Rheumatoid arthritis, NICE guideline

1.1 Referral, diagnosis and investigations

1.1.1 Referral for specialist treatment

1.1.1.1 Refer for specialist opinion any person with suspected persistent synovitis of undetermined cause. Refer urgently 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.

1.1.1.2 Do not avoid referring urgently any person with suspected persistent synovitis of undetermined cause whose blood tests show a normal acute-phase response or negative rheumatoid factor.

1.1.2 Investigations

1.1.2.1 Offer to carry out a blood test for rheumatoid factor in people with suspected RA who are found to have synovitis on clinical examination.

1.1.2.2 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 (see 1.4.1.1).

1.1.2.3 X-ray the hands and feet early in the course of the disease in people with persistent synovitis in these joints. 

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