Crystal arthritis (gout)

Specialty: Rheumatology
Age group: Adult

Criteria for referral to public hospital specialist clinic services

• 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)
  • symptoms despite maximum tolerated allopurinol dosage
  • progressive joint damage despite medical management
  • compromised renal function: glomerular filtration rate (GFR) less than 30 mL/min/1.73m2
  • solid organ transplant
  • complex comorbidities.

Information to be included in the referral

Information that must be provided

• Description of joints affected and onset, characteristics and duration of symptoms
• Frequency of episodes and number of attacks that have occurred within the last 12 months
• Inter-episode blood uric acid levels
• Details of previous medical management including the course of treatment and outcome of treatment
• Relevant medical history
• Current and complete medication history (including non-prescription medicines, herbs and supplements)
• Glomerular filtration rate (GFR).

Provide if available

• How symptoms are impacting on daily activities (e.g. work, study, or carer role)
• Full blood examination results
• Relevant x-rays
• Results of previous joint aspirations.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

Where appropriate and available, the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

• 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.