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.

  • acute organ failure
    • acute renal failure, neurological signs including motor and sensory loss, severe intractable abdominal pain
  • acutely unwell children or those with purpura not typical for Henoch Scholein Purpura (immunoglobulin A vasculitis)
  • 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 metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Women's and Children's Health Network


  • Henoch Scholein Purpura and Kawasaki disease do not usually require rheumatological review unless severe disease, significant multi-organ involvement or refractory to standard therapy.

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • suspected systemic lupus erythematosus (SLE), juvenile dermatomyositis (JDM), vasculitis or other autoimmune connective tissue disease
    • suspected glomerulonephritis, pericarditis/pleuritis, severe polyarthritis or severe weakness secondary to myositis
  • all patients with suspected vasculitis except for Henoch Scholein Purpura and Kawasaki

Category 2 (appointment clinically indicated within 90 days)

  • Morphea

Category 3 (appointment clinically indicated within 365 days)

  • nil

For information on referral forms and how to import them, please view general referral information.

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.

History of presenting condition

  • duration and frequency of symptoms
  • pattern of pain, for example overnight waking with pain, morning pain, pain with exercise, early morning stiffness,
  • specific clinical features for concern:
    • rash, mouth ulcers, pain, chest pain, anaemia, leucopoenia, thrombocytopenia, active urine sediment or proteinuria if lupus suspected
    • Raynaud’s phenomenon or skin thickening if scleroderma suspected.
    • muscle weakness, rash (heliotrope, Gottrens) if dermatomyositis is suspected
    • muscle pain, marked early morning stiffness, nasal stuffiness, dyspnoea, cough with hemoptysis if small vessel vasculitis is suspected
    • purpuric rash, nephritis, lung or ear, nose and throat (ENT) involvement, fever, constitutional features such as weight loss
  • aggravating and relieving factors
  • treatments used/sought so far including response to nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy or any other treatments


  • rashes, specifically vasculitis rashes
  • joint swelling
  • evidence of muscle weakness, for example Gower’s test
  • evidence of lymphadenopathy, organomegaly
  • blood pressure
  • any previous history of specialist therapy, including investigations and treatments

Additional information to assist triage categorisation

  • ethnicity/ geographic origin
  • relevant diagnostic/imaging reports including location of company and accession number
  • skin biopsy histology
  • blood tests if available:
    • full blood count (FBC)
    • electrolytes, urea, creatinine (EUC)
    • liver function tests (LFTs)
    • C- reactive protein (CRP)
    • erythrocyte sedimentation rate (ESR)
    • complement levels (C3, C4)
    • rheumatoid factor, anti-CCP antibody
    • antinuclear antibody (ANA) titre and pattern must be included, extractable nuclear antigen (ENA), dsDNA, antineutrophil cytoplasmic antibodies (ANCA), urinalysis
    • creatinine kinase
    • thyroid function

Clinical management advice


  • systemic lupus erythematosus (SLE) - multisystem inflammatory presentation often with arthritis, rash, anaemia, serositis, nephritis, CNS involvement, positive antinuclear antibody (ANA)
  • juvenile dermatomyositis (JDM) – inflammatory myopathy with proximal weakness, typical skin rash, arthritis
  • vasculitis - purpuric rash, nephritis, lung or ent involvement, fever, constitutional features
  • other connective tissue disease - features include Raynaud’s phenomenon, rash, arthritis, serositis, myositis, proteinuria, positive ANA
  • localised scleroderma (morphoea) – discrete areas of skin inflammation and fibrosis.
  • behcet’s disease – recurrent oral and/or genital ulcers, rash, arthritis, uveitis


  • early consideration of connective tissue disease is essential to allow prompt diagnosis and management
  • generally no other specific management is required prior to assessment in rheumatology clinic
  • it should be noted that systemic lupus erythematosus would invariably have a positive ANA, however the vast majority of positive ANAs in children are not related to autoimmune conditions such as lupus.

Clinical resources

Consumer resources