Synopsis
Recognise persistent synovitis and spondyloarthritis signals in first-contact care, exclude immediate infection, and secure the correct specialist route without waiting for serology, inflammatory markers or radiographic damage.
- Refer suspected persistent synovitis affecting more than 1 joint or the small joints of the hands or feet to rheumatology within 3 working days of primary-care presentation; refer every persistent synovitis of uncertain cause without waiting for normal inflammatory markers, negative serology or normal early radiographs.
- Refer rheumatoid-pattern synovitis even when CRP, ESR, RF and anti-CCP are normal and early radiographs show no erosion.
- For suspected axial or peripheral spondyloarthritis, use age at onset, inflammatory back pain, enthesitis, dactylitis, psoriasis, uveitis, bowel disease and family history rather than HLA-B27 alone.
Key red flags
Acute severe monoarthritis with fever, immunosuppression, skin infection or a prosthesis requires urgent acute-team sampling and specialty management instead of routine referral.
Investigation priorities
Provide the core evidence for inflammatory-arthritis triage and a baseline for specialist review.
Management branches
Persistent synovitis exists without current sepsis or organ-threatening features.
- Map swollen joints, function and extra-articular findings; offer RF and, after a negative result, consider anti-CCP for a rheumatoid phenotype while obtaining baseline bloods.
- Send the referral without awaiting tests. For suspected persistent synovitis affecting more than 1 joint or the small joints of the hands or feet, refer within 3 working days of primary-care presentation; also mark it urgent under NG100 when symptoms began at least 3 months before medical advice was sought.