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Referral
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Early arthritis clinic - RD&E
Early recognition & treatment of inflammatory arthritis significantly improves outcome; delay reduces efficacy of treatment and leads to poor outcome. After consultant assessment, if thought suitable then patients will be seen in The Early Arthritis clinic within 2-3 weeks.
The following are clues to an Inflammatory Arthritis – Please see specific criteria for Referral to Early Arthritis further down page
History
- Prolonged morning stiffness (more than 30 minutes), response to NSAID, & joint swelling
- Extra-articular features: Psoriasis, rheumatoid nodules, sicca
- Risk Factors: family history & smoking (RA)
Examination
- Symmetry, small joint synovial (soft tissue) swelling.
- Presence of enthesitis e.g. sausage digit
- Distribution: e.g. wrists, MCP & PIP and feet MTP for rheumatoid arthritis
- Look for extra-articular features
Differential Diagnoses
- Post viral arthritis, drug reactions, fibromyalgia, osteoarthritis & crystal arthropathy (gout & pseudogout)
The S Factor? (used by RCGP & NRAS)
- Stiffness - Early morning joint stiffness lasting more than 30 minutes
- Swelling - Persistent swelling of one joint or more, especially MCP joints
- Squeezing - Squeezing the joints is painful in inflammatory arthritis
- FBC, U&E, liver, CRP, urate, rheumatoid factor.
- Don't delay referral waiting for test results.
- CRP can be normal in early RA.
- Rheumatoid factor can be negative.
- Analgesia & NSAIDs
See: 4.7 Analgesics and 10.4 Pain and inflammation in musculoskeletal disorders
Do NOT administer steroid before referral & diagnosis
Referral criteria
- Suspicion inflammatory arthritis as above
- Symptoms more than 4 weeks & less than 6 months*
- At least 3 swollen joints
- Not explained by flare of osteoarthritis / gout
*Patients with longer history will be seen in general rheumatology clinic
Referral instructions
- Request early synovitis clinic via DRSS referral. Patients can only be seen at the RD&E main site.
- Include duration of symptoms & examination findings
- Please refer to your local rheumatology service – these patients require lots of visits, tests & monitoring - IT systems are not shared between Trusts
- Discuss any queries with rheumatologist e.g. rheumatology consultant mobile phone 07920781631 answered between 12.45 = 1.45
Pathway Group
This guideline has been signed off on behalf of NHS Devon.
Publication date: July 2016
