Who is referred for specialist rheumatology care?

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Abstract
Sir, Although referral for specialist advice in secondary care rheumatology departments is a key determinant of clinical activity within the speciality, this has not been comprehensively or systematically studied. Isolated reports from the UK and Ireland [1–8], continental Europe [9, 10] and North America [11] suggest there is wide diversity in the pattern of referral. Although local factors may be especially important in determining which patients are referred and the reasons why, there have been no comparisons of the management of musculoskeletal diseases between primary and secondary care in one or more areas. We therefore compared rheumatology referrals to one specialist unit with cases with rheumatic disorders seen at a nearby general practice where one general practitioner (GP) had a specific interest in rheumatology. We also reviewed experience at other UK specialist rheumatology centres. Our aims were to define the patterns of specialist rheumatology referrals and to suggest how these are likely to affect the future development of the speciality.