When should I consider referring a patient with reactive arthritis to a rheumatologist?

Consider referring a patient with reactive arthritis to a rheumatologist if:

• They have persistent synovitis or inflammatory arthritis symptoms that do not resolve after initial infection treatment.
• There is involvement of multiple joints or small joints of the hands or feet.
• Symptoms have lasted longer than 3 months or there is diagnostic uncertainty.
• They present with features suggestive of spondyloarthritis, such as enthesitis without mechanical cause, dactylitis, or extra-articular manifestations like uveitis or psoriasis.
• There is a history of recent gastrointestinal or genitourinary infection triggering arthritis symptoms.

Initial management includes treating the triggering infection and offering NSAIDs at the lowest effective dose for symptom control while awaiting specialist assessment. Long-term antibiotic treatment solely for reactive arthritis is not recommended. Referral should not be delayed by normal blood tests or pending results. Glucocorticoids should not be prescribed in primary care before specialist assessment as they may mask key clinical features.

Urgent referral is indicated if there are signs of new-onset inflammatory arthritis or if extra-articular features such as acute anterior uveitis are suspected.

These recommendations align with the NICE guidance on spondyloarthritis and reactive arthritis management.

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