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Crystal Arthritis (Gout) Referral Access Criteria

Crystal Arthritis (Gout) Referral Access Criteria

Referrers should use this page when referring patients to public adult rheumatology outpatient services for Crystal Arthritis - Gout and Calcium Pyrophosphate Deposition.
Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
  • Concerns for septic arthritis/sepsis
  • Severe drug reaction to Allopurinol
  • Patients with acutely painful, hot, swollen joint(s) especially if febrile
  • Acute rheumatic fever
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate rheumatology assessment (seen within 7 days):
  • Nil

To contact the relevant service, see HealthPathways: Acute Rheumatology Assessment (external site).
Presenting issues
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • Suspected gout in premenopausal women or men aged <40 years
  • Tophaceous gout with progressive joint damage, active symptoms or growing tophi despite medical management
  • Gout that has previously been diagnosed with any of the following:
    • Allopurinol intolerance (e.g. rash, hepatitis)
    • Symptoms despite maximum tolerated allopurinol dosage
    • Progressive joint damage despite medical management
    • Compromised renal function: glomerular filtration rate (GFR) < 30 mL/min/ 1.73m2
Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test due to financial reasons or geographical location).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History
  • Relevant history, onset, duration and severity of symptoms including:
    • Joints involved (swelling, pain, morning stiffness, number of joints involved and location)
    • Whether presence of swelling/tenderness/synovitis
  • Current medication list
  • Any known allergies
  • Details of previous treatment and outcome
Examination
  • Nil
Investigations
  • FBC
  • U&Es
  • LFTs
  • Uric acid
  • CRP
  • ESR
  • XR or MRI/CT of affected joints
Highly desirable
History
  • Impact on ADLs and working ability
  • Other screening previously performed including rheumatoid factor and anti-CCP
  • Results of previous joint aspirations
Examination
  • Nil
Investigations
  • Synovial fluid microscopy with cell count and crystal analysis
  • Cancer screening if applicable
Indicative triage category

Category 1

Appointment within 30 days

  • No defined category 1 criteria 

Category 2

Appointment within 90 days

  • Polyarticular gout
  • Recurrent gout despite treatment, with any of the following:
  • Maximum tolerated allopurinol dose
  • Allopurinol intolerance
  • Chronic tophaceous gout
  • Calcium Pyrophosphate Deposition (CPPD)/pseudogout

Category 3

Appointment within 365 days

  • No defined category 3 criteria
Exclusions
  • Crystal Arthritis (gout):
    • Excluded condition when the following features apply:
      • Asymptomatic hyperuricaemia
      • A single attack of gout
      • Previously diagnosed gout that is adequately managed
      • Previously diagnosed gout without prophylactic treatment
Useful information
Last reviewed: 18-03-2024
wa.gov.au