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.

  • septic arthritis, concern for infection — consider contacting on call orthopaedic service for advice

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

Inclusions

  • new onset arthritis

Exclusions

  • acute infectious monoarthritis

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • all new onset inflammatory arthritis
  • known or suspected arthritis and the patient is pregnant or planning a pregnancy

Category 2 (appointment clinically indicated within 90 days)

  • established rheumatological disease on active treatment

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
  • history of presenting complaint:
    • duration of symptoms: < 6 weeks, > 6 weeks, < 12 months, > 2 years
    • relevant history, including - history of recent soft tissue infection or portal of entry, foreign body or prostheses, chronic joint disease, recent joint injection, gout, psoriasis, gastrointestinal or genitourinary infection, trauma, back pain and stiffness, fever
    • associated symptoms: inflammatory back pain, diarrhoea, weight loss
    • history of recent travel, tuberculosis exposure
    • family history of rheumatological disease, psoriasis, inflammatory bowel disease, or other autoimmune disease
  • functional impairment
  • treatments used/opinions sought thus far
  • clinical examination:
    • weight
    • blood pressure
    • joint 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)
    • C- reactive protein (CRP)
    • erythrocyte sedimentation rate (ESR)
    • urate

Additional information to assist triage categorisation

  • consider ultrasound-guided aspiration by a radiologist if aspiration at the bedside is not possible or transfer to hospital is delayed
  • synovial fluid for gram stain, microscopy, culture and sensitivity (sepsis), and examination of synovial fluid polarised light microscopy for crystals (gout and pseudogout)
  • previous assessments or opinions from a rheumatologist or other relevant specialist or allied health clinician
  • blood results including location of company and accession number if available:
    • rheumatoid factor and anti CCP antibody titres
    • antinuclear antibodies (ANA) (titre and pattern must be included), human leukocyte antigen B27(HLA B27)
    • blood cultures
    • stool culture
  • urethral swab for gonorrhoea, urine PCR for chlamydia
  • relevant diagnostic/imaging reports including location of company and accession number

Clinical management advice

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.