For referring doctors
Referring a patient to rheumatology
For general practitioners, physicians, orthopaedic surgeons and other specialists in Pune and Pimpri-Chinchwad: who to send urgently, what to send with them, and how to refer. Shared care with the referring doctor is welcome, including DMARD blood monitoring closer to the patient’s home.
Call the same day
Urgent: do not send by routine referral
These can cost sight, kidneys or life within days. Phone the clinic directly so the patient is seen at the earliest possible session, and send to emergency care if the patient is unwell.
Suspected giant cell arteritis
New headache over 50, scalp tenderness, jaw claudication or any visual symptom. Start high-dose steroids without waiting for a biopsy or a scan if vision is threatened, then call.
Suspected systemic vasculitis
Purpura with haematuria or proteinuria, haemoptysis, mononeuritis multiplex, or rapidly rising creatinine with active urine sediment.
Lupus with organ involvement
New proteinuria or active urine sediment, cytopenias, serositis or neuropsychiatric features in a patient with known or suspected SLE.
Inflammatory myopathy
Proximal weakness with a raised CK, especially with dysphagia, breathlessness or a heliotrope or Gottron's rash.
Scleroderma with new hypertension or digital ulcers
Possible renal crisis, or critical digital ischaemia: a finger that stays white or turns dark.
A hot, swollen single joint with fever is septic arthritis until proven otherwise, and belongs in emergency care for aspiration, not in a clinic queue.
Refer within weeks
Early referral changes the outcome
Inflammatory arthritis treated within the first three months has a substantially better chance of remission. Please do not wait for test results to come back abnormal before referring.
Persistent joint swelling
Synovitis of more than one joint, or of the small joints of the hands or feet, lasting beyond a few weeks. Refer even if RF, anti-CCP and ESR are normal: seronegative early RA is common, and outcomes depend on treatment within the first three months.
Inflammatory back pain
Onset before 45, over three months, worse with rest and in the second half of the night, better with exercise. Especially with uveitis, psoriasis, IBD or a good NSAID response.
Positive ANA with symptoms
Raynaud's, photosensitive rash, oral ulcers, sicca, inflammatory arthralgia, unexplained cytopenias or proteinuria.
Gout not controlled
Recurrent attacks, tophi, or uric acid not at target despite urate-lowering therapy, and gout with CKD.
Polymyalgia that is not typical
Age under 60, no clear steroid response, peripheral synovitis, systemic features, or relapses on tapering.
Osteoporosis that is complicated
Fractures despite treatment, glucocorticoid-induced osteoporosis, or patients for whom oral bisphosphonates are unsuitable.
Helpful, never a reason to delay
What to send with the patient
- Blood count, ESR and CRP
- Baseline for activity and for later DMARD monitoring.
- Creatinine and liver function tests
- Needed before almost every DMARD.
- Urine routine examination
- Blood or protein on a dipstick changes the urgency in lupus and vasculitis.
- RF and anti-CCP
- If inflammatory arthritis is suspected.
- ANA by immunofluorescence, with titre and pattern
- If connective tissue disease is suspected. ELISA screens alone are hard to interpret.
- Uric acid
- For suspected gout, checked at least two weeks after an attack.
- X-rays of the affected joints
- Hands and feet in suspected RA; pelvis for sacroiliitis.
Usually reassurance is enough
When a referral is usually not needed
- A low-titre ANA (1:80 or 1:100) in a person with no symptoms of connective tissue disease. It is found in 5 to 15% of healthy people.
- A positive HLA-B27 without inflammatory back pain or other features of spondyloarthritis.
- A raised uric acid with no gout attacks, tophi or stones.
- Mechanical back pain without inflammatory features.
If you are unsure, send a WhatsApp message with the reports. A quick opinion is often all that is needed.
How to refer
Three ways, all answered by the clinic
WhatsApp
Opens a referral template with the fields already laid out. Attach the reports as photos or PDFs.
Start a referral →Phone
For anything urgent, or to discuss whether a referral is needed at all.
+91 70571 19999Referral letter
The patient brings it to the clinic at Ravet, OPD Monday, Wednesday and Friday. Address and timings
Patient-facing guides you can share: conditions and medicines.