Rheumatology Consult 🦴

📋 Key Info to Have Ready

  • Patient identifiers: name, DOB, location, MRN
  • Admission details: may not be rheumatology-related
  • Reason for consult: joint pain, swelling, stiffness, rash, systemic symptoms (e.g. fatigue, fever, weight loss)
  • Duration and pattern of symptoms: acute vs. chronic, mono/oligo/polyarthritis, symmetry, morning stiffness
  • Past rheumatological or autoimmune diagnoses (e.g. RA, SLE, PsA, gout, vasculitis)
  • Relevant medications: steroids, DMARDs, biologics, NSAIDs
  • Any recent infections or trauma
  • Relevant imaging: XRays, US, MRI of affected joints if available
  • Recent bloods: FBC, U&E, LFTs, CRP, ESR, urate, ANA, RF, anti-CCP, ANCA if relevant
  • Synovial fluid analysis if available
  • What you're asking rheumatology to help with (e.g. ?inflammatory arthritis, ?flare, advice on steroids or DMARDs)

🔍 Investigations to Know

  • FBC, U&E, LFTs, CRP, ESR
  • Immunology: ANA, RF, anti-CCP, ENA, dsDNA, ANCA (as relevant)
  • Urate level if ?gout
  • Synovial fluid: WCC, crystals, gram stain, culture
  • Relevant joint imaging: X-ray, US, MRI

📞 Example Script

  • Hi, this is [Your Name], the intern on [Ward/Team]. I'm calling to refer a [Age] year-old [M/F] with [reason for admission], now with concern for [e.g. inflammatory arthritis / lupus flare / ?gout].
  • They have a background of [e.g. RA diagnosed 3 years ago, currently on methotrexate], presenting with [e.g. 3-day history of swollen, painful MCP joints, morning stiffness >1 hour].
  • CRP is [value], ESR [value], ANA is [positive/negative], urate is [value], and X-rays show [findings if relevant].
  • We're hoping for your advice on diagnosis and management — would you be able to review? I can send through the bloods and imaging if needed.

📝 Tips

  • Be clear whether this is a new diagnosis or a known patient with a flare
  • Clarify any immunosuppression, especially steroid use and recent infection
  • If requesting urgent input (e.g. ?septic joint), flag this early and ensure basic investigations are already underway
  • Knowing the pattern of joint involvement and systemic features helps narrow the differential