Personally, my first stop is always my primary. She and I have developed a good working relationship. If she thinks that my symptoms are Lupus or FM related, she will run tests and then schedule an appointment for me with my rheumatologist. Kaiser has an on-line system for patients wherein we can read the results of all lab work within a day or two of doing the labs. We can also e-mail our doctors who have to respond within 48 hours.
Often, my primary will e-mail to let me know that she spoke with my rheumatologist and he either wants to see me, or wants me to modify my medications. I will, at the same time, get an e-mail from my rheumatologist with the same information.
Recently, I went to my primary who thought that my problem was due to my thyroid and she contacted my endocrinologist who fit me in within 2 hours of my appointment with my primary.
Many patients have their rheumatologist as their primary physican! As far as which one to call, that is entirely up to you. If your lupus is active or if you are in a flare, you could start with you rheumatologist. If you lupus is not active, you could probably start with your primary!!
I wish you the best
Peace and Blessings
Look For The Good and Praise It!