Referral Proforma: Royal Free Early Inflammatory Arthritis Clinic This is a Rapid Access Clinic with access to ultrasound for the early diagnosis and management of suspected rheumatoid arthritis only. Referrals will only be accepted if the patient meets a minimum of 3 of the following criteria: Please tick box 1. Symptom duration ≥ 4 weeks □ 2. Tenderness and/or swelling at ≥ 2 joints (not including DIP, 1st CMC or 1st MTP joints) □ 3. Involvement of the small joints (hands, feet, wrists) □ 4. Positive Rheumatoid Factor or Anti-CCP antibodies □ 5. Elevated Inflammatory Markers □ Please undertake the following investigations at the Royal Free Hospital or if done elsewhere please give the patient a copy of the results to bring to their clinic appointment. Please tick box FBC, U&E, LFT □ ESR, CRP □ Rheumatoid Factor, Anti-CCP antibodies □ ANA □ Xray hands, feet (only if affected & done at Royal Free) □ Patient Name Address NHS Number Telephone Number GP Name Address Telephone Number Signature Please either attach completed form to ‘choose and book’ referral or alternatively Fax for attention of Dr Pamela Mangat: Fax 0207 830 2428, Tel 0207 830 2284