Criteria for referral

[Lclmlbls]

Does anyone know what criteria are generally used when GPs consider referring patients to a Rheumatologist?

Is referral something one should expect or only if there are other health issues or if tapering is not going well?

[Seacat30]

I think it might just be the GP/practice/regional policy? I didn't have any other issues and my GP referred me straight to Rheumatology at the very start based on her view that I had PMR.

[Jigsawlass]

I think it depends on GP surgery . Ours always refers if they are not sure . I was referred at the outset on the basis of blood tests. I see my consultant every few months. I initially paid to go private as I couldn't wait 3 months for my appointment due to the pain I was in.

[SheffieldJane]

It is quite usual for straightforward PMR to be treated and managed by our GPs. GCA/LVV, on the other hand needs the expertise of a Rheumatologist familiar with these conditions.

[rosie_jones]

If you look at the National Institute for Health and Care Excellence (NICE) information on management of PMR (see cks.nice.org.uk/topics/poly... ) it says:

Refer for specialist management if:

It is not possible to reduce corticosteroids at reasonable intervals without causing relapse.

Corticosteroids are required for more than 2 years.

The person is experiencing (or is at high risk of) adverse effects from corticosteroids.

Having said that, I agree with previous comments that it does seem to be down to individual GP's views.

[Lclmlbls in reply to rosie_jones]

Many thanks for all the replies. The information on here is invaluable.

[piglette]

Around 75% of patients with PMR never see a rheumatologist and can be managed by primary care. You would normally be referred if you have GCA, if you are under 50, if you have been taking steroids for over two years, if you have strange symptoms, if the GP has not got a clue about PMR and things like that.

[PMRpro Ambassador in reply to piglette]

In my experience, the GP not having a clue about PMR is rarely a reason to get a second opinion ...

[piglette in reply to PMRpro]

That is true. Although some of them just find it easier to dump the patient into secondary care.

[PMRpro Ambassador in reply to piglette]

When what they really need is tertiary care and a real expert.

[piglette in reply to PMRpro]

What is a real expert? Some mythical being!!

[PMRpro Ambassador in reply to piglette]

I saw one yesterday ...

[piglette in reply to PMRpro]

They are not quite extinct yet then?

[PMRpro Ambassador in reply to piglette]

Oh no - I know 3 who actually collaborate on research in PMR! Mine who is lead author on the T2T for PMR paper, Sarah Mackie and Max Yates who did his PhD on PMR ...

[PMRpro Ambassador in reply to PMRpro]

Ooops - I lied, forgot another in Gateshead ...

[Bcol]

I'm 2.75 years (approx) in my PMR journey and happily managed by my local surgery. ( actually not totally sure whether they are managing me or vica versa -either way we are both happy).

[PMRCanada]

My GP oversaw my care (PMR) for 3.5 years and agreed to do so as long as I didn’t show GCA symptoms or if I got stuck at a pred dose for months. I got stuck at 9mgs for over a year so discussed my being referred to a rheumatologist together.

I did see a rheumy shortly after diagnosis however she was unprofessional and dismissive so that only lasted 3 appointments.