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.

  • concerns for 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 medicines

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 rheumatoid arthritis
  • active established rheumatoid arthritis requiring escalation of management
  • known or suspected rheumatoid arthritis and the patient is pregnant or planning a pregnancy

Category 2 (appointment clinically indicated within 90 days)

  • known rheumatoid arthritis on established conventional or biologic/targeted synthetic disease-modifying antirheumatic drugs (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
  • details of previous medical management including the course of treatment and outcome
  • current and complete medication history including non-prescription medicines, herbs and supplements
  • history of presenting complaint
    • description of joints affected
    • onset
    • characteristics
    • duration of symptoms
    • number and location of swollen, tender joints and other examination findings
    • duration of early morning stiffness, greater or less than 30 minutes
  • 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
  • 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 test (LFTs)
    • C-reactive protein (CRP)
    • erythrocyte sedimentation rate (ESR)
    • anti-cyclic citrullinated peptide (anti-CCP) antibodies
    • rheumatoid Factor (RF)
  • relevant diagnostic/imaging reports including location of company and accession number

Additional information to assist triage categorisation

  • extra-articular and systemic features, if any including weight loss
  • relevant biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) PBS application documentation and prior rheumatology clinic letters if available
  • other screening previously performed including hepatitis B, hepatitis C, human immunodeficiency virus (HIV), QuantiFERON Gold (QFG) if available
  • 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.

For mild to moderate inflammatory joint pain, nonsteroidal anti-inflammatory drugs (NSAIDs) are most commonly used because of their known efficacy in treating pain, stiffness and swelling associated with established inflammatory rheumatological disease

  • use the minimum effective dose of NSAID for the shortest time possible
  • in cases with more severe impairment, oral prednisolone could be considered, doses >10mg not often required, dose < 7.5mg daily preferred if to be used beyond 2 weeks

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.