Rheumatology |
F8
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Referral Guidelines
Referral Guidelines
Suspected Inflammatory Arthritis
Key message: Early referral and treatment prevents joint damage
Any person with suspected, persistent synovitis of undetermined cause should be referred for a specialist opinion
Referral should be URGENT if:
- Symptoms for more than 6 weeks and less than 6 months
AND any one of the following symptoms:
- Swelling in 2 or more joints
- Swelling in the small joints of the hand or feet
- Positive MCPJ or MTPJ 'squeeze test'
- Early morning stiffness >30 minutes
Refer ROUTINELY if:
- Symptoms more than 6 months
If patient had symptoms for >6 months, but still felt urgent, please discuss via Consultant Connect prior to referral.
Additional features that raise suspicion of early inflammatory arthritis:
- Constitutional symptoms
- Presence of other features related to arthritis eg rash, painful red eyes or inflammatory bowel disease
- Family history of autoimmune disease
- Family history of psoriasis
Suggested investigations prior to referral via ICE
- 'Early arthritis' profile (includes FBC, CRP, CE, LFT, Ca, RhF, Urate, Hep2 ANA)
- TSH
- Creatinine
- Bone profile
- Plasma viscosity or ESR
- XR the affected areas (as appropriate)
Details to be included in referral letter:
Please mark referral SUSPECTED INFLAMMATORY ARTHRITIS
- Duration of symptoms
- Pattern of joint involvement/spinal symptoms
- Duration of early morning stiffness
- History of psoriasis/IBD/uveitis/CTD symptoms if present
- FH of psoriasis
- Details of systemic symptoms eg weight loss, fever, SOB
- Examination findings
- Investigations requested/results
- PMH and medication