ABSTRACT
Patients with synovitis or inflammatory sounding joint pain should be referred to an Early Arthritis Service, even if they have normal inflammatory markers and negative autoantibodies. All blood tests can be normal in patients with rheumatoid arthritis. Immunosuppression from long-term steroids, disease-modifying anti-rheumatic drugs and biological therapies can put patients at higher risk of infection. Giant cell arteritis (GCA) is a sight-threatening medical emergency. Most rheumatology departments will see patients with suspected GCA the same or the following day – start corticosteroids if there are any delays. Polymyalgia rheumatica is characterised by proximal limb girdle stiffness (without weakness), worse in the mornings and improving with exercise/movement – usually in those over 50. If a rheumatological disorder or flare of a known rheumatological condition is suspected, a urinalysis should always be performed as part of the clinical assessment. Inflammatory arthritis, lupus and other connective tissue diseases can occur in children and adolescents.
