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Referral & assessment
When to Refer to Rheumatology
Which presentations need urgent, soon or routine rheumatology input.
Video lesson
Key points
Urgent same-day or next-day: suspected giant cell arteritis with visual or jaw symptoms, suspected vasculitis with kidney or lung involvement, new myositis with weakness or swallowing trouble, and a hot swollen joint where infection is possible (also involve orthopedics or ED). Within 2 to 4 weeks: new inflammatory polyarthritis with morning stiffness over 30 minutes, positive anti-CCP with synovitis, or suspected lupus with organ involvement.
Practical approach
Include history, joint count, ESR or CRP, CBC, CMP, urinalysis, RF, anti-CCP, and ANA only when connective tissue disease is suspected. X-rays of hands and feet help in suspected RA. Avoid starting steroids before seeing synovitis documented unless the presentation is urgent.
Pearls
Early RA has a window of opportunity: outcomes are best when DMARDs start within 3 months of symptom onset. A low-titer positive ANA without symptoms rarely needs referral.
At a glance
Category
Referral & assessment
Reviewed by Farhan Tahir, MD, FACR
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