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.
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.