Vol.:(0123456789) 1 3 Rheumatology International https://doi.org/10.1007/s00296-018-4094-1 PUBLIC HEALTH Standardization of red fags for referral to rheumatologists and ophthalmologists in patients with rheumatic diseases and ocular involvement: a consensus statement Ignazio Olivieri 1  · Massimo Accorinti 2  · Irene Abicca 2  · Paola Bisceglia 3  · Luca Cimino 4  · Loredana Latanza 5  · Pietro Leccese 1  · Ennio Lubrano 6  · Antonio Marchesoni 7  · Elisabetta Miserocchi 8  · Piergiorgio Neri 9  · Carlo Salvarani 10,11  · Rafaele Scarpa 12  · Salvatore D’Angelo 1,13  · On behalf of the CORE Study Group Received: 24 May 2018 / Accepted: 21 June 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Ocular involvement is a common manifestation of infammatory rheumatic diseases, often requiring a multidisciplinary col- laboration between rheumatologists and ophthalmologists. The aim of this study was to standardize “red fags” for referral for rheumatologists and ophthalmologists using a Delphi consensus for the management of rheumatic diseases with ocular involvement. The scientifc board comprised 11 Italian hospital-based rheumatologists (N = 6) and ophthalmologists (N = 5). A systematic review identifed potential red fags for referral. The panel developed 19 statements consisting of (a) referral from ophthalmologist to rheumatologist (b) referral from rheumatologist to ophthalmologist and (c) overarching principles relating to multidisciplinary roles/goals and management. Voting was performed anonymously using an online Delphi method. Each participant expressed a level of agreement on each statement using a 5-point scale (1=“strongly disagree”; 5=“strongly agree”). Total cumulative agreement was defned as the sum of the percentage of response to items 4 (“agree”) and 5 (“absolutely agree”), consensus defned as ≥ 80% cumulative agreement for each statement. Positive consensus among 11 participants was reached for 15/19 (78.9%) statements. Statements not reaching consensus were discussed in a face-to- face meeting prior to the second vote (10 participants). Positive consensus was reached for all 19 statements, with fnal total cumulative agreement of 90–100%. This is the frst Delphi consensus undertaken to standardize red fags for referral to rheumatologists and ophthalmologists for patients with rheumatic diseases and ocular involvement. Keywords Delphi · Consensus · Statement · Red fags · Referral · Rheumatologist · Ophthalmologist · Rheumatic disease · Ocular involvement · Uveitis Rheumatology INTERNATIONAL * Salvatore D’Angelo saldangelo@katamail.com 1 Rheumatology Institute of Lucania (IRel) and Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy 2 Department of Ophthalmology, Sapienza University of Rome, Rome, Italy 3 The Ocular Immunology Service, The Eye Clinic, Polytechnic University of Marche, Ancona, Italy 4 Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy 5 Ocular Immunopathology Unit, Department of Ophthalmology, “Antonio Cardarelli” Hospital, Naples, Italy 6 Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute “Vincenzo Tiberio”, Università degli Studi del Molise, Campobasso, Italy 7 Department of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy 8 Ocular Immunology and Uveitis Service, Department of Ophthalmology, San Rafaele Scientifc Institute, Milan, Italy 9 Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates 10 Rheumatology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy 11 University of Modena and Reggio Emilia, Reggio Emilia, Italy 12 Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy 13 Fondazione Basilicata Ricerca Biomedica (BRB), Basilicata, Italy