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Polymyalgia Rheumatica Referral Access Criteria

Polymyalgia Rheumatica Referral Access Criteria

Referrers should use this page when referring patients to public adult rheumatology outpatient services for Polymyalgia Rheumatica.
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
  • Visual disturbance or loss in patients with confirmed/suspected Giant Cell Arteritis/Temporal Arteritis
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate rheumatology assessment (seen within 7 days):
  • Any concern for concomitant Giant Cell Arteritis/Temporal Arteritis
  • 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).
  • Muscle pain and stiffness in the upper arms, neck, buttocks and thighs on both sides of the body
  • Pain on active and passive movements of joints
  • Pain and stiffness worse in the morning (>45 minutes), and after rest such as after a long car ride or sitting too long in one position
  • Difficulty sleeping and doing daily activities due to pain and stiffness
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:
    • Whether presence of muscle pain, swelling/tenderness/synovitis
    • Duration of early morning stiffness (greater or less than 30 minutes)
    • Whether presence of headaches
    • Whether presence of amaurosis fugax
  • Current medication list
  • Any known allergies
  • Details of previous treatment and outcome
Examination
  • Nil
Investigations
  • FBC
  • U&Es
  • LFTs
  • ESR
  • CRP
Highly desirable
History
  • Other screening previously performed including CXR, HepB, HepC, HIV, bone density
Examination
  • Nil
Investigations
  • TFTs
  • CK
  • Rheumatic Factor
  • Anti-CCP
  • Serum protein electrophoresis
  • Cancer screening information if applicable
Indicative triage category

Category 1

Appointment within 30 days

  • No defined category 1 criteria

Category 2

Appointment within 90 days
  • New onset polymyalgia rheumatica with typical shoulder/hip girdle features with raised ESR/CRP
  • Known and treated PMR established on steroids requiring further escalation of management

Category 3

Appointment within 365 days

  • No defined category 3 criteria
Exclusions
  • Patients aged <45 years. The incidence of Polymyalgia Rheumatica in this patient cohort is rare.
Useful information
Last reviewed: 18-03-2024
wa.gov.au