Crystal Arthritis (e.g. gout)

Availability

North South North West Statewide

Pre-referral work-up

History

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.

Tests

  • FBE
  • U&E + LFT
  • ESR and CRP
  • Uric Acid
  • Consider joint aspiration (Looking for crystals)
  • X-ray of affected joint/s if relevant

Interim/GP management

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

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED
– Phone: (03) 6777 6405  Fax: (03) 6348 7382
MCH ED
– Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED
– Phone: (03) 6493 6340  Fax: (03) 6464 1926
RHH ED
– Phone: (03) 6166 6100  Fax: (03) 6173 0489

Urgent:

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.

Semi-urgent:

We will endeavour to see these patients within 12 weeks

Routine:

Next available appointment