What are the current guidelines for referring patients with suspected autoimmune diseases to a specialist?

Referral guidelines for suspected autoimmune diseases:

• Rheumatoid arthritis: Refer adults with persistent synovitis of unknown cause urgently to a rheumatologist within 3 working days if small joints of hands or feet are affected, more than one joint is involved, or symptoms have persisted for 3 months or more. Do not delay referral based on normal blood tests or pending results. Avoid prescribing glucocorticoids before specialist assessment. NSAIDs may be offered at the lowest effective dose until specialist review. Investigations such as rheumatoid factor, anti-CCP antibodies, and X-rays should not delay referral. Refer within 3 weeks for any persistent synovitis without urgent features ³,⁵.
• Psoriatic arthritis and spondyloarthritis: Arrange urgent referral to rheumatology if psoriatic arthritis is suspected to prevent joint damage. For spondyloarthritis, refer to rheumatology if low back pain started before age 45 and has lasted >3 months with at least 4 additional criteria (e.g., improvement with movement, family history, psoriasis). Urgently refer new-onset inflammatory arthritis unless RA, gout, or pseudogout is suspected. Refer patients with dactylitis or persistent/multisite enthesitis with associated features (e.g., psoriasis, uveitis, IBD) ¹,⁸.
• Crohn's disease with autoimmune features: Urgent referral to a gastroenterologist is indicated if Crohn's disease is suspected, aiming for specialist assessment within 4 weeks to initiate immunosuppressive or biologic therapy. Referral for suspected extra-intestinal autoimmune manifestations should also be considered ².
• Hypothyroidism: Refer to endocrinology if subacute thyroiditis, thyroid cancer, atypical or difficult-to-interpret thyroid function tests, or if pregnancy is planned. Referral is also indicated if central adrenal insufficiency cannot be ruled out ⁴.
• Drug allergy suspected to be autoimmune-mediated: Refer to specialist drug allergy services if there is a suspected anaphylactic reaction or severe non-immediate cutaneous reaction ⁶.

In all cases, early specialist referral is emphasized to enable timely diagnosis and management, reduce risk of complications, and improve outcomes. Referral urgency varies by condition and clinical features but generally prioritizes persistent, multi-joint, or systemic involvement and diagnostic uncertainty ¹,²,³,⁴,⁶,⁸.