What criteria should I use to refer a patient with rheumatoid arthritis to a specialist for further management?

Refer adults with suspected persistent synovitis of undetermined cause to a rheumatologist for an appointment within 3 weeks of referral ¹.

Urgently refer, within 3 working days of presentation, if any of the following apply: small joints of the hands or feet are affected, more than one joint is affected, or there has been a delay of 3 months or longer between symptom onset and seeking medical advice ¹.

Do not delay referral based on blood test results, even if they are normal or pending ¹.

Consider offering a nonsteroidal anti-inflammatory drug (NSAID) at the lowest effective dose until a rheumatology appointment is available, but do not prescribe glucocorticoids before specialist assessment ¹.