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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 Criteria | Present | |
|---|---|---|
| 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