What are the referral criteria for a patient with suspected scleroderma to a specialist rheumatology service?

Referral criteria for suspected scleroderma to specialist rheumatology:

• Refer patients with Raynaud's phenomenon who have digital ulcers and/or severe ischaemia urgently to rheumatology for specialist assessment and treatment, as these may indicate systemic sclerosis (scleroderma) complications.
• Any worsening symptoms of Raynaud's phenomenon should trigger referral to rheumatology to assess for underlying connective tissue disease such as systemic sclerosis.
• Early referral is important for prompt diagnosis, organ screening, and initiation of treatment to reduce risk of complications.
• Specialist investigations such as digital perfusion testing (plethysmography or thermography) may be required and are usually available in specialist centres.
• Referral should also be considered if there is severe or refractory digital ischaemia or ulceration despite medical treatment.

These criteria are based on the European Society for Vascular Medicine (ESVM) guidelines, British Society for Rheumatology (BSR) publications, and expert opinion emphasizing early identification and management of systemic sclerosis.

Summary: Urgent rheumatology referral is indicated for patients with suspected scleroderma presenting with Raynaud's phenomenon accompanied by digital ulcers, severe or worsening ischaemia, or other signs suggestive of connective tissue disease, to enable early diagnosis and specialist management.

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