Polymyalgia Rheumatica Referral Access Criteria

• Complications of disease or therapy requiring emergent review – systemically unwell
• Visual disturbance or loss in patients with confirmed/suspected Giant Cell Arteritis/Temporal Arteritis

• Any concern for concomitant Giant Cell Arteritis/Temporal Arteritis
• Acute, otherwise unexplained, monoarthritis
• Acute, otherwise unexplained, polyarthritis
• Patients with a previously diagnosed condition who are acutely unwell e.g.:
  • Chronic idiopathic arthritis (inflammatory arthritis, psoriatic arthritis, axial spondylitis)
  • System lupus erythematosus, myopathies, scleroderma
  • Necrotising vasculitis (anti-neutrophilic cytoplasmic autoantibody-associated vasculitis)
  • Patients on biological agents

To contact the relevant service, see Clinician Assist WA: Acute Rheumatology Assessment (external site).

• Muscle pain and stiffness in the upper arms, neck, buttocks and thighs on both sides of the body
• Pain on active and passive movements of joints
• Pain and stiffness worse in the morning (>45 minutes), and after rest such as after a long car ride or sitting too long in one position
• Difficulty sleeping and doing daily activities due to pain and stiffness

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

• Relevant history, onset, duration, and severity of symptoms including:
  • Whether presence of muscle pain, swelling/tenderness/synovitis
  • Duration of early morning stiffness (greater or less than 30 minutes)
  • Whether presence of headaches
  • Whether presence of amaurosis fugax
• Current medication list
• Any known allergies
• Details of previous treatment and outcome

• Nil

• FBC
• U&E
• LFT
• ESR
• CRP

• Other screening previously performed including CXR, Hepatitis B, Hepatitis C, HIV, bone mineral density

• Nil

• TFT
• CK
• RF
• Anti-CCP
• Serum protein electrophoresis
• Cancer screening information if applicable

Category 1

Appointment within 30 days

• No defined category 1 criteria

Category 2

Appointment within 90 days

• New onset polymyalgia rheumatica with typical shoulder/hip girdle features with raised ESR/CRP
• Known and treated PMR established on steroids requiring further escalation of management

Category 3

Appointment within 365 days

• No defined category 3 criteria

• Patients aged <45 years. The incidence of Polymyalgia Rheumatica in this patient cohort is rare.

• See Clinician Assist WA: Polymyalgia Rheumatica (external site)