Direct to an emergency department for:
- New neurological features in a patient with previously diagnosed ankylosing spondylitis
- Patients with acutely painful, hot, swollen joint(s) especially if febrile
- Suspected sepsis in a patient with previously diagnosed inflammatory back pain
- Unexplained illness or fever in a patient being treated with biologic or immunosuppressant medicines.
Criteria for referral to public hospital specialist clinic services
- Inflammatory back pain with onset of symptoms before 45 years, with more than 3 months of symptoms, with one or more of the following:
- heel pain (enthesitis)
- peripheral arthritis
- iritis or anterior uveitis
- inflammatory bowel disease
- positive family history of axial spondyloarthritis, reactive arthritis, psoriasis, inflammatory bowel disease or anterior uveitis
- previous good response to non-steroidal anti-inflammatory medicines
- raised acute phase reactants (erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) or both)
- HLA-B27 positive
- sacroiliitis shown on x-ray or MRI.
Information to be included in the referral
Information that must be provided
- Description of joints affected and onset, characteristics and duration of symptoms
- Details of all sentinel findings
- Report on x-ray or imaging that includes the sacroiliac joint
- Details of previous medical management including the course of treatment and outcome of treatment
- Full blood examination results
- Erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- Current and complete medication history (including non-prescription medicines, herbs and supplements)
- If the patient is pregnant or planning a pregnancy.
Provide if available
- Reports of previous results of x-ray or imaging of the sacroiliac joint
- Liver function tests
- Urea and electrolyte results
- How symptoms are impacting on daily activities (e.g. work, study, or carer role)
- Previous rheumatology assessments or opinions.
The Summary and referral information lists the information that should be included in a referral request.
As inflammatory back pain is chronic or progressive condition that requires ongoing specialist advice the referral should request partnership care between the patient, their general practitioner and the health service.
The referral should note if the request is for a second or subsequent opinion as requests for a second opinion will usually not be accepted.
Where appropriate and available the referral may be directed to an alternative specialist clinic or service.
Referral to a public hospital is not appropriate for