When to refer to rheumatology
A one-page guide for GPs and physicians: what to refer, how urgently, which tests help, and how to send a patient to the AIMS Mohali clinic.
Refer early — the window that matters
In inflammatory arthritis, outcomes are best when disease-modifying treatment starts within the first 12 weeks of symptoms. EULAR recommends that people with arthritis (joint swelling, pain or stiffness) are referred to and seen by a rheumatologist within 6 weeks of symptom onset.
- Swelling of more than one joint, or any persistent synovitis
- Involvement of the MCP or MTP joints (positive squeeze test)
- Morning stiffness of 30 minutes or more
- Raised ESR/CRP or positive RF/anti-CCP with joint symptoms — but normal tests do not exclude inflammatory arthritis
Combe B, et al. 2016 update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis 2017;76:948–59.
Who to refer, and how urgently
| Situation | Urgency |
|---|---|
| Suspected giant cell arteritis (new headache >50 years, jaw claudication, scalp tenderness, visual symptoms) | Same day. Start glucocorticoids immediately on strong suspicion (higher dose or IV methylprednisolone if visual symptoms); do not wait for biopsy or ultrasound |
| Suspected vasculitis or connective tissue disease with organ involvement (active urine sediment, rising creatinine, haemoptysis, mononeuritis) | Urgent / same day |
| Hot, swollen single joint with fever — possible septic arthritis | Emergency — aspirate before antibiotics; orthopaedics / emergency department |
| New inflammatory arthritis (criteria above) | Within 2–6 weeks |
| Suspected axial spondyloarthritis: back pain ≥3 months, onset <45, inflammatory features, or HLA-B27 / uveitis / psoriasis / IBD | Routine, but don't let it drift — average diagnostic delay is years |
| Recurrent gout despite treatment, tophi, or gout with CKD | Routine |
| Positive ANA with symptoms (rash, ulcers, Raynaud's, cytopenias, serositis) | Routine to soon, depending on features |
| Positive ANA with no symptoms | Usually no referral needed — low-titre ANA is common in healthy people |
Helpful tests to send before referral
- FBC, ESR, CRP, creatinine, LFTs, urine routine (protein/blood)
- RF and anti-CCP for suspected RA
- Uric acid for suspected gout (may be normal during an attack — repeat later)
- HLA-B27 and X-ray of the sacroiliac joints / pelvis for suspected axial SpA
- ANA only if there are features of connective tissue disease — indiscriminate ANA testing creates confusion and anxiety
- X-rays of hands and feet in suspected RA (baseline for erosions)
Before the patient is seen
- Painkillers and NSAIDs are reasonable for symptoms.
- Avoid starting long-term steroids before review where possible — they can mask the picture. If a short course is needed for severe symptoms, note the dose and dates on the referral.
- Don't start methotrexate or other DMARDs unless you are confident in the diagnosis and monitoring is in place.
- Note any infections, TB exposure, hepatitis, pregnancy plans and current medicines on the referral.
How to refer to the AIMS Mohali rheumatology OPD
The clinic runs as a walk-in OPD on Monday and Thursday, 8:00 AM to 2:00 PM, at AIMS Mohali (District Hospital, Phase 6, Mohali). Patients should register by 11:30 AM. No appointment is needed.
A short note helps: main problem and duration, joint findings, relevant results, medicines tried (with doses), and any urgent concern. Patients can use the first-visit summary tool to prepare.
For an urgent query, call +91 97509 00081.
Referring a patient?
Walk-in rheumatology OPD at AIMS Mohali — no appointment needed. A short note with recent results helps the patient get the most from the visit.
Clinic timings & location