Croydon University Hospital Early Inflammatory Arthritis Clinic
Referral Proforma
Patient name
Patient identifier
Patient address and phone number
GP name, address and phone/fax number
Essential Criteria for referral
Swelling of two or more joints
yes □no□
Symptoms for more than 3 weeks but less than 1
year
yes □no □
Desired criteria for referral
Early morning stiffness greater than 30 minutes
yes □no □
Swelling of the small joints of the hands, wrists
and or feet
yes □ no□
Tests to be done before appointment
Do not delay referral for the results of the
above tests as these may be normal in Early
Inflammatory Arthritis.
Bloods
FBC□ U+E□ LFT□ ESR□ CRP□ RF□ ANA□
X-rays
Hands □ Feet□ Chest□
Criteria for referral to early arthritis clinic
Essential

2 or more joints affected

Symptoms present for more than three weeks but less than 1 year
Desirable

Swelling of small joints of the hands, wrists or feet

Early morning stiffness of more than 30 minutes
Other features suggestive of inflammatory arthritis include

constitutional upset e.g. loss of appetite, weight loss, fatigue

extra articular features such as psoriasis, iritis, uveitis or inflammatory bowel disease

positive MCPJ or MTPJ squeeze
Blood tests to be done – can be normal please do not delay referral for the results

FBC

U+E’s

LFT’s

ESR

CRP

RF

ANA
X-rays to do (chest x-ray should be normal x-rays of hands and feet can be normal)

hands x-ray

feet x-ray

chest x-ray
Do not delay referral for the results of the above tests.
Refer urgently if symptoms have been present for 3 weeks or longer and there is more than 1 joint
affected, the small joints of the hands are affected or there is a positive MTPJ or MCPJ squeeze.
Croydon University Hospital Rheumatology department is setting up a new early arthritis
clinic. Early inflammatory arthritis and rheumatoid arthritis should be priorities. This is
because:

They are preventable causes of disability. Time is of the essence in early disease
because delays lead to joint damage and disability. The NICE RA management
guidelines recommend seeing patients early and treating intensively to prevent
disability (NICE CG79, 2009). However, only 10% of patients are put onto
DMARDs within 3 months of symptom onset (NAO, 2009).

They are very common conditions; IA affects over 1,000,000 people in England,
(NAO, 2009; RCP, 2011). Many patients with inflammatory arthritis are young
and of working age.

High costs for the U.K. NHS costs are rising rapidly. The cost of RA alone to the
UK economy is almost £8 billion a year (DH drug costs 2011, NRAS, 2010)
Recent Best Practice Tariffs from the Department of Health in conjunction with the British
Society of Rheumatology have four different aspects to rapidity and nature of treatment.

People referred with suspected early inflammatory arthritis (EIA) should have their
first specialist appointment within three weeks of their referral date. 

Within six weeks of referral, diagnostic testing and any necessary clinical reviews
should be completed. By the end of these six weeks, people who do not have EIA
should be discharged back to the care of their GP, and people who have EIA should
have received their first prescription for disease-modifying therapy.

Every person diagnosed with EIA should receive an annual review, within one year of
the date of referral.

During their first year of care, people diagnosed with EIA should have regular clinical
reviews with monitoring of disease activity, therapeutic benefit and treatment safety
in line with published National Institute for Health and Clinical Excellence (NICE) and
BSR guidance.
Given all these recent developments, we have set up a dedicated fax number for early
arthritis for any patients who meet the criteria set out above. We aim to see these patients
within three weeks and start them on DMARDs within 6 weeks or discharge them back to
your care.
Referrals should be made using the proforma and a standard referral letter.
Rheumatology Consultant
Department of Rheumatology
Croydon University Hospital
530 London Road
Surrey CR7 7YE
Fax Number 020 8401 3407