Early Inflammatory Arthritis Clinic - PHNT

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 30mins), response to NSAID, & joint swelling
• Extra-articular features: Psoriasis, rheumatoid nodules, sicca, inflammatory eye disease, STI/urethritis/gastroenteritis
• 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

Do NOT administer steroid before referral & diagnosis as patient will be seen in The Early Arthritis clinic within 2-3 weeks

Referral Criteria

1. Suspicion of inflammatory Arthritis as above

2. Symptoms lasting more than 4 weeks & less than 12months*

3. Not explained by flare of osteoarthritis / gout

*Patients with longer history will be seen in general rheumatology clinic

Do NOT administer steroid before referral & diagnosis

Referral Instructions

1. Request early inflammatory arthritis clinic -– urgent via DRSS referral

2. Include duration of symptoms & examination findings

3. Please refer to your local rheumatology service – these patients require lots of visits, tests & monitoring - IT systems are not shared between Trusts

4. Discuss any queries with rheumatologist on call via Derriford switchboard or via email plymouth.rheumatology@nhs.net

Patient Information

GPs and patients can refer to Long Term Conditions Self Management Programme Improving Lives Plymouth for patient support with any long-term physical or low level mental health condition. The service helps people to better manage their condition and to achieve a better quality of life.

Pathway Group

This guideline has been signed off by the Western Locality on behalf of NEW Devon CCG.

Publication date: December 2016
Updated: October 2018