Changes

1. October 2026

   Full accuracy and usability review

   Updated to current guidelines

   • All recommendations re-checked against guidance current to October 2026, including the ACR 2026 OA, axSpA and JIA guidelines, the EULAR 2025 PMR and large-vessel vasculitis recommendations, the ACR 2025 SLE guideline, the BSR 2025 csDMARD guideline, the EULAR 2024 pregnancy and lactation update, the ERS/EULAR 2025 CTD-ILD guidelines, and USPSTF 2025.
   • PMR: semi-urgent without GCA features (emergent with them). It can often be managed in primary care, with referral whenever the referring clinician isn't comfortable. Updated to EULAR 2025 (no 'trial of steroids' as a diagnostic test, updated dosing), with a note on where EULAR 2025 and the new BSR 2026 guideline differ.
   • GCA: urgent specialist referral within 24 hours, vascular ultrasound first-line where available, updated dosing and steroid-sparing options.
   • Axial SpA: AP pelvis X-ray first, then SI joint MRI without contrast; SI joint MRI for children.
   • Osteoarthritis: GLP-1 receptor agonists for knee OA with obesity, methotrexate for erosive hand OA, and the updated list of treatments to avoid.
   • JIA: 2026 first-line treatment, uveitis screening and monitoring intervals.
   • DMARD monitoring: BSR 2025 risk-adaptive approach and action thresholds; pregnancy, breastfeeding and paternal guidance from EULAR 2024.
   • Recent FDA approvals noted where they affect referral (deucravacitinib for PsA, obinutuzumab for lupus nephritis, emapalumab for MAS in Still's disease, sublingual cyclobenzaprine for fibromyalgia, upadacitinib for GCA, inebilizumab for IgG4-related disease).
   • E-consult guide reframed as a pre-referral tool for deciding whether, and how soon, a patient needs to be seen. It is never a substitute for an in-person examination when one is needed.

   Corrections

   • Fixed citation errors (the Abeles positive-ANA review, the 2012 PMR classification criteria, the EULAR SLE link, the EULAR gout recommendations, NICE osteoarthritis guidance, and an author name on a triage study).
   • Replaced statistics that couldn't be verified with sourced figures from the 2015 ACR Workforce Study and published triage research.
   • Removed a TNF-inhibitor baseline lipid test and a leflunomide TB screen that guidelines don't call for, and corrected several monitoring intervals.
   • Repaired RheumForPrimaryCare.org links and removed links to downloads that didn't exist.
   • Independent safety review: fever with purpura now routes to sepsis assessment first; dark urine, kidney injury or swallowing weakness with a raised CK is flagged as same-day; stridor in relapsing polychondritis, cardiac sarcoid arrhythmias, and eye, lung or neurologic signs in Behçet's are marked as emergencies; persistent swelling of several joints is referred without waiting 6 weeks.
   • Medicines: the FDA boxed warning on denosumab in advanced CKD, the ACR 2022 treatment order for glucocorticoid-induced osteoporosis, US label advice on mycophenolate in men, stopping cyclophosphamide at least 3 months before conception, NSAIDs in pregnancy (EULAR 2024 and FDA), voclosporin dosing by eGFR, yearly blood tests for children on hydroxychloroquine, and the CDC note that PCV21 lacks serotype 4 (relevant in Alaska and other Western areas).
   • IgA vasculitis: urine and blood pressure checks for at least 6–12 months (SHARE 2019), with pediatric nephrology once nephritis is confirmed (KDIGO 2025).
   • Smaller wording fixes: gout dose titration (ACR 2020 sets no fixed interval, so urate is checked after each increase), topical NSAIDs in OA, complement patterns, and the MIS-C case definition.
   • Added sources for every FDA approval mentioned, the 2025 ACR VEXAS guidance, CDC hepatitis C screening, anti-DFS70 antibodies, and the ASAS back pain criteria.

   Easier to use

   • Every section is now a real web page with its own link, works without JavaScript, and prints cleanly. Each condition has its own page.
   • Ask the Assistant: 270 decision points, a link to every answer, 'None of these / not sure' on every question, a Back button that goes one step back, a copyable summary, and an A–Z list of all answers.
   • Search across conditions, Assistant answers, workup checklists and medicines.
   • All downloads regenerated from the same content as the site, so they always match.
   • Dark mode, keyboard navigation, screen-reader labels and reduced-motion support.
2. July 2026

   Relaunched as an independent resource

   • RheumReferral relaunched as an independent, personal project with separate pathways for referring providers and rheumatologists.