Guidance on Referrals to the Rheumatology Department

Only the provision of relevant information on the referral letter allows effective triage of referrals and timely assessment and management of patients with rheumatological conditions. The following applies to all referrals to Rheumatlogy:

Please provide the following information on any referral:

• Symptoms including duration and distribution
• Findings on clinical examination
• Current working diagnosis and / or clinical concern
• Tried medication / Management so far and response to this
• Relevant past medical history
• Current medication and doses
• Investigations undertaken (results attached wherever possible):
  1. General “baseline” investigations for all patients:
  a. FBC, U+E, LFT, CRP, TFT, uric acid
  2. Other investigations as indicated by symptoms:
  a. suspected inflammatory arthritis: RhF, anti CCP if RhF negative, ANA
  b. suspected connective tissue disease: RhF, ANA, DNA, ENA, complement
  c. suspected vasculitis: ANCA,  RhF, ANA, DNA, ENA
  d. suspected osteoporosis: anti TTg Abs, testosterone + SHBG in men, Ca, PTH
  e. suspected osteomalacia: Ca, PTH, ALP
  f. new onset inflammatory arthritis: CXR, x-ray hands and feet
  i. please enclose report with referral if possible, especially if imaging done in Eccleshill
  ii.Please include whether patient has agreed to shared care on system one as this would aid our referral triage, patient management and communication with you.

Consider urgent referrals if you suspect:

• New onset inflammatory arthritis including acute mono-arthritis
  In suspected early arthritis (symptoms < 12 months but ideally as soon as patient presents to you with their new symptoms). Please use Early Arthritis Referral form to allow most effective assessment and management except if mono-arthritis
• Suspected vasculitis or organ threatening connective tissue disease
• Giant cell arteritis/Temporal arteritis – please arrange urgent temporal artery biopsy with vascular surgeons even prior to referral. Steroids can be started – biopsy useful if done within 10 days of starting steroids
• Back pain with red flags (see back pain section)

Please fax urgent referral to 01274 36 5770 or, in very urgent cases, phone consultant to discuss. This will help to ensure that our urgent slots are used in the most appropriate way. Please see notes above on required information and helpful investigations.  For more detailed information on referral pathways please refer to further information below.