Crystal arthritis (gout)

Crystal arthritis (gout) — referral criteria for Rheumatology services.

Full SRC reference

Eligibility

At least one must be met for the patient to be eligible for referral.

Clinically suspected or confirmed crystal arthritis (gout) with initial primary-care work-up completed

Red flags

Indicate urgent (Category 1) referral or emergency assessment.

Patients with acutely painful, hot, swollen joint(s) especially if febrile

Suspected sepsis in a patient with previously diagnosed gout

Routine referral criteria

Determine Category 2 or 3 urgency.

Suspected gout in premenopausal women or men younger than 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)

Gout that has previously been diagnosed with any of the following — symptoms despite maximum tolerated allopurinol dosage

Gout that has previously been diagnosed with any of the following — progressive joint damage despite medical management

Gout that has previously been diagnosed with any of the following — compromised renal function: glomerular filtration rate (GFR) less than 30 mL/min/1.73m2

Gout that has previously been diagnosed with any of the following — solid organ transplant

Gout that has previously been diagnosed with any of the following — complex comorbidities

Usually managed in primary care

Asymptomatic hyperuricaemia
A single attack of gout
Previously diagnosed gout that is adequately managed
Recurrent episodes of gout without the use of rate lowering therapy