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Peripheral Spondyloarthritis Psoriatic Arthritis and Reactive Arthritis Referral Access Criteria

Peripheral Spondyloarthritis Psoriatic Arthritis and Reactive Arthritis Referral Access Criteria

Referrers should use this page when referring patients to public adult rheumatology outpatient services for peripheral spondyloarthritis - psoriatic arthritis and reactive arthritis.
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.
  • Concerns for septic arthritis/sepsis
  • Complications of disease or therapy requiring emergency review – systemically unwell
  • Patients with acutely painful, hot, swollen joint(s) especially if febrile
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate rheumatology assessment (seen within 7 days):
  • 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 Clinician Assist WA: Acute Rheumatology Assessment (external site).
Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • Suspected psoriatic arthritis with one or more of the following:
    • Inflammatory back pain
    • Heel pain (enthesitis)
    • Uveitis
    • Dactylitis
    • Psoriasis
    • Inflammatory bowel disease
    • Positive family history of spondyloarthritis
    • HLA-B27 positive
  • Reactive arthritis
    • Pain, swelling and stiffness of joints
    • Pain and stiffness in buttocks and back
    • Pain in tendons
    • Rash on palms of hands or soles of feet
    • Pain and redness in the eyes
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 in regional or remote areas or due to financial reason).

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, severity of symptoms including:
    • Number and location of swollen, tender joints, tenosynovitis, enthesitis or dactylitis
    • Duration of early morning stiffness (greater or less than 30 minutes)
    • Whether presence of psoriasis, inflammatory bowel disease, or uveitis
  • Current medication list
  • Any known allergies
  • Details of previous treatment and outcome
  • Extra-articular, axial or systemic features
  • Details of skin conditions
  • If on a biologic Disease Modifying Anti-Rheumatic Drug (DMARD) and for PBS review, please state timeframe
Examination
  • Nil
Investigations
  • FBC
  • U&E
  • LFT
  • CRP
  • ESR
  • X-ray, or MRI / ultrasound (US) of affected joints
Highly desirable
History
  • Pain assessment – nocturnal waking, analgesic consumption, aggravating and relieving factors
  • Degree of functional impairment (e.g. impact on mobility/exercise tolerance/ADLs/ability to work/quality of life)
  • HLA-B27 result
  • Other screening previously performed including CXR, Hepatitis B, Hepatitis C, HIV, RF and anti-CCP
  • Previous rheumatology and dermatology assessments or opinions
  • If patient is pregnant or planning a pregnancy
Examination
  • Nil
Investigations
  • STI screening if applicable
  • Cancer screening if applicable
Indicative clinical urgency category

Category 1

Appointment within 30 days

  • New onset, suspected or recently diagnosed inflammatory arthritis
  • Active established inflammatory arthritis requiring escalation of management

Category 2

Appointment within 90 days

  •  Known spondylarthritis on established conventional or biologic Disease Modifying Anti-Rheumatic Drugs (DMARDs)

Category 3

Appointment within 365 days

  • No defined category 3 criteria
Exclusions
  • Nil
Useful information

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Last reviewed: 18-03-2024
wa.gov.au