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Connective Tissue Disease Referral Access Criteria

Connective Tissue Disease Referral Access Criteria

Referrers should use this page when referring patients to public adult rheumatology outpatient services for Connective Tissue Diseases including Systemic Lupus Erythematosus (SLE), Scleroderma, Mixed Connective Tissue Disease (MCTD), Sjogren's Syndrome and undifferentiated or overlap Connective Tissue Diseases (CTD).
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.
  • Complications of disease or therapy requiring emergency review – systemically unwell
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate rheumatology assessment (seen within 7 days):
  • 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).
Presenting issues
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
Systemic Lupus Erythematosus (SLE)
  • Joint pain and/or swelling, especially in the hands or feet
  • Photosensitive skin rash
  • Nasal or oral ulcers
  • Anaemia

Scleroderma

  • Thickening and hardening of the skin, particularly on the fingers, arms, and face
  • Raynaud’s phenomenon
  • Calcium deposits (small, white, chalky lumps) under the skin
  • Stiffness and pain in the muscles and/or joints
  • Gastroesophageal reflux
  • Diarrhoea or constipation
  • Dyspnoea or reduced exercise tolerance

Mixed Connective Tissue Disease (MCTD)

  • Dactylitis
  • Raynaud’s phenomenon
  • Fatigue and malaise
  • Myalgia and arthralgia

Sjogren’s Syndrome

  • Keratoconjunctivitis sicca
  • Xerostomia
  • Swollen lymph nodes around face and neck
Mandatory information
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.
History
  • Relevant history, onset, duration and severity of symptoms including:
    • Joints/muscles involved (swelling, pain, morning stiffness, number of joints involved and location)
    • Whether presence of ulcers, Raynaud’s, alopecia, skin rashes or ulceration, dysphagia or GORD, sicca symptoms
    • Whether presence of swelling/tenderness/synovitis
  • Current medication list
  • Any known allergies
  • Details of previous treatment and outcome
  • Extra-articular manifestations including kidney, lungs, cardiac, neurological
Examination
  • Nil
Investigations
  • FBC
  • U&Es
  • LFTs
  • CRP
  • ESR
  • Rheumatoid Factor or anti-CCP
  • ANA
  • ENA
  • dsDNA
  • C3, C4
  • CK
  • Urinalysis for MCS, casts and protein
Highly desirable
History
  •  Advise if presence of sicca symptoms
Examination
  • Nil
Investigations
  • XR or MRI/CT of affected joints
  • Skin biopsy histology
  • Cancer screening if applicable
Indicative triage category

Category 1

Appointment within 30 days

  • Acute or active organ threatening Connective Tissue Disease
  • Connective Tissue Disease associated myositis

Category 2

Appointment within 90 days

  • Connective Tissue Disease on established treatment and stable
  • Likely Connective Tissue Disease requiring assessment and management

Category 3

Appointment within 365 days

  • Connective Tissue Disease for exclusion with minimal symptoms
Exclusions
  • Fibromyalgia
  • Chronic pain including chronic mechanical back pain due to degenerative joint disease
  • Chronic fatigue syndrome
    • Refer to general medicine/pain specialist
  • Ehlers-Danlos syndrome or hypermobility spectrum disorder
    • Please refer to relevant specialty whose symptoms predominate (i.e. pain specialist/orthopaedics/gastroenterology/vascular surgery, depending on symptoms)
    • See HealthPathways: Ehlers-Danlos Syndromes (external site)
Useful information
  • Nil
Last reviewed: 18-03-2024
wa.gov.au