In line with BSR standards of best practice we are developing an EIA service. We aim to see patients within 3 weeks of referral and start DMARDs if indicated within 6 weeks. However not all patients are suitable for referral to the EIA clinic and must meet the criteria below to be referred.
If you feel the patient has an inflammatory arthropathy and requires rheumatology assessment but DOES NOT met the criteria below- please refer as a routine rheumatology referral instead via eRS.
All referrals will be triaged by the rheumatology consultant/registrar.
Please complete this Referral form in full, save and attach to e-referral. Incomplete forms will be returned to the GP.
Must have suspected persistent joint inflammation for at least 4 weeks (and for less than 6 months) & 2 of the following:
- Swelling of 3 or more joints
- Swelling of the small joints of the hands and/or the feet
- Positive MCPJ or MTPJ squeeze test
- Persistently raised CRP (greater than 10)
In addition please assess for other associated features:
Pmhx/Fhx Inflammatory bowel disease/Psoriasis/Iritis
Other useful information:
Impact of symptoms on daily activities
Primary care investigations:
Please ensure the following is requested prior to clinic
Bloods: FBC, U+E’s, LFTs, CRP, Bone, Rheumatoid factor, TFTs, anti CCP
Nb. AN order set for these is available on ICE under neuro/musculoskeletal tab, then click ‘Referral: early inflammatory arthritis clinic’
X-rays: X-rays of the hands and feet (order via ICE- radiology under plain film tab on LHS)
Note: normal CRP/ESR, negative rheumatoid factor or normal x-rays do not exclude an inflammatory arthritis
Tfts are helpful as there is increased incidence of autoimmune thyroid disease, esp. hypothyroidism associated with Rheumatoid arthritis and hypothyroidism can also present with an arthopathy.
Please do not prescribe steroids before rheumatology review because they can result in delay to the diagnosis being made. Patients can be given good pain relief with full dose NSAIDS (if no contraindications) and paracetamol-based analgesia prior to their appointment in the rheumatology clinic.
Dr Martin James (SpR, Rheumatology, RCHT)
Dr Bridgitte Wesson, GP & Kernow RMS Rheumatology guideline lead
Guidelines reviewed: February 2021
Next review due: February 2022