When should I consider referring a patient with suspected GPA to a specialist, and what information should I include in the referral?

When to refer: Consider referring a patient with suspected granulomatosis with polyangiitis (GPA) to a specialist (usually a rheumatologist or immunologist) urgently if there is clinical suspicion based on symptoms such as systemic vasculitis signs, respiratory tract involvement, renal impairment, or other organ manifestations suggestive of GPA. Early specialist referral is important to confirm diagnosis and initiate appropriate immunosuppressive treatment to prevent organ damage.

Information to include in the referral: Include a detailed clinical summary highlighting presenting symptoms (e.g., nasal or sinus symptoms, cough, haematuria, constitutional symptoms), relevant examination findings, results of initial investigations such as inflammatory markers (CRP, ESR), renal function tests, urinalysis, and any imaging or biopsy results if available. Also include any treatment already started, such as corticosteroids, and the urgency of the referral.

Prompt referral facilitates early diagnosis and management, which is critical given the potential severity of GPA and risk of irreversible organ damage.