiboski et al., 2017). Score ≥4 meets classification, provided the inclusion gate is met and no exclusion is present.

Inclusion gate (at least one)

Exclusion criteria (any one disqualifies)

Weighted criteria

Sjögren weighted score
0
Inclusion gate not met yet.
📚 Criteria notes
From Shiboski et al. 2017 (Arthritis & Rheumatology): the inclusion gate must be met, no exclusion present, and total weighted score ≥4 to meet classification. Anticholinergic medications can confound objective dry findings - evaluate after a sufficient interval off the medication.
2017 EULAR/ACR

👁️💪 DM / IIM calculator

Idiopathic Inflammatory Myopathy classification. Score variables present; sum is matched to a probability tier. Muscle biopsy is generally required unless a pathognomonic DM rash (heliotrope rash, Gottron papules, or Gottron sign) is present, in which case the “without biopsy” column applies.
IIM aggregate score
0.0
Select variables above.
📚 Cutoffs reference
Without biopsy: ≥7.5 = definite IIM (≥90%); 5.5–7.4 = probable (≥55%); 5.3–5.4 = possible (≥50%). With biopsy: ≥8.7 = definite; 6.7–8.6 = probable; 6.5–6.6 = possible. Source: Lundberg et al., 2017 (PMC).
Dermatomyositis pathway

👁️💪 Do not miss DM

Knuckle/elbow rash is not automatically eczema. Rash over MCP/PIP extensor surfaces or elbows should trigger Gottron papules/sign consideration.
DM suspicion: Not scored yet.
🤝 Open Companion Guide Run the formal 2017 EULAR/ACR classification on the Calculators page, or jump to overlap/MCTD/patient-script content.
🍽️ Ask dysphagia directly
Patients may not volunteer “trouble swallowing.” Ask: pills stuck? cough/choke with liquids? food hangs up? need extra water? avoid meat/bread/dry foods? wet/gurgly voice after meals? nasal regurgitation? long meals or weight loss?
Rash translator

🦋 vs 👁️

🦋 Malar/butterfly rash: cheeks + bridge of nose, often sparing nasolabial folds. Think SLE pathway.
📷 Reference images: DermNet - cutaneous lupus · SLE image gallery
👁️ Heliotrope rash: purple/dusky upper eyelid or periorbital rash, sometimes swollen. Think dermatomyositis pathway.
📷 Reference image: DermNet - heliotrope rash
✋ Gottron papules: red-purple raised papules/plaques over MCP/PIP extensor surfaces. Think dermatomyositis.
📷 Reference image: DermNet - Gottron papules
🤚 Gottron sign: flat red/violaceous macules over extensor joints - elbows, knees, MCP/PIP. Think dermatomyositis.
📷 Reference images: DermNet - dermatomyositis image gallery
Flip cards

📚 Click-to-learn without clutter

Interactive QA

🎯 Must-know quick check

How to use

Keep this quiz short and repeated. It teaches the essential pattern recognition that prevents misses.

Score: 0 / 0
Generate

📋 Chart note builder

Output

Stable resources

🔗 Evidence / firsthand links

Prefer peer-reviewed PMC full text, professional society pages, and stable educational pages. Avoid transient blog links for core criteria.

2019 EULAR/ACR SLE criteriaPMC full text
2010 ACR/EULAR RA criteriaPMC full text
2017 EULAR/ACR idiopathic inflammatory myopathy criteriaPMC full text
ACR patient resource: inflammatory myopathiesAmerican College of Rheumatology
2016 ACR/EULAR classification criteria for primary Sjögren's syndrome (Shiboski et al.)PMC full text
EULAR recommendations for management of Sjögren's syndrome (Ramos-Casals et al., 2020)Ann Rheum Dis
Companion tool - MCTD, overlap, UCTD, patient scriptsOpen Autoimmune Companion Guide →
Patient education (bilingual, no login required)Understanding Your Autoimmune Workup - EN / ES ↗
Dermatomyositis visual clinical educationDermNet NZ
Dermatomyositis image gallery (heliotrope, Gottron papules, Gottron sign)DermNet - DM images
Cutaneous lupus / malar rash image referenceDermNet - cutaneous lupus
SLE cognitive dysfunction reviewPMC review
Review note: Rheumatology review may be incorporated in future updates.
Blair Compass Autoimmune CDSM | PCP workflow support and education | Rheumatology review may be incorporated in future updates
PREPARED BY RAYMOND BLAIR, MD EST. 2025 IRON PASSAGE HOLDINGS B

Authoritative sources

Educational support only. Verify patient-specific decisions against current source guidance and local policy.