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Rheumatoid arthritis

Red flags

Consider immediate referral to/liaison with specialist for

  • New onset inflammatory polyarthritis (swollen, tender joints with early morning stiffness > 30 minutes) even if RhF/CCP/ESR/CRP normal
  • Concerns for septic arthritis
  • Complications of disease or therapy requiring emergent review – systemically unwell

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • New onset, suspected or recently diagnosed rheumatoid arthritis
  • Active established rheumatoid arthritis requiring escalation of management

Category 2

Appointment within 90 days is desirable

  • Known rheumatoid arthritis on established conventional or biologic DMARDs

Category 3

Appointment within 365 days is desirable

  • No defined category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other Important Information for referring practitioners

Referral requirements

A referral may be rejected without the following information.

Essential referral information

History and examination

  • Inflammatory arthritis symptoms, evolution and rate of deterioration
  • Number/location of swollen tender joints
  • Duration of early morning stiffness (greater or less than 30 minutes)
  • If on a biologic DMARD and for PBS review, please stat timeframe

Investigations

  • FBC
  • E/LFT
  • ESR/CRP
  • Rheumatoid Factor/anti CCP antibody
  • ANA

Additional referral information (useful for processing the referral)

  • Extra-articular and systemic features, if any including weight loss
  • Imaging e.g. SR, MRI/US results of affected joints
  • Details of previous treatment/management offered and assessment of efficacy including relevant PBS documentation
  • Pain assessment e.g. waking up at night, analgesic consumption, aggravating and relieving factors
  • Interference with activities of daily living and working ability
  • Other screening previously performed including CSR, HepB, HepC, HIV, QuantiFERON Gold (QFG)

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • 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

  • 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

  • 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

  • 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

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

  • 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.)

Send referral

Hotline: 1300 364 938

Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs

Mail:
Metro North Central Patient Intake
Aspley Community Centre
776  Zillmere Road
ASPLEY QLD 4034

Health pathways

Access to Health Pathways is free for clinicians in Metro North Brisbane.

For login details email:
healthpathways@brisbanenorthphn.org.au

Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org

Locations

Consider routine referral for

  • Established RA on biologic therapy – it is vital that the date the patient will be filling the last repeat on their current PBS biologic prescription is included in the referral. The patient must also have CRP and ESR tested <4 weeks prior to review. Failure to include this information risks the patient being unable to continue treatment.
  • All established RA

Resources

Methotrexate

Other medications

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