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

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

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