COVID-19: Rheumatology service guide (Devon)

Updated December 2020


This information provides guidance on the management of rheumatology patients across Devon during the Covid-19 pandemic. The information is based on national guidance from the British Society of Rheumatology and NHSE.

National guidance

The British Society for Rheumatology

NHS England specialty guides for patient management during the coronavirus pandemic: Urgent and Emergency Musculoskeletal Conditions Requiring Onward Referral

NHS Devon CCG Commissioning Policy for injections for non-specific low back pain without sciatica

Conditions with specific guidance

In line with NHS Specialty guides for patient management during the coronavirus pandemic:

Urgent and Emergency Musculoskeletal Conditions requiring onward referral 23 March 2020

  • Acute inflammatory arthritis and suspected rheumatological conditions: Refer any person to rheumatology with:
    • persistent synovitis: (ie swollen joints), particularly if the small joints of the hands (metacarpophalangeal or proximal interphalangeal) and/or feet are affected, and person reports early morning joint stiffness lasting more than 30 minutes, even if the acute phase response (C-reactive protein – CRP or erythrocyte sedimentation ratio – ESR) is normal and cyclic citrullinated peptide antibody (anti-CCP) or rheumatoid factor (RF) are negative. The person may have rheumatoid arthritis or psoriatic arthritis
    • a suspected new-onset autoimmune connective tissue disease (e.g. lupus, scleroderma) or vasculitis: Symptoms include extra-articular manifestations such as a rash, Raynaud's (colour change, with hands and/or feet turning white– blue and/or red in the cold), mouth ulcers and/or sicca symptoms (dry eyes/mouth) in association with their new inflammatory arthritis
    • myalgia: which is not secondary to a viral infection or fibromyalgia but worsens proximally, ie affects the shoulder and pelvic girdles in a symmetrical pattern, is worse in the morning and associated with more than 30 minutes of stiffness, and accompanied by a raised acute phase response (ESR or CRP). They could have:
      • polymyalgia rheumatica (PMR): person usually aged over 50, (usually managed by GP but may want to discuss steroid dosing)
      • myositis: any age, usually accompanied by some weakness and raised creatine kinase (CK greater than 500); refer urgently to rheumatology service
    • new-onset headache: predominantly in temples with or without associated symptoms such as jaw claudication, proximal girdle pain, visual symptoms and accompanied by a raised acute phase response (ESR or CRP) in people usually aged over 50. They may have giant cell arteritis
  • Insufficiency fracture: Commonly presents with sudden onset of pain, mostly located in the thoraco-lumbar region following low impact trauma. The pain varies in presentation, but is often severe and mostly localised to the area of the fracture. Consider risk factors associated with osteoporosis; however, exclusion of a more serious pathological cause may be indicated.

Urgent referrals

Refer conditions above as urgent, rheumatology will review and determine the type of consultation required:

  1. Face to face appointment (clean site if possible)
  2. Video consultation
  3. Telephone consultation
  4. Defer with advice and guidance

If in doubt during the COVID-19 pandemic, rheumatology teams are happy to be contacted for advice. Please see contact information for further details.

Routine referrals

All new routine referrals will be clinically triaged and will either be added to a waiting list or, if appropriate, A&G will be given.

Please ensure that a practice-based system is in place to check daily for returning referrals with A&G.

Prior to making a routine referral, please ensure that any appropriate Policy or CRG has been reviewed and that all the suggested investigations and management options have been considered.

Existing new and follow-up routine appointments have been cancelled and changed to telephone / video consultation where appropriate.

Rheumatology at NDHT runs a patient initiated follow-up (PIFU) service for patients identified as suitable.

  • PIFU describes when a patient (or their carer) can initiate their follow-up appointments as and when required, e.g. when symptoms or circumstances change. This helps patients access support when they need it (e.g. during a flare-up of their symptoms) and avoids unnecessary routine 'check in' appointments. The patient is empowered to manage their own condition and takes responsibility for initiating the appointment.

  • Patients will be identified and consented at their outpatient appointment if they are suitable to commence Patient Initiated Follow Ups, and will receive a leaflet and letter explaining the process. The GP will also be notified that the patient will be on a PIFU pathway.
  • Patient information leaflet can be accessed here

Urgent advice

Please call the relevant Trust rheumatology department. Any patient at risk of organ threatening complications should be discussed urgently.

Advice & Guidance

Please see 4. above in urgent referrals.

If concerned about patient please contact relevant department via contact information.

COVID-19 High risk patient advice

Patients will be contacted by their rheumatology team with advice on shielding and social distancing, based on a national risk stratification grid of medication and comorbidities. The grid and patient letter are available at:

The British Society for Rheumatology: Coronavirus and identifying patients for shielding

Devon Rheumatology contact information

Northern Devon Healthcare Trust:

Rheumatology Secretary telephone: 01271 311571

or via switch board, nurse helpline telephone: 01271 322359

Rheumatology email:

Royal Devon and Exeter NHS Foundation Trust:

Rheumatology Consultant on call telephone: 07920 781631 (Mon – Fri, 9am-5pm)

Nurse advice line telephone: 01392 403502 or email:

South Devon and Torbay NHS Foundation Trust:

Rheumatology Dr Tel. for urgent calls telephone: 0777407925 (Mon-Fri 9-5) or email:

Nurse advice line telephone: 01803 654939

University Hospitals Plymouth NHS Trust:

Via Switchboard telephone: 01752 202082, radio page Registrar on 81007 or Consultant: 81639 or

Nurse advice line telephone: 01752 439688 or email

Supporting information

Patient information

Pathway Group

This guideline has been developed by Devon NHS Rheumatologists and signed off on behalf of the NHS Devon Clinical Commissioning Group

Publication Date: May 2020

Date Updated: February 2021

Pathway Group

This guideline has been developed by Devon NHS Rheumatologists and signed off on behalf of the NHS Devon Clinical Commissioning Group

Publication Date: May 2020

Date Updated: February 2021

Last updated: 23-02-2021


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