Irreversible joint damage can occur within months rather than years of the onset of rheumatoid arthritis.1 It is therefore important that these patients are diagnosed and treated as early as possible. To facilitate the early introduction of effective treatment, a rapid referral system is important. Throughout Europe, a number of centres have developed early synovitis clinics (ESCs) for this purpose. However, the diagnosis of early inflammatory arthritis (IA) is often difficult and confusing for the primary care doctor and experience suggests that the efficiency of ESCs is impaired by inappropriate referrals.2 Is this criticism justified? If general practitioners find it difficult to diagnose early IA, what about hospital …