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RHEUMATOLOGY CONSULTATION GUIDELINES


In order to make a timely diagnosis and start treatment sooner, please use the following guidelines for Rheumatology referrals:

== 1.	Osteoarthritis: ==
  
* X-rays of the affected joint must be done prior to the consultation appointment. If the patient complains of pain in multiple joints, please x-ray the two most painful joints.  
* X-rays of the knees must be AP weightbearing views.
* For hip OA, single x-ray AP Pelvis is sufficient.   


== 2.	Inflammatory arthritis (Rheumatoid arthritis, Gout) Screening: ==
* Suspected inflammatory arthritis can be further evaluated by ESR, CRP, Rheumatoid factor (quantitative RF; Quest test # 4418), Uric acid and screening ANA (Quest # 38318).  
* In addition to the rheumatoid factor, rheumatoid arthritis patients (diagnosed or suspected) should have a current CBC, comprehensive metabolic panel (CMP/Chem-12), ESR, quantitative CRP, and CCP antibody (Quest test # 11173).
* Please obtain x-rays of bilateral hands (ball-catcher's views), bilateral wrists, and feet to rule out erosions, prior to the Rheumatology appointment.  


== 3.	Lupus Screening: ==
* Clinical suspicion of connective tissue disease/Lupus can be further evaluated by ordering ANA with reflex titer (Quest test # 38318).


== 4.	Positive ANA test: ==
* A positive ANA can be further evaluated by obtaining a Lupus(12)panel (Quest # 10716). This 12 test Quest panel includes: SS A, SS B, ds-DNA, Smith(SM), SM/RNP, C3, C4, TPO, SCL 70, Anti-Ribosomal P.


== 5.	Suspected spondyloarthropathy (Ankylosing Spondylitis): ==
  
* Single AP pelvis with 30 degree cranially angulated view(to confirm sacroilitis) and
* Cervical, Thoracic & Lumbar spine(AP & lateral)


== 6.	Past Labs: ==
* Please fax all pertinent labs(CBC, CMP, Urine analysis and other labs done in the past 12 months), relevant CT and MRI reports as well as the primary physician’s last chart note, prior to the consultation.


== 7.	Imaging: ==
* Patients must obtain a copy of their X-rays. Please make it clear to the patient that only the report of the x-ray will be sent by your office, and that they must obtain the actual films themselves to bring to their appointment. Actual films of MRI and CT scans are not required for Rheumatology consults, but may be required for Orthopedic consultations.  

Thank you for your time and consideration of this matter.

Return to Rheumatology Guidelines.

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