Guidelines for Referral to Adult Rheumatology
|Guidelines for Referral to Adult Rheumatology |
|For all the following indications we recommend that referral should be made to the rheumatology clinic in the first instance, and not to a musculoskeletal |
|triage service: |
| |
|1) Suspected inflammatory arthritis (including RA, seronegative arthritis, severe gout) |
| |
|Specific symptoms and investigations suggestive of this diagnosis include one or more of: |
| |
|Recent onset visible joint swelling |
|Prolonged early morning stiffness >30 mins |
|Night pain |
|Recent change in joint function ( e.g. difficulty gripping) |
|Elevated inflammatory markers in the context of the above symptoms |
|Elevated titre of anti-CCP antibodies, elevated RF if inflammatory symptoms (only of value for patients suspected of having Rheumatoid arthritis) |
|Hyperuricemia with clinical attacks suggestive of gout |
| |
|2) Suspected multisystem inflammatory disease, including vasculitis and connective tissue disease |
| |
|Specific symptoms and investigations suggestive of these diagnoses include: |
| |
|Recent onset arthralgia, myalgia, fatigue |
|Recent onset Raynauds phenomenon |
|Unexplained persistent rash, particularly if photosensitive or vasculitic |
|Symptoms to suggest polymyalgia or temporal arteritis |
|Strongly positive ANA, particularly if associated with abnormal ENA / DsDNA (request advice from virtual clinic if unsure) |
|Unexplained elevation of ESR / CRP in the context of above symptoms (CRP may not be elevated in patients with SLE) |
| |
|3) Unexplained severe musculoskeletal pain |
| |
|Urgent referral should be considered for patients with severe worsening pain which includes one or more of the following features: |
| |
|Night pain /sweats |
|Pain associated with recent onset neurological abnormalities |
|Pain associated with progressive blood test abnormalities (anaemia, hypercalcaemia, marked elevation of inflammatory markers) |
| |
|4) Suspected fibromyalgia / chronic pain |
| |
|Symptoms suggestive of this diagnosis include: |
| |
|Chronic widespread musculoskeletal pain |
|Poor disturbed sleep / fatigue |
|Investigations should be normal including: ESR, CRP, TFT, FBC, U+E, LFT, CK |
|Consultant |Dr Fawthrop, Consultant Rheumatologist, RFT |
|GP Lead |Dr J Kitlowski, Clinical Commissioning Group, NHS Rotherham |
|Date Approved |16 November 2011 |
|Review Date: |16 November 2013 |
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|The following guidelines have been developed to provide a rationale for referral of patients to the adult rheumatology service in Rotherham. Paediatric |
|rheumatology and the bone health service are not included within the scope of this document. |
| |
|Adult rheumatologists are specifically trained to be highly skilled in: |
| |
|Developing a differential diagnosis of rheumatic disorders and autoimmune diseases |
| |
|Efficient use of diagnostic evaluations in rheumatic disorders |
| |
| |
|Selecting appropriate medical therapy for treatment of rheumatic disease given the patient’s lifestyle and co-morbidities including the use of intra-articular |
|injection |
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|Monitoring long term efficacy and side effects of multiple medications including anti-inflammatory and biologic agents used to treat rheumatic disease |
| |
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|Improving quality of life and decreasing disability of patients suffering from rheumatic disease |
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