Referral criteria from primary care - suspected rheumatoid arthritis (RA)

Refer for specialist opinion any adult with suspected persistent synovitis of undetermined cause.

Refer urgently (even with a normal acute-phase response, negative anti-cyclic citrullinated peptide [CCP] antibodies or rheumatoid factor) if any of the following apply:

• the small joints of the hands or feet are affected
• more than one joint is affected
• there has been a delay of 3 months or longer between onset of symptoms and seeking medical advice
• suggested investigations
  • rheumatoid factor in people with suspected RA who are found to have synovitis on clinical examination
  • consider measuring anti-cyclic citrullinated peptide (CCP) antibodies in people with suspected RA if:
    • they are negative for rheumatoid factor, and
    • there is a need to inform decision-making about starting combination therapy
  • x-ray the hands and feet early in the course of the disease in people with persistent synovitis in these joints

Reference:

1. NICE. Rheumatoid arthritis in adults: management. NICE guideline NG100. Published July 2018, last updated October 2020.