This page is intended for use by clinicians at Queen Elizabeth Hospital Birmingham as a guideline for referring patients to Rheumatology.
How to refer
If a patient needs further support from Rheumatology, please refer via the following methods:
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
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
Early Inflammatory Arthritis (EIA)
Early Inflammatory Arthritis (EIA) is an umbrella term used to describe new onset unexplained inflammatory joint disease, typically characterised by swelling, stiffness, and pain.
Most new EIA patients can be discharged with appropriate first-line management (see below) and referred directly to rheumatology via PICS. New EIA referrals are seen urgently, usually within three weeks.
Who to refer
Please refer patients with suspected persistent joint inflammation of 4 weeks or more AND any one of the following:
- swelling of three or more joints
- swelling of the small joints of hands or feet
- positive MCPJ or MTPJ “squeeze test” (i.e. pain produced by squeezing across the metacarpophalangeal/metatarsophalangeal joints)
- early morning joint stiffness (EMS) >30mins
What to include in the referral
Specify ‘Early Inflammatory Arthritis referral’ in the body of the referral if this applies to ensure your referral is triaged appropriately. If you are uncertain, please discuss with rheumatology on-call.
Include the following minimum dataset in each referral:
- approximate date of symptom onset
- key features of inflammatory arthritis
- joint swelling for four weeks or more*, but less than six months (*refer to general rheumatology clinic if longer history)
- swelling in three or more joints
- swelling in the small joints of the hands or feet
- raised inflammatory markers
- early morning stiffness >30 mins
- additional features to raise suspicion of inflammatory arthritis
- constitutional symptoms e.g., weight loss, anorexia or fatigue
- other features related to arthritis, e.g. rash, painful red eyes, inflammatory bowel disease
- family history of autoimmune disease
- family history of psoriasis
Investigations to be sent before discharge
FBC, U&E, LFT, CRP, Rheumatoid Factor (RF), anti CCP antibody.
(Please note the diagnosis of early inflammatory arthritis is not excluded by normal inflammatory markers and/or a negative rheumatoid factor/anti-CCP and/or normal x-rays.)
Treatment
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.
Who to admit
Inpatient admission may be considered in some circumstances e.g.:
- severe inflammation, particularly if accompanied by fever, intractable pain or inability to self-care or perform ADLs
- infection requiring inpatient investigation/management
- systemic complications related to inflammatory arthritis e.g. lung/renal disease, severe vasculitis etc.
- significant functional impairment such that the patient is unsafe to be discharged
Other conditions
Giant cell arteritis
If you suspect giant cell arteritis (GCA), please ensure:
- Bloods (FBC, U+Es, CRP and ESR) are completed
- Calculate and document the Southend GCA Probability Score
- Imaging – there is no need to routinely book a US 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 suspecting GCA
Gout
Please see the guidelines in the downloads section.
Last reviewed: 04 August 2025