referral criteria from primary care - suspected rheumatoid arthritis (RA)

Last edited 10/2018 and last reviewed 01/2023

Refer for specialist opinion any adult with suspected persistent synovitis of undetermined cause.

Refer urgently (even with a normal acute-phase response, negative anti-cyclic citrullinated peptide [CCP] antibodies or rheumatoid factor) 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 adviceNotes:
  • suggested nvestigations
    • rheumatoid factor in people with suspected RA who are found to have synovitis on clinical examination
    • 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
    • x-ray the hands and feet early in the course of the disease in people with persistent synovitis in these joints


  1. NICE (July 2018). Rheumatoid arthritis- The management of rheumatoid arthritis in adults