Direct to an emergency department for:

  • Patients with acutely painful, hot, swollen joint(s) especially if febrile.
  • Suspected sepsis in a patient with previously diagnosed gout. 

Criteria for referral to public hospital specialist clinic services

  • Suspected gout in premenopausal women or men < 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) < 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.