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.

  • complications of disease or therapy requiring emergent review — systemically unwell

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.

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 polymyalgia rheumatica (PMR) with typical shoulder/hip girdle features with raised erythrocyte sedimentation rate / C- reactive protein
  • known and treated PMR established on steroids requiring further escalation of management or currently on a disease-modifying antirheumatic drugs (DMARDs)

Category 2 (appointment clinically indicated within 90 days)

  • polymyalgia rheumatica on active treatment on established DMARDs

Category 3 (appointment clinically indicated within 365 days)

  • nil

For more on outpatient referrals, see the 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.

  • identifies as Aboriginal and/or Torres Strait Islander
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter required
  • complete medical history
  • details of treatments offered (non-steroidal anti-inflammatory drugs, prednisolone, glucocorticoids, disease-modifying antirheumatic drugs including dose and response
  • history of presenting condition:
    • description of affected areas, for example shoulders, hips, knees including which side
    • duration of symptoms
    • recurrence
    • symptoms, for example, muscle pain, morning stiffness greater or less than 30 minutes
  • clinical examination including presence of any joint swelling. If small joints, please specify metacarpophalangeal / proximal inter-phalangeal / distal interphalangeal joint / metatarsophalangeal joint
  • 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)

Additional information to assist triage categorisation

  • family history of polymyalgia rheumatica
  • 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
  • relevant/diagnostic/imaging reports including location of company and accession number
  • thyroid function tests
  • creatinine kinase
  • rheumatoid factor (RF)
  • anti-cyclic citrullinated peptide (anti-CCP)
  • serum protein electrophoresis (SPEP)
  • other screening previously performed including X-ray, hepatitis B, hepatitis C, human immunodeficiency viruses, QuantiFERON Gold (QFG), bone density
  • cancer screening information
  • previous assessments or opinions from a rheumatologist or other relevant specialist or allied health clinician