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Myositis Referral Access Criteria

Myositis Referral Access Criteria

Referrers should use this page when referring patients to public adult rheumatology outpatient services for Myositis - Polymyositis, Dermatomyositis, Connective Tissue Disease Associated Myositis and Undifferentiated Inflammatory Myositis.
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 emergent 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 (inflammatory 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).
  • New onset muscle weakness resulting in functional decline (e.g. unable to stand from chair)
  • Pain
  • Fatigue
  • Dysphagia
  • Dyspnoea
  • Presence of respiratory symptoms in context of myositis
  • Fevers
  • Weight loss
  • Red/purple rash or other skin changes on eyelids, elbows, knees, chest, back, fingers and knuckles
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
    • Whether muscle weakness and/or pain
    • Whether presence of swelling/tenderness/synovitis
  • Current medication list
  • Any known allergies
  • Details of previous treatment and outcome
Examination
  • Nil
Investigations
  • FBC
  • U&Es
  • LFTs
  • ESR
  • CRP
  • CK
Highly desirable
History
  • Extent of skin, joint, respiratory or other symptoms
  • History of statin use
Examination
  • Nil
Investigations
  • Muscle or skin biopsy histology
  • ANA
  • ENA
  • dsDNA
  • C3, C4
  • Myositis panel
  • CT chest
  • Other previous MRI, EMG
  • Cancer screening if applicable
Indicative triage category

Category 1

Appointment within 30 days

  • New onset and/or active myositis including polymyositis, dermatomyositis, Connective Tissue Disease associated myositis and undifferentiated inflammatory myositis 

Category 2

Appointment within 90 days

  • Inflammatory myositis on established treatment and stable
  • Possible myositis with weakness for further review

Category 3

Appointment within 365 days

  • No defined category 3 criteria 
Exclusions
  • Focal muscle weakness
  • Fasciculations
Useful information
  • Nil
Last reviewed: 18-03-2024
wa.gov.au