Medical same day emergency care (MSDEC) referrals to Rheumatology

Emergency

If you feel that the patient has a rheumatological emergency:

• Contact the rheumatology SpR on call via switchboard between:
  • Monday to Friday, 09:00-17:00
  • Saturday to Sunday, 09:00-12:00
• Outside of the above hours, refer to the on call medical registrar and make a PICS referral to Rheumatology who will review the referral in normal working hours

Urgent referrals

Patients under the care of the Rheumatology team at QEHB have access to specialist nurses during normal working hours via the patient helpline and a biologic support lines below. Consider if the patient query can be resolved via these channels without admission or inpatient rheumatology review.

• 0121 371 6827
• 0121 371 6829

Monday to Sunday (all hours)

• Refer all patients via PICS (Requests > Rheumatology referral QEHB)
• Contact Rheumatology on call via Switchboard to discuss the referral between the following times:
  • Monday to Friday, 09:00-17:00
  • Saturday to Sunday, 09:00-12:00
• Outside of the above hours, the referral will be triaged by the Rheumatology team and the patient will be contacted appropriately as an outpatient
• Do not bring the patient back to MSDEC for an inpatient Rheumatology review
• Inform the patient to email Rheumatology if they have not heard from them within seven days
• Ensure the contact details are correct (address and telephone number) and include a telephone number in the referral
• Who to refer? See the British Society for Rheumatology (BSR) adult rheumatology referral guidance regarding symptoms and conditions which warrant referral to Rheumatology

• RheumatologyMedSecQueries@uhb.nhs.uk

Routine referrals

If patient is known to the Rheumatology team, please email their known consultant and secretary team to arrange routine follow up.

• RheumatologyMedSecQueries@uhb.nhs.uk

Sub-speciality referrals and investigations

Giant cell arteritis (GCA)

If you suspect GCA, please send appropriate investigations as per the GCA Diagnosis and Management guidelines (please note the link is only accessible via a Trust PC or VPN).

If the patient presents:

• within rheumatology team working hours, speak to team as soon as possible to arrange review if possible
• outside of rheumatology working hours:
  • Calculate and document the Southend GCA Probability Score
  • Imaging: there is no need to routinely book a ultrasound scan or temporal biopsies, the Rheumatology team will arrange these
  • If you feel the patient can be discharged, please prescribe 40mg Prednisolone OD with PPI cover for 14 days
  • If there is visual symptoms/loss, start high dose IV steroids and arrange Ophthalmology review as well as Rheumatology

• Giant Cell Arteritis Diagnosis and Management

Early Inflammatory Arthritis (EIA)

EIA is an umbrella term used to describe new onset unexplained inflammatory joint disease, typically characterised by swelling, stiffness, and pain.

Delay in the diagnosis and treatment of inflammatory arthritis has long term consequences in terms of joint damage and quality of life. Therefore, urgent recognition and referral are vital.

Please refer patients with suspected persistent joint inflammation of four weeks or more and any one of the following:

1. Swelling of three or more joints
2. Swelling of the small joints of hands or feet
3. Positive MCPJ or MTPJ “squeeze test” (i.e. pain produced by squeezing across the metacarpophalangeal/metatarsophalangeal joints)
4. Early morning joint stiffness (EMS) > 30mins

Most new EIA patients can be discharged with appropriate first-line management and referred directly to rheumatology via PICS. Rheumatology consultants will triage the referrals and arrange outpatient appointments.

Please specify ‘Early Inflammatory Arthritis referral’ if this applies to ensure your referral is triaged appropriately. If EIA criteria are not met, please specify ‘General Rheumatology Clinic referral’. If you are uncertain, please discuss with rheumatology on-call.

Prior to discharge, please ensure bloods for FBC, U&E, LFT, CRP, Rheumatoid factor (RF), anti CCP antibody have been sent. Please document a thorough history, including constitutional symptoms and FHx, as well as a thorough examination.

Initial management in symptomatic. Simple analgesics like regular paracetamol and co-codamol are appropriate. If safe to do so, consider a 21 day course of NSAID + PPI cover if needed. Do not start glucocorticoids unless agreed by the rheumatology on-call.