All information is correct at time of printing and is subject to change without notice. The Devon Formulary and Referral Website is not in any way liable for the accuracy of any information printed and stored by users. For the most up-to-date information, please refer to the website.
Referral
Contact us about this page
Early arthritis clinic
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: Analgesics and Musculoskeletal & joint 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
- 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 - GP to give them a phone number – ideally a direct line – and that the Rheumatologists will call them in a designated timeslot. This would be:
- Stuart Kyle – Thursdays 12:30-13:00
- Roope Manhaus – Tuesdays 12:30 – 13:00
Pathway Group
This guideline has been signed off on behalf of NHS Devon.
Publication date: July 2016
