Urgent RA Referral Timeline — SCE Rheumatology MCQ

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EasyRheumatoid ArthritisUrgent RA Referral TimelineSCE Rheumatology

A 45-year-old woman presents to her GP with persistent symmetrical swelling of the MCP and PIP joints for 10 weeks. The GP makes an urgent referral for suspected persistent synovitis. According to NICE QS33, within what interval from referral should specialist rheumatology assessment occur?

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Correct answer: D — Within 3 weeks

Explanation lettering: B = shown as A · C = shown as B · A = shown as C · E = shown as D · D = shown as E

The correct answer is E: specialist rheumatology assessment within 3 weeks of referral. NICE QS33 uses this interval as a process measure for suspected persistent synovitis. Her polyarticular small-joint synovitis also meets NICE NG100 criteria for urgent referral. Three working days (A) is the quality-standard interval for the GP to make the rheumatology referral after presentation, not for specialist assessment. Six weeks (D) is the target for starting cDMARD monotherapy in adults confirmed to have active rheumatoid arthritis. Three months (C) refers to the recommendation that initial cDMARD treatment should ideally begin within 3 months of the onset of persistent symptoms. A 2-week assessment interval (B) is not the specified NICE rheumatoid arthritis measure.

Reference: NICE. Rheumatoid arthritis in over 16s, QS33, Quality statement 2: Treatment — process measure for specialist assessment within 3 weeks of referral. Updated 2020. https://www.nice.org.uk/guidance/qs33/chapter/Quality-statement-2-Treatment