Ankylosing Spondylitis Referral Access Criteria
Ankylosing Spondylitis Referral Access Criteria
| Referrers should use this page when referring patients to public adult rheumatology outpatient services for axial spondyloarthritis/ankylosing spondylitis. |
| Emergency referral |
 If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region. |
- New neurological features in a patient with previously diagnosed ankylosing spondylitis
- Patients with acutely painful, hot, swollen joint(s) especially if febrile
- Concerns for septic arthritis/sepsis
- Unexplained illness or fever in a patient being treated with biologic or immunosuppressant medicines
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| Immediate referral |
 Immediately contact on-call registrar or service to arrange immediate rheumatology assessment (seen within 7 days):
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- Acute, otherwise unexplained, monoarthritis
- Acute, otherwise unexplained, polyarthritis
- Patients with a previously diagnosed condition who are acutely unwell e.g.:
- Chronic idiopathic arthritis (rheumatoid arthritis, psoriatic arthritis, axial spondylitis)
- System lupus erythematosus, myopathies, scleroderma
- Necrotising vasculitis (anti-neutrophilic cytoplasmic autoantibody-associated vasculitis)
- Patients on biological agents
To contact the relevant service, see HealthPathways: Acute Rheumatology Assessment (external site)
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| Presenting issues |
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
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- Inflammatory back pain with onset of symptoms before age 45 years, with more than 3 months of symptoms with one or more of the following:
- Heel pain (enthesitis)
- Peripheral arthritis
- Dactylitis
- Iritis or anterior uveitis
- Psoriasis
- Inflammatory bowel disease
- Positive family history of axial spondyloarthritis, reactive arthritis, psoriasis, inflammatory bowel disease or anterior uveitis
- Previous good response to non-steroidal anti-inflammatory medicines
- Raised acute phase reactants (erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) or both)
- HLA-B27 positive
- Sacroiliitis on XR or MRI
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| Mandatory information |
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Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test due to financial reasons or geographical location).
This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
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| History |
- Relevant history, onset, duration and severity of symptoms including:
- Features of inflammatory back pain e.g. morning stiffness, young age, nocturnal pain, response to NSAIDs
- Whether presence of psoriasis, inflammatory bowel disease, or uveitis
- Current medication list
- Any known allergies
- Details of previous treatment and outcome
- Family history of spondyloarthritis (e.g. psoriasis, inflammatory bowel disease, or uveitis)
- If on a biologic Disease Modifying Anti-Rheumatic Drug (DMARD) and for PBS review, please state timeframe
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| Examination |
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| Investigations |
- FBC
- U&Es
- LFTs
- CRP
- ESR
- XR or MRI/CT of sacroiliac joints
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| Highly desirable |
| History |
- HLA-B27 result
- Impact on ADLs
- Previous rheumatology (adult) assessments or opinions
- If patient is pregnant or planning a pregnancy
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| Examination |
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| Investigations |
- MRI results of affected joints
- Cancer screening if applicable
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| Indicative triage category |
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Category 1
Appointment within 30 days
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No defined category 1 criteria
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Category 2
Appointment within 90 days
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- Suspected ankylosing spondylitis/axial spondyloarthritis with or without peripheral symptoms and/or extra-articular manifestations
- Known ankylosing spondylitis/axial spondyloarthritis established on treatment including biologic DMARDs
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Category 3
Appointment within 365 days
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- No defined category 3 criteria
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| Exclusions |
- Chronic pain including chronic mechanical back pain due to degenerative joint disease
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Last reviewed: 18-03-2024