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Spondyloarthopathies

Red flags

Consider immediate referral to relevant service if

  • Red flags for back pain or septic arthritis
  • Features of anterior uveitis

Consider routine referral for

  • Most spondyloarthropathies
  • Established PsA/AS 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.

For example:

  • Ankylosing Spondylitis (AS)
  • Psoriatic Arthritis (PsA)
  • Reactive Arthritis (ReA)

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

  • NSAID + paracetamol +/- codeine as appropriate
  • Treat associated extra-articular conditions where possible
  • Consider role for physio/OT/hydrotherapy

Referral requirements

A referral may be rejected without the following information.

Essential referral information

History

  • Time since onset of joint symptoms
  • Duration of early morning stiffness
  • Features of inflammatory back pain
    • Onset <45 years
    • > 3 months – possibly intermittent
    • early morning stiffness> 1 hour
    • improves with exercise
    • insidious onset
  • Extra-articular features (skin / nails / IBD / eyes)

Examination

  • Number / location of swollen tender joints
  • Tenderness over SI joints
  • Extra-articular features (skin / nails / IBD / eyes)

Investigations

  • FBC
  • E/LFT
  • ESR / CRP
  • Extra-articular symptom history

Additional referral information (useful for processing the referral)

  • HLA B27
  • Reactive arthritis serology +/- GU microbiology
  • X-rays – lumbar spine and SIJ (AS)
  • X-rays – affected joints (psoriatic)

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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