SCOPE OF PRACTICE
RHEUMATOLOGY
Name
License #
Supervising Physician
Alternating Supervising Physicians
Physician Assistant
Practice Site
Address
Phone
*Please add additional practice sites*
Hospital or University Affiliation
Signatures
Supervising physician
Physician Assistant
Alternate supervising
Date _________________________
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Medical Conditions: This protocol is developed for the rheumatic disease patients.
Diagnoses managed by this practice include but not limited to the following: rheumatoid
arthritis, juvenile rheumatoid arthritis, lupus, sarcoidosis, osteoarthritis, muscle spasm/strain,
fibromyalgia, arthralgia/myalgia, polymyositis, dermatomyositis, scleroderma, Raynaud
phenomenon, Sjogren’s syndrome, mixed/undifferentiated connective tissue disorders,
inflammatory polyarthritis, gout, sacroiliitis, spondyloarthropathies, reactive syndrome,
enteropathic arthritis, psoriatic arthritis, carpal tunnel syndrome, polymyalgia rheumatica, giant
cell arteritis, bursitis/tendonitis, osteoporosis, spinal stenosis, vasculitis and various pain
syndromes.
Associated illnesses may include but are not limited to various skin disorders, nail
disorders, alopecia, disorders of the eye and lids, diseases of the sinuses, oral cavity and
pharynx, neck masses, pulmonary disease, pleural and airway disorders, pulmonary infections
and masses, congestive heart failure, hypertension, valvular and coronary artery disease,
anemias, neutropenia, leukemia, lymphoma, platelet and coagulation disorders, diseases of the
esophagus, stomach, duodenum, small intestine and colon, disease of the liver, biliary tract and
pancreas, menopausal syndrome, allergic rhinitis, electrolyte disorders, renal disease, headache,
seizures, neurological disorders, weakness, common mood disorders, substance abuse, thyroid
and bone disease, DM type 1 and 2, lipid abnormalities, infectious disease and fatigue.
PA will obtain accurate information regarding HPI, PMH, FH, SH, medications, allergies and
ROS. She will perform appropriate physical examination, including skin, HEENT,
cardiovascular, pulmonary, abdominal and muscular/neurologic. When appropriate, after
obtaining verbal consent and appropriate preparation joint fluid will be aspirated, analyzed
microscopically and sent for labs including cell count, culture, gram stain and crystals. PA will
order and interpret necessary testing to develop differential diagnosis and monitor medication
toxicities, including but not limited to serum and urine labs and radiological studies. She also
will periodically access port-a-catheters for infusions and/or serum.
Treatments
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Establish differential diagnosis
Educate and counsel patients
Prescribe physical and occupational therapy, including therapy and splints
Order further testing
Maintain open communication with patients and physicians
Make appropriate referrals to other physicians/institutions
Dispense samples and prescribe medications as dictated by prescriptive
privilege, state law or verbal order of physician
Aspirate and inject joints
Access and flush port-a-catheters for infusions
Tasks that all certified PAs are qualified to perform
 Local anesthesia
 Suture lacerations
 Pap smear
 Catheterization
 Start IV
 Flush portacath
 Venipuncture
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Assist in surgery
Apply cast for stable fractures
Uncomplicated deliveries
Cauterize benign lesions
Skin biopsy
ACLS/BLS
Remove foreign bodies
Drug Therapy
 Standard prescriptive privileges approved by SCMB, prescriptive authority #A781IM
 Medications appropriate to treat rheumatic disease and associated illnesses, PA will
both initiate and refill the following:
1. Prednisone and various oral steroids
2. NSAIDs
3. Antimalarials
4. Antidepressants
5. Skeletal muscle relaxants
6. Neurontin/Lyrica
7. Bisphosphonates
8. DMARDS – including but not limited to Sulfasalazine, d-Penacillamine,
Imuran, Methotrexate, Cytoxan, Cyclosporine, gold, Cellcept, Rituximab,
Arava, Kineret, Enbrel, Remicade, Humira and Orencia
 Corticosteroid and viscosupplementation injections as necessary
Direct Evaluation/Immediate Referral
 Patients with inadequate response to therapies initiated by P.A.
 Patients presenting with conditions requiring hospitalization
 PA may direct BLS/ACLS/PALS until physician assumes patient care