Arthritis and musculoskeletal pain are among the most common chief complaints in primary care clinics. MaineGeneral rheumatologists are available to help providers diagnose and treat patients with inflammatory arthritis, systemic autoimmune connective tissue diseases and vasculitis, musculoskeletal pain, soft tissue rheumatism, and unexplained systemic symptoms and findings. Early diagnosis and treatment have been shown to improve long-term outcomes in many of these conditions, so these general referral guidelines are intended to improve the efficiency of the consultative process and to assure that urgent consultations are appropriately prioritized.
Appropriate pre-referral laboratory/imaging should be based on the clinician’s thorough history and physical examination and depends upon the nature of the patient’s problem(s). Most referred patients should have a recent CBC, CMP, urinalysis, and both ESR and CRP. Beyond these basic studies, additional initial laboratory testing should be considered based upon the diagnosis under consideration. As examples:
In addition, we have the following recommendations on appropriate pre-consultation lab/imaging ordering:
If you have specific questions regarding what to order prior to referral, please call the Rheumatology clinic at 207-621-9580.
Certain patients require urgent/emergent consultation and may require immediate therapeutic or diagnostic interventions. Please call rheumatology to discuss appropriate immediate care. Urgent/emergent consultation may be necessary for the following:
When possible, avoid high dose corticosteroids (e.g. prednisone, Medrol dosepak, etc.) therapy prior to consultation, unless discussed with a rheumatologist.
Ideal coordinated care requires teamwork between primary care clinicians and specialists. Rheumatologists will usually continue to follow patients with inflammatory conditions and will assume responsibility for primary management of these rheumatologic problems. Primary care clinicians play a critical role in assuring that co-morbidities are assertively managed and in assuring that necessary preventive health interventions (e.g. immunizations and surveillance screenings) are accomplished. Patients who do not require on-going rheumatology follow-up (e.g. fibromyalgia, low back pain, chronic pain syndromes) will be referred back to their primary care clinicians with advice and recommendations for the subsequent care of their musculoskeletal symptoms.