Rheumatoid Arthritis – For Clinicians

Rheumatoid arthritis is an autoimmune condition primarily affecting the joints. It causes joint pain, stiffness and swelling usually of multiple joints. Typically patients will have symptoms of pain and stiffness that are worse in the morning. Many joints can be affected but usually the arthritis is symmetrical, most often affecting the hands and feet.  Early identification is important as prompt initiation of treatment helps reduced long term joint damage and deformity. Therefore urgent referral to secondary care is advised.  There are often ‘early inflammatory arthritis’ slots dedicated to these patients on NHS eReferrals in order to aid prompt review. Referral letters should make it clear that inflammatory arthritis is suspected to aid triaging.

NICE have produced useful information regarding when to suspect rheumatoid arthritis. For more information visit: 
cks.nice.org.uk/rheumatoid-arthritis#!diagnosis

Arthritis Research UK have useful information on assessment of the musculoskeletal system. For more information visit: 
www.arthritisresearchuk.org/health-professionals-and-students/student-handbook/intro-to-msk-assessment.aspx

Several blood tests can be useful in suspected rheumatoid arthritis. Inflammatory markers are typically raised. Rheumatoid factor can also be measured as this provides prognostic information but it is not diagnostic. Asymptomatic patients with a positive rheumatoid factor do not necessarily have RA as false positives can occur. A negative result does not exclude the diagnosis and patients with the typical features but negative serology are termed ‘seronegative rheumatoid arthritis’. Baseline full blood count, liver and renal function is useful in planning medical therapy. Patients seen in rheumatology clinics will typically have x-rays of their hands and feet to look for radiological evidence of erosive disease that is important for prognosis.

For more information on investigations in rheumatoid arthritis visit:
NICE cks.nice.org.uk/rheumatoid-arthritis#!diagnosissub:2

Arthritis Research UK www.arthritisresearchuk.org/health-professionals-and-students/student-handbook/investigations.aspx

Suspected cases of rheumatoid arthritis should be referred to a rheumatologist for further evaluation and initiation of treatment.  Most rheumatology departments will aim to see patients within 8 weeks of referral as patients who are diagnosed and treated early have been shown to have better long term outcomes.

For more information  on national guidance and local rheumatology visit:
NICE www.nice.org.uk/guidance/CG79

University Hospitals Bristol NHS Foundation Trust www.uhbristol.nhs.uk/for-clinicians/our-clinical-services/adult-rheumatology/

North Bristol NHS Trust www.nbt.nhs.uk/our-services/a-z-services/rheumatology/rheumatology-services

Royal National Hospital for Rheumatic Diseases www.rnhrd.nhs.uk/our-services/rheumatology/referring-to-us