NICE guidelines recommend that patients with suspected inflammatory arthritis should be referred urgently for assessment.
Inflammatory arthritis in its early stages may not exhibit the typical patterns of established disease. However, it is in the early stages that treatment with appropriate disease-modifying medication can have the maximum impact on response and outcome.
How to refer
Patients can be referred by GPs or by consultants in other specialities. Patients need to meet the eligibility criteria below. Patients who do not meet the eligibility criteria should be referred through the usual channels.
NHS GP referrals
All NHS GP referrals must be submitted using the NHS e-Referral Service (e-RS). Referrals sent by email or post from NHS GPs will not be processed.
Should you require advice about a patient, please use the advice and guidance facility through e-RS.
Non GP and tertiary referrals
Patients who meet the eligibility criteria should be referred by completing the referral form (Word 454Kb) and emailing it to firstname.lastname@example.org.
To help us book your patient into the most appropriate clinic, please provide as much information as possible. We may contact the patient before offering an appointment to make sure they're seen at the most suitable clinic.
Referrals from other hospitals must include a completed Inter-Provider Minimum Data Set or ensure that one is sent within 48 hours of referring a patient.
Patients with suspected inflammatory arthritis should be referred urgently if symptoms have been present for more than six weeks and any of the following apply:
- swelling is present in two or more joints
- the small joints of the hands or feet are affected
- there is a positive MCPJ or MTPJ squeeze test (pain produced by gentle pressure across the metacarpophalangeal or metatarsophalangeal joints).
Other features which should raise suspicion of inflammatory arthritis include:
- early morning joint stiffness for more than 30 minutes
- joint stiffness following periods of immobility
- constitutional upset, such as loss of appetite, weight loss, fatigue
- the presence of other conditions associated with inflammatory arthritis such as psoriasis, iritis or uveitis, inflammatory bowel disease.
It would be helpful if the following investigations could be arranged before clinic appointment and the results sent with the patient or original referral. However, the results should not influence the decision to refer, as normal or negative results do not exclude an inflammatory condition.
- full blood count
- renal function(urea, electrolytes and creatinine)
- liver function tests
- erythrocyte sedimentation rate (ESR)
- c-reactive protein (CRP)
- rheumatoid factor
- antinuclear antibody.
In addition, it would be helpful if X-rays of the hands and feet could be arranged if these joints are affected, but only if these are done at Guy's and St Thomas', otherwise they will be arranged when the patient attends the clinic.
If you have any general queries about eligibility for referral or the early arthritis clinic, please email them to email@example.com. We try to answer any queries within one working day. If you require urgent advice please bleep the on-call rheumatology registrar during working hours.