Recognise suspected rheumatoid arthritis. Refer early.
A practical guide for GPs assessing adults with possible rheumatoid arthritis or persistent joint inflammation.
Clinical decision support only. This checklist does not diagnose rheumatoid arthritis or replace clinical judgement. It is a referral aid, not a validated scoring system, and it does not produce a score, probability or risk rating.
Suspected rheumatoid arthritis warrants rheumatology referral
Based on the Malaysian Ministry of Health clinical practice guideline on the management of rheumatoid arthritis. Supporting findings include:
- Four or more swollen joints.
- MCP or MTP involvement with a positive squeeze test.
- Morning stiffness lasting over 30 minutes.
- Persistent synovitis without an established explanation.
These are supporting findings, not a requirement to tick multiple boxes. Investigations should not hold up referral, and there is no minimum symptom duration before referring.
Malaysian MOH CPG — Management of Rheumatoid Arthritis, Section 6 (printed pages 10–11)Persistent synovitis: when to prioritise referral
For adults with suspected persistent synovitis of unexplained cause, urgent referral is indicated when the small joints of the hands or feet are involved, when more than one joint is involved, or when the delay from symptom onset to seeking medical advice is three months or longer.
Normal inflammatory markers and negative rheumatoid factor or anti-CCP must not downgrade this recommendation, and investigations must not hold up referral.
NICE is presented here as supplementary international guidance, not a Malaysian service standard.
NICE NG100 — Recommendation 1.1.1What is the MCP/MTP squeeze test?Show
- MCP joints are the knuckles where the fingers meet the hand.
- MTP joints are where the toes meet the foot.
- A clinician applies gentle lateral compression across these joint regions and records whether it provokes pain.
- A positive result can support suspicion of local inflammation but is not specific to rheumatoid arthritis.
- A negative result cannot exclude inflammatory arthritis.
This records a clinician-performed examination. It is not a patient self-test.
Squeeze-test diagnostic accuracy (PubMed)Suspected RA? GP referral checklist
Answers are processed in your browser only. Nothing is saved, sent or added to a link. Please keep this version free of patient names, identity numbers, phone numbers and addresses.
Acute joint assessment
Answer this before the rest of the checklist.
Patient and clinical suspicion
Joint findings
MCP/MTP squeeze test
Record the clinician-performed examination for each site.
Investigations (optional)
Results never override a clinical referral indication, and referral should not wait for them.
Clinical notes (optional)
Functional impact, extra-articular features, comorbidities, current medication and available investigations. Do not enter identifying details.
No referral indicators identified from the entered answers
This does not exclude inflammatory arthritis. Reassess persistent, recurrent or worsening symptoms and refer if clinical suspicion remains.
Unanswered items are treated as unknown, never as negative. Missing:
- Acute joint safety check
- Adult patient confirmation
- Clinical suspicion of rheumatoid arthritis
- Suspected persistent synovitis
- Number of swollen joints
- Delay from symptom onset to seeking advice
- Squeeze-test findings
GP REFERRAL CHECKLIST — SUSPECTED RHEUMATOID ARTHRITIS Dr. Ramani Rheumatology Clinic · drramani.co Clinical decision support only. Not a diagnosis and not a validated score. RECOMMENDATION No referral indicators identified from the entered answers This does not exclude inflammatory arthritis. Reassess persistent, recurrent or worsening symptoms and refer if clinical suspicion remains. SAFETY CHECK - Acutely hot/swollen/severely painful joint or concern for infection: Not answered CLINICAL ASSESSMENT - Adult patient (18+): Not answered - Clinical suspicion of rheumatoid arthritis: Not answered - Suspected persistent synovitis of unexplained cause: Not answered JOINT FINDINGS Joint regions affected: - Not answered - Number of swollen joints: Not answered - More than one joint with suspected synovitis: Not answered - Morning stiffness: Not answered - Symptom duration: Not answered - Delay from onset to seeking advice: Not answered MCP/MTP SQUEEZE TEST (clinician-performed) - Right hand (MCP): Not answered - Left hand (MCP): Not answered - Right foot (MTP): Not answered - Left foot (MTP): Not answered INVESTIGATIONS - RF: Not answered - Anti-CCP: Not answered - ESR: Not answered - CRP: Not answered Laboratory results do not override a clinical referral indication. CLINICAL NOTES None entered UNANSWERED ITEMS (treated as unknown, not negative) - Acute joint safety check - Adult patient confirmation - Clinical suspicion of rheumatoid arthritis - Suspected persistent synovitis - Number of swollen joints - Delay from symptom onset to seeking advice - Squeeze-test findings
Contacting the clinic on +601145798121 opens a blank professional enquiry. Checklist answers are never attached, and no clinical answers are placed in the link.
Sources behind this guide
- Malaysian MOH — Management of Rheumatoid Arthritis, Section 6 (printed pages 10–11)
- NICE NG100 — Recommendation 1.1.1
- Squeeze-test diagnostic accuracy (PubMed)
- NHS — Septic arthritis
The interactive checklist is a website implementation informed by these sources. It is not an officially validated MOH or NICE tool.