Referral to emergency
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- acute inflammatory monoarthritis
- suspected systemic juvenile idiopathic arthritis which may present with symptoms of fever, salmon pink rash +/- arthritis.
- unexplained illness or fever in a patient being treated with biologic or immunosuppressant medicines
Please contact the on-call registrar to discuss your concerns prior to referral.
For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.
Women's and Children's Health Network
- Women’s and Children’s Hospital (08) 8161 7000
Category 1 (appointment clinically indicated within 30 days)
- suspected systemic juvenile idiopathic arthritis
- patients with severe polyarthritis with high inflammatory burden evidenced by multiple active joint count or high C-reactive protein / erythrocyte sedimentation rate, or with significant functional limitation.
- chronic inflammatory arthritis with inadequate symptom management
Category 2 (appointment clinically indicated within 90 days)
- nil
Category 3 (appointment clinically indicated within 365 days)
- nil
For more on outpatient referrals, see the general referral information.
Essential referral information
Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
- identifies as Aboriginal and/or Torres Strait Islander
- identify within your referral if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf
- interpreter required
- history of presenting complaint:
- duration and frequency of symptoms
- symptoms such as rash, fever, growth abnormalities, functional decline, developmental regression, vision impairment, psoriasis, early morning stiffness
- family history of inflammatory joint disease
- treatments used/sought so far including response to nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy or any other treatments
- examination:
- effusion/swelling
- reduced range of movement
- muscle atrophy
- limp
Additional information to assist triage categorisation
- relevant diagnostic/imaging reports including location of company and accession number if available.
- any blood test results if available
Clinical management advice
- consider non-steroidal anti-inflammatory drugs for symptom relief unless contraindicated
- generally, no other specific management is required prior to assessment
- Blood tests are generally not helpful in excluding a diagnosis of juvenile idiopathic arthritis (JIA), as 50% of JIA patients are antinuclear antibody (ANA) negative, >90% are rheumatoid factor negative, and inflammatory markers are frequently normal. Therefore, if the clinical history and examination findings are suggestive of JIA, prompt referral to paediatric rheumatology is warranted.
- For flares of disease in a patient already known to the rheumatology service, families will have contact with the rheumatology nurse in order to bring forward appointments or escalate therapy. These patients do not require a re-referral to rheumatology services.
Clinical resources
- The Royal Children's Hospital Melbourne - Information about rheumatological conditions
- The Australian Rheumatology Association - ARA