Connective tissue disorders

Red flags

Consider urgent referral for patients with the following

Chest pain
- Suspected myocarditis
Neurological symptoms

Information That May Lead To More Urgent Categorisation

Renal involvement with deteriorating renal function
Vasculitis
Cardiac involvement
Weight loss with dermatomyositis/polymyositis
Significant proximal myopathy

Conditions in this category commonly referred to Immunology are:

SLE
Dermatomyositis
Giant cell arteritis
Polymyositis
Scleroderma
Sjogren’s syndrome
Sarcoidosis

Patients with diagnosed rheumatoid disease should be referred to Rheumatology

Other important information for referring practitioners

Lifestyle changes

Advise on healthy lifestyle, diet and exercise.
Advise on and assist smoking cessation

Medical Management

Monitor renal function in SLE, scleroderma
If polymyositis/dermatomyositis is suspected screen for occult malignancy
Perform medication review if on multiple medications as some drugs can be implicated in connective tissue diseases

Referral requirements

A referral may be rejected without the following information.

Essential referral information

Presence of any Red Flags
Reason for referral
Suspected diagnosis
Timeline of symptoms
- Include severity and if lifestyle limiting
- List organ systems affected and severity if multisystemic (e.g.in SLE, scleroderma etc)
If seen by another immunologist please include the last 2-3 letters
Family history if present
Co-existing medical conditions
Treatments trialled and reasons for failure
Current medication list and known allergies
E/LFT, ESR,CRP

Additional referral information (useful for processing the referral)

Tissue autoantibodies, especially if these help to confirm the diagnosis
CPK

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.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

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 Information (essential)

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