Crystal Arthritis (e.g. gout)

This condition is treated in the Rheumatology clinic.

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 the 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 HealthPathways Tasmania website.

Patient information advice is found at Arthritis Australia

Clinic appointments

🚩 Red location flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Urgent (Category 1)

🚩 Acute, hot, swollen joint with systemic features (fever) where septic arthritis needs exclusion

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 (Category 2)

Recurrent acute joint episodes

Chronic tophaceous gout

Availability

North

Refer to General Medicine

North West

Refer to General Medicine

South

Wellington Clinics (Level 10)
Phone: 03 6166 0000
Fax: 03 6234 3982