Reasons For Referral


Your child should meet with a paediatric rheumatologist if the child has one or more of the following symptoms or complaints

  • Prolonged fever with no specific cause found
  • Pain and swelling of the joints with early morning stiffness i.e. arthritis
  • Back pain with alternating buttock pain and difficulty in moving in the morning i.e. inflammatory low back pain.
  • Combination of several complaints: Red rashes on the face or sun exposed parts of the body, blue discolouration of the fingers on cold exposure, skin thickness and stiffness, hair fall, oral ulcers, protein and blood leaking from the kidneys, swollen joints, fluid accumulation in the lungs or heart lining. Thus multisystem disorders in one  patient is likely to be a rheumatologic disease, broadly called connective tissue disease
  • Features that suggest blood vessel inflammation such as: high grade fever, red eyes, red mouth, skin rashes and later skin peeling in young children. Combination of nodules in lungs, blood and protein in the urine, blood spots on the skin or hearing or eye problems. These diseases are called vasculitis i.e. inflammation of the blood vessels.
  • Unexplained aches and pains, low platelets, haemolytic anemia, loss of limb function etc.

Guidelines for doctors for referral to a paediatric rheumatologist


(As detailed by the American College of Rheumatology)

1. Diagnostic Evaluation of Patients with Unclear Diagnose

  • Prolonged fever
  • Loss of function
    1. inability to attend school
    2. regression in physical skills
  • Normal laboratory findings but local or generalized pain and/or swelling
  • Abnormal laboratory findings but symptoms and/or examination do not fit  clinical criteria  for a specific rheumatic disease
  • Complaints not consistent with laboratory findings or physical examination
  • Unexplained physical findings such as rash, fever, arthritis, anemia, weakness, weight loss, fatigue or anorexia
  • Unexplained musculoskeletal pain
  • Undefined autoimmune disease

2. Diagnostic evaluation and long-term management of: –
     Juvenile idiopathic arthritis (J.I.A)

  • Spondyloarthropathies
    1. Ankylosing Spondylitis
    2. Reactive arthritis
    3. Arthritis associated with inflammatory bowel disease
  • Other arthritides
    1. Lyme disease with arthritis
    2. Post-infectious arthritis
  • Connective Tissue Diseases and related syndromes
    1. Systemic lupus erythematosus
    2. Juvenile Dermatomyositis or polymyositis
    3. Mixed connective tissue disease
    4. Scleroderma – systemic and localized
    5. Sjögren syndrome
    6. Anti-phospholipid antibody syndrome
  • Chronic vasculitides
    1. Polyarteritis nodosa
    2. Wegener granulomatosis
    3. Behcet syndrome
    4. Takayasu arteritis
    5. Hypocomplementemic vasculitis
    6. Hypersensitivity vasculitis
    7. Cerebral vasculitis
    8. Post-infectious vasculitis
  • Other Inflammatory Diseases
    1. Autoinflammatory and Periodic fever syndromes
    2. Chronic recurrent multifocal osteomyelitis
    3. Relapsing polychondritis
    4. Sarcoidosis

3. Confirm diagnosis and help formulate and/or participate in a treatment plan for the following conditions: –

  • Acute rheumatic fever
  • Apophysitis
  • Complex autoimmune thrombocytopenia
  • Complex Regional Pain Syndrome
  • Erythromelalgia
  • Growing pains
  • Henoch-Schonlein Purpura
  • Hypermobility
  • Cold Induced injury
  • Kawasaki disease
  • Osteochondroses
  • Osteoporosis
  • Pain syndromes
  • Raynaud phenomenon
  • Secondary autoimmune hemolytic anemia
  • Serum sickness
  • Uveitis

4. Diagnostic or treatment plan evaluation for autoimmune disorders associated with other primary diseases such as: immunodeficiency, neoplasm, infectious disease, endocrine disorders, genetic and metabolic diseases, post-transplantation, cystic fibrosis and arthritis associated with birth defects.

5. Provide second opinion or confirmatory evaluation when requested in certain cases where primary care physicians request expert opinion for families requiring subspecialty input to cope with disease process, accept treatment plan, allay anxiety and provide education.