Medicine · Referral letter · Task 3

Inflammatory joint symptoms with functional decline

You are a GP at Oakfield Surgery. Today is 24 September 2026. Using the case notes, write a referral letter to Dr Farah Rahman, Consultant Rheumatologist, Oak Hospital, 9 Acorn Street, Fairford. Request expedited assessment and preserve the significance of persistent symptoms despite a negative test. Write approximately 180-200 words in the body of your letter.

Patient: Samuel Price, born 17 September 1972

Case notes

• N01Patient: Samuel Price; eight weeks of pain and swelling in both hands; morning stiffness around 90 minutes; difficulty fastening buttons.
• N02Examination today: swelling and tenderness at several small joints of both hands; no injury history; symptoms interfere with work using tools.
• N03Investigations: inflammatory markers above laboratory reference ranges; rheumatoid factor negative; copies attached; no confirmed diagnosis.
• N04History: type 2 diabetes on stable treatment; current medicine list attached; no known drug allergies.
• N05Plan: expedited rheumatology assessment requested under local pathway; no disease-modifying treatment started; GP to continue existing symptom plan pending specialist advice.
• N06Patient concern: assumes negative rheumatoid factor excludes inflammatory disease; GP explained result must be interpreted with symptoms and examination.
• N07Practical: can attend short-notice appointment; wishes to remain at work; partner helps with buttons.
• N08Other: restores old bicycles; annual eye check booked separately; moved house three years ago.