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Crystal Arthritis – Gout and CPPD (pseudogout)

ADULT

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.


Rheumatoid Arthritis

  • Concerns for septic arthritis
  • Complications of disease or therapy requiring emergent review – systemically unwell

Peripheral Spondyloarthritis - Psoriatic arthritis and Reactive arthritis

  • Concerns for septic arthritis
  • • Complications of disease or therapy requiring emergent review – systemically unwell

Axial Spondyloarthritis – Ankylosing Spondylitis

  • Concerns for septic arthritis
  • Complications of disease or therapy requiring emergent review – systemically unwell

Crystal Arthritis – Gout and CPPD (pseudogout)

  • Concerns for septic arthritis
  • Severe drug reaction to Allopurinol

Polymyalgia Rheumatica

  • Complications of disease or therapy requiring emergent review – systemically unwell

Connective Tissue Disease - SLE, Scleroderma, MCTD, Sjogren’s Syndrome and undifferentiated or overlap CTDs

  • Complications of disease or therapy requiring emergent review – systemically unwell

Myositis - polymyositis, dermatomyositis, CTD associated myositis and undifferentiated inflammatory myositis

  • Complications of disease or therapy requiring emergent review – systemically unwell

Vasculitis

  • Complications of disease or therapy requiring emergent review – systemically unwell

Giant Cell Arteritis/Temporal Arteritis

  • Presentation to ED if visual disturbance or loss
  • Complications of disease or therapy requiring emergent review
  • Refer to local Healthpathways or local guidelines

Patient resources

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • No defined category 1 criteria
  • Category 2
    (appointment within 90 calendar days)
    • Polyarticular gout
    • Recurrent gout despite treatment, with any of the following:
      • maximum tolerated allopurinol dose
      • allopurinol intolerance
    • Chronic tophaceous gout
    • CPPD
  • Category 3
    (appointment within 365 calendar days)
    • No defined category 3 criteria

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • History of onset and time of gout onset, recurrence, joints involved (swelling, pain, morning stiffness, number of joints involved and location)
  • Details of treatments offered (if available)
  • FBC, E/LFT, Urate, CRP and ESR

3. Additional referral information Useful for processing the referral

  • Synovial fluid microscopy with cell count and crystal analysis
  • Interference with activities of daily living and working ability
  • Imaging of joints (XR/CT/MRI results)
  • Other screening previously performed including rheumatoid factor and anti-CCP (if available)

4. Request

Patient's Demographic Details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
  • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

  • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

  • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.