Referral Criteria

We require specific information to accurately triage referrals. Please ensure your referral includes the below information. Incomplete referrals will be returned to the referring provider.

Inflammatory Arthritis

  1. Reason & urgency (1 line)
  2. Symptom summary
    • Onset
    • Joints involved
    • Morning stiffness (minutes)
  3. Physical exam noting any joint swelling
  4. CRP
  5. RF
  6. +/- anti-CCP (if covered by MSP)
  7. X-rays of affected joints

Ankylosing Spondylitis

  1. Inflammatory back pain (see below) and
  2. Onset before age 45
  3. Relevant associated diseases
    • Uveitis
    • Crohn’s disease or ulcerative colitis
    • Psoriasis
    • Family history of ankylosing spondylitis
  4. HLA B27
  5. CRP
  6. X-ray of the sacroiliac joints
  7. +/- MRI of the sacroiliac joints

Features of inflammatory back pain:

  • Morning stiffness over 1 hour
  • Nocturnal awakening due to stiffness (not pain)
  • Alternating buttock pain
  • Improves with NSAIDs
  • Improves with activity

Lupus

A positive ANA can be seen in healthy people who do not have lupus or another connective tissue disease. It is a non-specific test. An ANA should not be ordered unless there is a high clinical suspicion of connective tissue disease.

Referrals are accepted if there are specific signs or symptoms of connective tissue disease and the appropriate lab work has been completed. Incomplete referrals will be returned.

  • Specific signs/symptoms
    • Photosensitive rash (differentiate from rosacea)
    • Joint swelling on exam
    • Pleuritis or pericarditis
    • Oral ulcers
    • Significant dry eyes and/or dry mouth
    • Alopecia
    • Raynaud’s phenomenon +/- digital pits or ulcers
    • Skin thickening
    • Proximal muscle weakness on exam
    • Recurrent miscarriages, venous thromboembolism or stroke
  • Labs
    • CBC + diff, Cr, eGFR, ALT, AST
    • ANA, ENA, dsDNA, C3, C4
    • CRP, CK
    • Urinalysis, urine ACR