Crystal Arthritis (e.g. gout)
North South North West Statewide
Referral for recurrent gout which is chronic, polyarticular, tophaceous or if diagnosis is uncertain. Consider pseudogout (calcium pyrophosphate arthropathy).
All referrals should comply to referral standards and include in particular:
- History of onset, recurrence, acuity, joints involved and extra-articular features
- Co-morbidities including alcohol intake and medications and need to remain on that medication.
- Detail previous therapies tried and effects
Please note: Exclusion of infection (hot, red, swollen joint with pyrexia) can be difficult clinically and may require urgent assessment eg via DEM for diagnostic joint aspiration.
- U&E + LFT
- ESR and CRP
- Uric Acid
- Consider joint aspiration (Looking for crystals)
- X-ray of affected joint/s if relevant
To refer a patient with this condition, please see the Rheumatology clinic page for the full referral process and templates.
Consider NSAIDS or colchicines for acute symptoms.
Consider prophylaxis with allopurinol or probenecid. NB caution in CKD3b-4.
Dietary modification (particularly alcohol intake) – information available on Arthritis Australia website.
Modifying medication regimen that might contribute to gout.
Increased fluid intake.
For more information please see the Tasmanian Health Pathways website.
Urgent / category 1
Acute, hot, swollen joint with systemic features (fever) where septic arthritis needs exclusion
Semi-urgent / category 2
Recurrent acute joint episodes
Chronic tophaceous gout
Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.
Patient information advice is found at Arthritis Australia
Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 8302 Fax: (03) 6777 5201
MCH ED – Phone: 0409 867 492 Fax: (03) 6441 5923
NWRH ED – Phone: 0459 848 725 Fax: (03) 6464 1926
RHH ED – Phone: (03) 6166 6101 Fax: (03) 6173 0489
Please discuss with registrar or consultant. We will endeavour to see these patients within four weeks.
Urgent referrals (e.g. temporal arteritis, septic arthritis) should be accompanied by a phone call to the Rheumatology Registrar or Consultant for urgent assessment, or patient should be directed to the Emergency Department.
We will endeavour to see these patients within 12 weeks
Next available appointment