Crystal Arthritis (gout)

Emergency

• Exclusion of infection (hot, red, swollen joint with pyrexia) can be difficult clinically and may require urgent assessment e.g. via DEM for diagnostic joint aspiration.

If you, or someone else, are experiencing a serious and life-threatening injury or illness call triple zero (000) immediately or go to the nearest Emergency Department.

Learn more about when to access emergency care and non-emergency care options if the injury or illness is not serious or life-threatening.

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

Information to be included in the referral

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

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

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