New Rheumatology Algorithms and Referral Guidelines

Seattle Children’s Rheumatology has created new algorithms and other resources to support PCPs in managing some conditions that are commonly referred for specialty care.

• Antinuclear antibodies (ANA): Algorithm
• Back pain: Algorithm
  • Also see Evaluation of back pain in children and adolescents (AAFP)
• Growing pains: Algorithm
• Henoch-Schonlein purpura (HSP): Algorithm
• Hypermobility/BHJS/Ehlers-Danlos syndrome: Algorithm
• Urticaria: Algorithm (seen by Dermatology)
• Pain syndromes (fibromyalgia, central sensitization, pain amplification, chronic regional pain, complex regional pain syndrome, reflex neurovascular dystrophy)
• Postural orthostatic tachycardia syndrome (POTS)

Rheumatology also offers resources for families whose child has one of the conditions above. See the “Resources for families” section towards the bottom of our Refer a Patient page.

The Rheumatology Program sees children age 17 and younger for the following rheumatic diseases:

• Systemic lupus erythematosus
• Juvenile rheumatoid arthritis (also called juvenile idiopathic arthritis)
• Juvenile dermatomyositis
• Growing pains
• Fever of unknown origin (FUO) or periodic fevers
• Scleroderma
• Spondyloarthropathies
• Behcet’s disease
• Henoch–Schonlein purpura
• Kawasaki disease
• Polyarteritis nodosa and microscopic polyangiitis
• Psoriatic arthritis
• Rheumatic fever
• Wegener’s granulomatosis
• Benign hypermobility joint syndrome (BHJS)

The wait time for new patients is currently about two months. Recently updated referral guidelines clarify those conditions that are redirected to other specialties.

Conditions redirected to other specialties:

• Chondromalacia patella/anterior knee pain syndrome: Referrals are redirected to Orthopedics.
• Fibromyalgia or central sensitization or pain syndromes or reflex neurovascular dystrophy/complex regional pain syndrome (RND/CRPS): Referrals are redirected to the Pain Management Clinic.
• Hypermobility/benign hypermobility joint syndrome/Ehlers-Danlos syndrome (BHJS/EDS): Referrals are redirected to Genetics for Ehlers-Danlos and Cardiology for Marfan syndrome.
• Urticaria/rash: Referrals are redirected to Dermatology for workup; Dermatology will refer back to Rheumatology if appropriate. Less than 5% of these cases are autoimmune-related and need to be seen by Rheumatology.
• Postural orthostatic tachycardia syndrome (POTS): We provide information on our website on how to manage these patients and suggest referring patients to Dr. Erik Armitano, a neurologist with Neurological Associates Clinic in Kirkland, who specializes in the POTS community, if specialty care is required.