Early Arthritis Pathway

NICE guidelines state that patients with newly-diagnosed RA should be:

  • Referred urgently within 12 weeks of onset of symptoms
  • Seen within 6 weeks of referral
  • DMARDs started without delay, within 3 months of onset of symptoms
  • Fast escalation of DMARDs is required until a clinically effective dose is achieved
  • Disease activity and CRP should be measured monthly until disease is controlled (ie monthly visits)

Referral for Early Arthritis

Referral CriteriaPresent
Symptom onset of 6 weeks – 6 months 
And 2 of the following: 
Swelling in 2 or more joints 
Positive MCP/MTP squeeze test 
Small joints of hands, wrists or feet affected 
Date of Symptom Onset = 
Blood Tests
Please Arrange the following Prior to referral:
FBC 
ESR 
U&E 
CRP 
LFT 
URATE 
RF 
ANA 

Further Information

  • A standard referral letter needs to accompany the proforma.
  • Rheumatoid arthritis can present at any age, in both men and women.
  • A normal ESR & CRP does NOT exclude a diagnosis of Inflammatory Arthritis
  • A negative Rheumatoid Factor does NOT exclude a diagnosis.
  • Lack of erosions or osteoarthritic changes only on X-ray do NOT exclude a diagnosis