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Connective tissue diseases

Red flags

Consider immediate referral if

  • Patient unwell
  • Significant proteinuria

Consider routine referral for

  • Most connective tissue disease

Referral is usually NOT necessary for a positive ANA alone

  • A positive test for ANA does not, by itself, indicate the presence of autoimmune disease. Because of the design of the ANA test, 5% of normal individuals will have a positive test at 1:160 below. In the absence of symptoms/signs, even a high titre positive ANA does not indicate that a patient will ever have an autoimmune disease. Less than 1% of patients with a positive ANA have lupus.

For example:

Systemic Lupus Erythematosus (SLE)
Scleroderma
Polymyositis / Dermatomyositis
Sjogren’s Syndrome
Undifferentiated CTD

Other important information for referring practitioners

Lifestyle changes

  • Dietary changes and move towards healthy BMI
  • Alcohol reduction and smoking cessation
  • Keep active (NHMRC: moderate intensity activity for 2.5-5h/week)

Medical management

  • Consider drug-induced conditions and cessation of possible causes
  • Omega 3 fish oils may reduce disease activity

Referral requirements

A referral may be rejected without the following information.

Essential referral information

History and examination

  • Number/location of swollen tender joints and extent of other features
  • Time since onset of joint/other symptoms
  • Duration of early morning stiffness
  • Extra-articular features (most organs potentially affected)
  • BP

Investigations

  • FBC
  • E/LFT
  • ESR/CRP
  • ANA/dsDNA
  • CK
  • Urine analysis for casts and protein

Additional referral information (useful for processing the referral)

  • ENA
  • C3/C4
  • Rh F/anti CCP
  • Skin biopsy

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.)
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