Vasculitis

• General Rheumatology consultations (consultants, specialty doctors, specialist nurses, ANP, senior Pharmacist)
• AHP (Rheumatology Physiotherapy, Podiatry, Occupational Therapy)
• US scan of the joints (for internal referrals only)
• Intraarticular steroid injections (for internal referrals only or performed by Rheumatology Physiotherapist)
• Training for self-delivered subcutaneous injections (internal use only)
• Medical Day Unit (internal service for delivery of intravenous medication, subcutaneous medication, Short Synacthen test)
• Rheumatology on-call (quick access to the service, prompt reply to enquiries via email)
• Rheumatology page 1439 – covered by resident doctor
• Rheumatology helpline  - 01292513316 – Service run by Rheumatology Specialist nurses.

Vasculitis represents a large spectrum of pathologies with various manifestations depending on the type of vessels involved, the dimension and region of interest.

The diagnosis of vasculitis is considered based on the clinical presentation of a systemically unwell patient with raised inflammatory markers in the absence of infection or other explanation, usually with evidence of end organ damage such as skin infarction, visual loss, respiratory failure, cardiac failure, acute abdomen, acute kidney injury, acute sensory/motor loss.

Other symptoms may include:

• Respiratory – haemoptysis, shortness of breath
• Oral health – mouth ulcers
• Genitourinary medicine – genital ulcers
• Renal – haematuria, elevated creatinine
• Ophthalmology – scleritis, visual loss
• ENT – hearing loss, nasal crusting, nosebleeds, sinus pain
• Rashes, weight loss, night sweats, fatigue, joint pain.

Refer to Rheumatology with urgent priority if the patient displays persistent symptoms as above, by using SCI OP Gateway.

Do not refer to Rheumatology patients with sepsis or malignancy and a weakly positive ANCA (MPO/PR3) in the absence of relevant symptoms as above.

Do not send new referrals only for updates or to ask for urgent review do to flares for patients already known to Rheumatology, being on the list waiting for reviews, as we cancel such referrals to avoid duplication.

Please do not hesitate to keep in touch with us regarding your patients with any updates, symptom changes or flare ups using the Rheumatology Clinical email inbox: clinicalr@aapct.scot.nhs.uk

Please check prior to referring:

• FBC, U&Es, LFTs, ESR, CRP.
• Monitor blood pressure.
• Urine dip. If this shows trace of protein and haematuria, you should check urine albumin/creatinine ratio and refer to Renal in case of concerns.
• Chest X ray in case the patient displays respiratory symptoms.

Do not start on steroids unless the hospital doctor recommends.

1. British Society for Rheumatology Adult Rheumatology Referral Guidance. September 2021. Accessed at: https://www.rheumatology.org.uk/Portals/0/Documents/Policy/Adult-rheumatology-referral-guidance.pdf?ver=2022-08-04-104812-413
2. NHS Lanarkshire Rheumatology referral guidelines. March 2022. Accessed at: https://rightdecisions.scot.nhs.uk/media/2014/ebooklet-rheumatology-referrals-2022.pdf
3. NHS Lothian. RefHep. Accessed at:RefHelp – Instant Acces s to Referral Guidelines for Lothian