Acute hot joints may be infected, as here. Delay has serious consequences | Appointments | Back pain referrals - important update | Pre-appointment tests |
| Department protocols and teaching aids | National Guidelines | Images with messages |
At present we are operating a hybrid "Choose and Book" system so that you may use C&B to generate a unique booking number, but will still have to send a letter to Queen Mary's for processing manually if the request falls outside the "routine appointment" procedure. You may now specifiy a consultant but the system is cumbersome and if you wish to specify a particular consultant you may prefer to make a "manual" referral.
Should you have any query about problems of referral please contact one of the consultants directly by phone or email. we are anxious that patient safety is not compromised by reliance on a system that may allow delays. Waiting lists are presently very short. We continue to see referrals of all types of rheumatology problems and the PCT have made it clear to us that GPs may refer wherever they and their patients wish, and there is no obligation to refer to alternative community services.
You will note from the system that a few exclusions are specified.
Written referrals will be prioritised by the consultants as urgent, soon or routine. The Department sees all patients at present within the 13 week target; however, if patients have any special reason why they do not wish to be seen within this period (for example, if they are on an extended holiday) they may do so. Patients with suspected RA will be seen within 6 weeks.
Acute hot joints may be infected, as here. Delay has serious consequences
Acute hot joints will be seen if possible within 24 hours. Please telephone the appropriate secretary. Both consultants are happy to discuss urgent or difficult cases, or treatment issues, by phone.
Dr Bamji sees children with arthritis. However any child with possible joint infection should be referred as an emergency either to the Orthopaedic Department or through A&E.
All back pain referrals now go through our triage service, which is run by two specialist physiotherapists. Referrals to the service does not mean that all patients will be treated in physiotherapy. If the referral information indicates that they should first be seen by a consultant, an appropriate appointment will be generated. The back pain referral form can be accessed here. Please familiarise yourself with the protocol before completing it. Due to security concerns it cannot at present be submitted electronically; instructions for submission are on the form. The form can be saved and sent as an attachment to a Choose & Book referral.
We have found in recent months that many patients expect to have an MRI scan. This is not indicated except for red flag referrals or persistent sciatica symptoms (ie pain, numbness and paraesthesiae in a root distribution). Our expert triage therapists will, in discussion with a rheumatologist, decide if a scan is needed and you may be reassured that time is not lost in this process; the quickest scan took only two hours to be completed from the patient's arrival in the physiotherapy department.
Please click here for details.
It may save time for patients if some pre-referral tests have been done in general practice. However there are some tests which are not helpful and some which can confuse; thus rheumatoid factor may be elevated slightly and is not significant if the titre is below 1:16 (25IU) and antinuclear antibodies are quite commonly weakly positive without significance. HLA B-27 is positive in 95% of patients with ankylosing spondylitis, but also in 8% of the normal population. A negative test is thus statistically significant at the 5% level, but a positive test is not.
The context of these tests is also important.
Is this gout? No - it's acute pyrophosphate arthitis
Serum urate is likewise not helpful to make a diagnosis of gout as it may be normal in gout and high in normal people. Gout can only be definitely confirmed by finding uric acid crystals in a joint aspirate.
This X-ray shows extensive bony bridging due to Forestier's disease. The patient was asymptomatic.
X-rays are largely unhelpful; osteoporosis cannot be diagnosed from them, and degenerative changes are normal after the age of 55. The mismatch beteen symptoms and radiological signs is substantial.
The acute hot joint (This protocol is designed for A&E use but may direct your thinking; see a national version below))
Examination of the painful shoulder
Vaccinations in immunocompromised patients (BSR guidelines)
Osteoporosis treatment (Greenwich/Bexley guidelines)
"Mouse Arm" : dystonia from computer use, and tips on how to help
Royal College of Physicians "Working for Patients" - Rheumatology
BSR/BHPR guideline for the management of RA (the first 2 years)
Management of the hot swollen joint in adults (joint BSR, BHPR, BOA, RCGP & BSAC guideline)
Raynaus and Scleroderma: an up to date guide
TNF-alpha prescribing guidelines:
All three conditions are now covered by NICE guidelines and we are prescribing biologics for all of the above conditions