RA requires early intervention. The NICE quality standard for RA states that people with suspected inflammatory arthritis should be referred to a rheumatology service within three working days of presentation, but this cannot happen until the patient has been seen by their GP. Key symptoms or a medical history that can help to raise suspicion of early inflammatory arthritis include:

• Suspected joint inflammation for four weeks or more, characterised by warm, hot, tender and swollen joints
• Swelling of the small joints of the hands or feet
• Swelling of more than one joint 
• Pain produced by squeezing across the metacarpophalangeal or metatarsophalangeal joints
• Early morning stiffness for more than 30 minutes 
• Pain and/or stiffness worse after periods of rest 
• Constitutional symptoms (e.g. weight loss, anorexia or fatigue)
• Presence of other associated features, including rash, painful red eyes and inflammatory bowel disease
• Family history of autoimmune disease
• Family history of psoriasis
• Recent infection (e.g. diarrhoeal illness or sexually transmitted infection).

Any of these should prompt pharmacy professionals to advise a patient to make an urgent appointment with their GP for further assessment.