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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

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

Referral requirements

A referral may be rejected without the following information.

Essential referral information

History and examination

  • Number/location of swollen tender joints
  • Time since onset of joint symptoms
  • Duration of early morning stiffness
  • Extra-articular features (lungs/nodules)

Investigations

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

Additional referral information (useful for processing the referral)

  • X-rays of hands, wrists, feet and other affected joints
  • CXR and Hepatitis B and C serology (in anticipation of DMARDs)

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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