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Connective Tissue Disease - SLE, Scleroderma, MCTD, Sjogren’s Syndrome and undifferentiated or overlap CTDs

ADULT

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


Rheumatoid Arthritis

  • Concerns for septic arthritis
  • Complications of disease or therapy requiring emergent review – systemically unwell

Peripheral Spondyloarthritis - Psoriatic arthritis and Reactive arthritis

  • Concerns for septic arthritis
  • • Complications of disease or therapy requiring emergent review – systemically unwell

Axial Spondyloarthritis – Ankylosing Spondylitis

  • Concerns for septic arthritis
  • Complications of disease or therapy requiring emergent review – systemically unwell

Crystal Arthritis – Gout and CPPD (pseudogout)

  • Concerns for septic arthritis
  • Severe drug reaction to Allopurinol

Polymyalgia Rheumatica

  • Complications of disease or therapy requiring emergent review – systemically unwell

Connective Tissue Disease - SLE, Scleroderma, MCTD, Sjogren’s Syndrome and undifferentiated or overlap CTDs

  • Complications of disease or therapy requiring emergent review – systemically unwell

Myositis - polymyositis, dermatomyositis, CTD associated myositis and undifferentiated inflammatory myositis

  • Complications of disease or therapy requiring emergent review – systemically unwell

Vasculitis

  • Complications of disease or therapy requiring emergent review – systemically unwell

Giant Cell Arteritis/Temporal Arteritis

  • Presentation to ED if visual disturbance or loss
  • Complications of disease or therapy requiring emergent review

 

*Discuss immediately by phone with local Rheumatology service if available (or General/Emergency physician if not) to facilitate access to temporal artery biopsy

  • Refer to local Healthpathways or local guidelines
  • Early discussion with Rheumatologist will aid prioritisation, if the patient is unwell and may need to be seen urgently.

Patient resources

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Acute or active organ threatening Connective Tissue Disease
  • Category 2
    (appointment within 90 calendar days)
    • Connective Tissue Disease on established treatment and stable
    • Likely Connective Tissue Disease requiring assessment and management
  • Category 3
    (appointment within 365 calendar days)
    • Connective Tissue Disease for exclusion with minimal symptoms

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Relevant history, of onset and time since onset
  • Specify symptoms and examination findings  including joints/muscles, mouth ulcers, Raynaud’s alopecia, skin rashes or ulceration, dysphagia or GORD, sicca symptoms
  • Extra-articular manifestations including kidney, lungs, cardiac, neurological
  • FBC, E/LFT, CRP and ESR
  • Anti-CCP and Rheumatoid Factor (RF)
  • ANA, ENA, dsDNA, C3, C4
  • CK (if myalgia/muscle weakness) 
  • Urine analysis for MCS, casts and protein

3. Additional referral information Useful for processing the referral

  • Skin biopsy histology
  • Imaging results

4. Request

Patient's 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

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

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.)

  • Please note that 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 becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

  • 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.

 

Version: 3
Last updated: 12 January 2023

© State of Queensland (Queensland Health) 2023

Except as permitted under the Copyright Act 1968, no part of this work may be reproduced, communicated or adapted without permission from Queensland Health. To request permission email ip_officer@health.qld.gov.au.

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