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NICE rheumatoid arthritis guidance urges GPs to refer quicker

By Nigel Praities

GPs are being urged to assess and refer patients with suspected rheumatoid arthritis onto specialists quicker, even if blood tests are inconclusive.

Under new guidelines published by NICE, GPs are encouraged not to avoid referring any patient with suspected persistent synovitis, with an urgent referral required if patients have had symptoms for more than three months.

A King's Fund report published in January warned GPs delayed referring patients with rheumatoid arthritis because early indicators of the condition were missed and the importance of rapid therapy to prevent damage to joints was not understood.

This new guideline will put pressure on GPs to refer as soon as possible, even if tests for rheumatoid factor come back negative or patients have a normal acute-phase response.

It also warns an urgent referral is required if any of the small joints of the feet and hands are affected or more than one joint is affected, and calls for annual reviews for all patients with rheumatoid arthritis.

Dr Louise Warburton, a musculoskeletal GPSI who works in Shropshire and GP advisor of the NICE guideline development group, said it was essential GPs referred early to prevent further joint damage.

‘GPs don't need to have any hard signs, but if there is a suspicion that there is anything inflammatory going on then just refer. GPs should also educate patients and be aware that they might delay in presenting to them,' she said.

Dr Warburton said there would be some ‘argument' over who did the annual checks for patients between specialists and GPs.

‘Each person will probably argue about who should do the follow-ups because of the workload, but it should be done by specialists as it is not in QOF and there are no protocols GPs can work to,' she argued.

Dr Ian Gilchrist, a GP in Hatfield Heath, Essex, and president of the Primary Care Rheumatology Society, welcomed the guidance but warned it would put pressure on specialist services.

‘This will have some implications for hospital services, especially as they have to work within the 18 week time-scale,' he said.

New NICE guidance urges GPs to refer to specialists even if blood tests for rheumatoid arthritis are inconclusive

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