Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • suspected sepsis or septic arthritis
  • complications of disease or therapy requiring emergent review – systemically unwell
  • unexplained illness or fever in a patient being treated with biologic or immunosuppressant medications
  • severe disease with inability to function in the community – phone the rheumatology registrar or on call consultant to discuss options for admission
  • joint pain in someone from a population at high risk of acute rheumatic fever - Aboriginal and Torres Strait Islander people aged 18 to 20 years

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Category 1 (appointment clinically indicated within 30 days)

  • new onset, suspected or recently diagnosed inflammatory arthritis
  • active established inflammatory arthritis requiring escalation of management
  • known or suspected psoriatic or reactive arthritis and the patient is pregnant or planning a pregnancy

Category 2 (appointment clinically indicated within 90 days)

  • known Spondylarthritis on established conventional or biologic/targeted synthetic DMARDs (b/tsDMARDs)

Category 3 (appointment clinically indicated within 365 days)

  • nil

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • if the patient is pregnant or planning a pregnancy
  • complete medical history
  • presence of psoriasis, inflammatory bowel disease (IBD), or inflammatory eye disease (uveitis). If these conditions coexist, please consider concurrent referrals to the appropriate specialties
  • details of previous medical management including the course of treatment and outcome of treatment
  • current and complete medication history including non-prescription medicines, herbs and supplements
  • history of presenting condition:
    • description of joints affected and characteristics
    • duration of symptoms
    • duration of early morning stiffness, greater or less than 30minutes
    • extra-articular, axial or systemic features
  • clinical examination
  • blood results including location of company and accession number if available:
    • full blood count (FBC)
    • electrolytes, urea, creatinine (EUC)
    • estimated glomerular filtration rate (eGFR)
    • liver function tests (LFTs)
    • erythrocyte sedimentation rate (ESR)
    • C-reactive protein (CRP)
    • rheumatoid factor (RF)
    • anti-cyclic citrullinated peptide (anti-CCP) antibodies
    • human leukocyte antigen B27 (HLA-B27)

Additional information to assist triage categorisation

  • family history of axial spondyloarthritis
  • diagnostic/imaging reports including location of company and accession number, if there are inflammatory axial symptoms please consider plain x-ray of spine and sacroiliac joints.
  • interference with activities of daily living and working ability - for example, has the patient had to stop or change work practices, are they requiring assistance with self care
  • sexually transmitted infection screen/stool culture/details of preceding infection for suspected reactive arthritis
  • other screening previously performed including Hepatitis B, Hepatitis C, human immunodeficiency virus (HIV), QuantiFERON Gold (QFG)
  • previous assessments or opinions from a rheumatologist or other relevant specialist or allied health clinician

Clinical management advice

To preserve rheumatology outpatient capacity for high acuity presentations, an alternative service model has been adopted at the Royal Adelaide Hospital (RAH) and The Queen Elizabeth Hospital (TQEH). Patients with uncomplicated non-inflammatory musculoskeletal conditions and recent onset inflammatory arthritis requiring fast tracking may be triaged into a physiotherapist-led clinic at the RAH or TQEH for assessment and management, with rheumatology consultant access as required. Outcomes may include provision of non-pharmacological management options in primary care or further imaging/pathology and review with a rheumatologist for ongoing care where indicated.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.