Adults
Positive anti-CCP or high-titer RF with joint pain, no swelling
Arthralgia without synovitis but with autoantibodies. These patients are at higher risk of developing RA.
What to look for
- Joint pain, often in the hands, without objective swelling
- Anti-CCP positive (especially high titer) or high-titer RF
- Morning stiffness, difficulty making a fist, or a positive squeeze test raise the risk
What to do
- Examine carefully for synovitis. Any objective swelling makes this an urgent new inflammatory arthritis referral.
- Refer for assessment and, if available, ultrasound. Ask the patient to return promptly if joints swell.
About this urgency level
These benefit from rheumatology input but are not time-critical. Treatment can often begin, or continue, in primary care while the patient waits.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.