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Referral
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Early Inflammatory Arthritis Clinic - PHNT
Early recognition & treatment of inflammatory arthritis significantly improves outcome; delay reduces efficacy of treatment and leads to poor outcome. After consultant triage of referral, if thought suitable then patients will be seen in The Early Arthritis clinic within 2-3 weeks.
Do NOT administer steroid before referral & diagnosis as patient 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 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 on behalf of NHS Devon.
Publication date: December 2016
Updated: October 2018
