For Practitioners

  1. Purpose and scope
  2. Who This Clinic Sees
  3. Who We Do Not See
  4. How Triage Works
  5. Triage Categories and Targets
  6. Minimum Referral Set
  7. Common Reasons for Redirection
  8. When to Re-Refer
  9. Phone Advice Line

Purpose and scope

Our goal is to accurately triage and book the right patient into the right slot, with minimal back-and-forth.

This guidance applies to adult patients. Pediatric cases should be referred to pediatric rheumatology.

Who This Clinic Sees

  • Rheumatoid arthritis
  • Seronegative spondyloarthritis
    • Psoriatic arthritis
    • Ankylosing spondylitis
    • Inflammatory bowel disease related arthritis
    • Reactive arthritis
  • Polymyalgia rheumatica
  • Crystal arthritis (gout, pseudogout)
  • Connective tissue disease
    • Lupus
    • Sjogren’s disease
    • Scleroderma
    • Dermatomyositis
    • Mixed connective tissue disease
    • Undifferentiated connective tissue disease
  • Vasculitis
    • ANCA vasculitis
    • Giant cell arteritis
    • Behcet’s disease
    • Other vasculitidies (e.g., polyarteritis nodosa, Takaysu arteritis, etc.)
  • Sarcoidosis
  • IgG4 related disease
  • Autoinflammatory disease (e.g. Adult Onset Still’s disease, Familial Mediterranean Fever)

If unsure, you are welcome to refer — triage decisions are based on the information available at the time.

Who We Do Not See

  • Osteoarthritis
  • Mechanical or soft-tissue pain syndromes (e.g., fibromyalgia)
  • Chronic pain
  • Chronic fatigue
  • Osteoporosis
  • Heritable connective tissue disease (e.g., Ehler’s Danlos, Marfan)
  • Idiopathic uveitis
  • Idiopathic pericarditis
  • Unexplained elevated CRP
  • Positive “rheumatic screen” without signs or symptoms of rheumatic disease and without clear indication for ordering blood work

How Triage Works

Triage is not a diagnosis. It is a process used to:

  • Match urgency to clinical features

  • Ensure timely access for evolving rheumatic disease

  • Direct patients to the most appropriate pathway

Referrals may result in:

  • Acceptance and booking
  • Request for additional information
  • Redirection to another pathway, with clear re-referral criteria if symptoms evolve

All three outcomes are expected parts of the triage process.

Triage Categories and Targets

Urgent (aim less than 1 month)

  • Giant cell arteritis
  • Organ-threatening lupus, dermatomyositis or scleroderma
  • Organ-threatening vasculitis
  • Severe inflammatory arthritis
    • Objective joint swelling on exam
    • Rapid functional decline
    • Markedly elevated CRP
    • +/- positive RF, CCP

If your patient has a medical emergency, please call the office at 250 824 0266 or have the patient go directly to the emergency room. Our faxes are not monitored during office closures, which can result in delays in care.

Semi-urgent (aim 3-4 months)

  • New onset inflammatory arthritis
    • Joint swelling confirmed on practitioner’s exam
    • Morning stiffness over 1 hour
    • Elevated CRP
    • +/- positive RF and/or CCP
  • Ankylosing spondylitis
  • Non-organ threatening connective tissue disease
    • Lupus
    • Scleroderma
    • Dermatomyositis
  • Polymyalgia rheumatica
  • Sarcoidosis
  • IgG4 related disease

Routine (aim 6-12 months)

  • Transfer of care from another in-province rheumatologist
  • Sjogren’s disease
  • Crystal arthritis (gout, pseudogout)

Do not delay referral to obtain investigations — attach what you already have.

Minimum Referral Set

Including the items below allows accurate triage and reduces delays.

  • Reason & urgency (1 line)
  • Symptom summary
    • Onset
    • Joints involved
    • Morning stiffness (minutes)
    • Functional impact
  • Physical exam
    • Joints that appear swollen or tender
  • Labs
    • CRP, RF, +/- anti-CCP
    • CBC + diff, Cr, eGFR, ALT, AST
    • +/- ANA, ENA, dsDNA, C3, C4, CK, urinalysis, urine ACR if referring for connective tissue disease
    • +/- ANCA, anti-GBM, cryoglobulins if referring for vasculitis
  • Treatments tried
    • NSAIDs and/or steroids (dose, dates, response)
  • Past Medical History, Medications and Allergies

Common Reasons for Redirection

Referrals may be redirected when:

  • There is no objective joint swelling
  • Clinical pattern is non-inflammatory
  • Symptoms fit non-rheumatic disease, e.g., osteoarthritis or fibromyalgia
  • Morning stiffness is brief (less than 60 minutes)
  • Inflammatory markers are normal
  • Serology is normal

Redirection is intended to:

  • Keep the patient moving
  • Avoid unnecessary waits
  • Support reassessment if symptoms evolve

When to Re-Refer

Please re-refer using the inflammatory arthritis minimum set if new or evolving features develop:

  • Persistent and objective joint swelling
  • Morning stiffness over 60 minutes
  • Rising CRP or ESR
  • Positive RF or CCP

Evolving inflammatory patterns are prioritized.

Advice & Support

Phone Advice Line

If you are not sure whether your patient requires a consultation or you are looking for phone advice, a rheumatologist can be reached via Rapid Access Consultative Expertise (RACE)

Number: 604 696 2131 or use the RACEapp+

Hours: Monday to Friday, 0900 to 1700

https://www.raceconnect.ca/