Too many patients with suspected Early Inflammatory Arthritis (EIA) are being referred to routine rheumatology outpatients rather than into a dedicated EIA Clinic. This delays their diagnosis and treatment which puts their long-term health at risk.
Early treatment with modern DMARDs (disease modifying anti-rheumatic drugs) significantly reduces long term morbidity and disability. This should preferably be within three months of the onset of symptoms.
1. GHFT’s dedicated Early Inflammatory Arthritis Clinic aims to see all referrals within 3 weeks, to confirm the diagnosis where possible and to commence therapy at the earliest opportunity.
2. In suspected EIA, follow this pathway and refer the patient to the Early Inflammatory Arthritis Clinic.
The term 'inflammatory arthritis' describes a range of rheumatological conditions - predominantly autoimmune - which cause joint pain, swelling and stiffness. Included in this group is rheumatoid arthritis where evidence shows that early diagnosis, treatment and control of disease activity result in more rapid improvement in symptoms and function as well as reduction in joint damage.
In its early stages it can be difficult to diagnose with any degree of certainty. Early specialist assessment is therefore an essential ingredient if maximal long term control of the disease or a potential cure is to be achieved.
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Early Inflammatory Arthritis Pathway
Diagnosing rheumatoid arthritis early can be straightforward, but can also be tricky and complex. It requires:
The term ‘inflammatory arthritis’ describes a range of predominantly autoimmune rheumatological conditions that cause joint pain, swelling and stiffness.
Included in this group is rheumatoid arthritis where evidence shows that early diagnosis, treatment and control of disease activity results in more rapid improvement in symptoms and function as well as a reduction in long joint damage.
If Early Inflammatory Arthritis is suspected on clinical grounds it cannot be reliably excluded by normal inflammatory markers and/or a negative rheumatoid factor.
Research evidence shows that early treatment of inflammatory arthritis leads to better disease control, less joint damage and disability and improved long-term prognosis.
Refer suspected EIA to a rheumatologist promptly (using the above criteria), depending on the local referral pathway.
The GHFT Early Inflammatory Arthritis (EIA) Clinics at Gloucestershire Hospitals NHS Foundation Trust have been running since April 2013. The clinic’s focus is the early diagnosis and treatment of patients referred with suspected inflammatory arthritis, aiming to start treatment within three months of onset of symptoms.
A delay in referral can mean more damage to the joints and potentially the need for surgery. Early diagnosis within secondary care is deemed very important in proactively managing the condition in order to minimise or prevent disability and enable them to continue to work.
Please see the National and NICE Guidance section.
Significant Variations for this Pathway
There are no significant variations from the national standards.
Please see the GP Education section.
|Gill Coombes||Consultant Rheumatologist||Gloucestershire Hospitals NHS Foundation Trustemail@example.com|
|Hein Le Roux||GP Principal||NHS Gloucestershire Clinical Commissioning Groupfirstname.lastname@example.org|
|Ruth Hallett||Project Manager||NHS Gloucestershire Clinical Commissioning Groupemail@example.com|
To reduce the number of patients being referred to routine rheumatology clinics who need early assessment for suspected EIA.