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Inflammatory Arthritis

 

More info on Synovitis

*Note, sometimes synovitis can be seen in the small joints of the hand with OA. If the synovitis is associated with pain at the DIP joints and base of the thumb and with clear X-ray evidence of significant OA with no other associated features such as MCP joint involvement, it would be appropriate to trial OA treatment before considering referral.

 

Investigations prior to referral:

·         FBC, ESR, CRP, U&E, LFTS

·         Rheumatoid factor ( if synovitis in PIP/ MCP joints), see limitations of test

Xrays can be useful to exclude OA but note may be normal in inflammatory arthropathy, (it can take up to 2yrs to see erosions in RA)

 

Desirable information:

·         Occupation

·         Impact on daily activities

Red flags:

·         Weight loss

·         Fever

·         Night pain

·         Neurological symptoms/signs

 

 

 

References:

NICE CG79 , Dec 2015

Personal communication Dr Hutchinson, Consultant Rheumatologist, RCH, 2017