Referral to emergency

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.

  • septic arthritis – consult local orthopaedic team
  • lower limb joint pain and associated inability to weight bear
  • joint pain in a child from a population at high risk of acute rheumatic fever - Aboriginal and Torres Strait Islander children

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Women's and Children's Health Network

Exclusions

  • reactive arthritis of less than 4 weeks duration

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • evidence of synovitis, arthritis or joint erosion on imaging
  • joint pain with elevated inflammatory markers that are otherwise unexplained
  • joint pain accompanied by symptoms or history of other inflammatory disease
    • inflammatory bowel disease, uveitis, new rashes
  • joint deformity / decreased range of movement

Category 2 (appointment clinically indicated within 90 days)

  • undiagnosed cause of joint or musculoskeletal pain that is not listed in category 1
  • pain with significant functional impairment on the child and family

Category 3 (appointment clinically indicated within 365 days)

  • nil

For information on referral forms and how to import them, please view general referral information.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. 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.

  • identifies as Aboriginal and/or Torres Strait Islander  
  • identify within your referral if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf
  • interpreter required
  • history of presenting complaint:
    • duration and frequency of symptoms
    • pattern of pain — overnight waking with pain, morning pain, pain with exercise, early morning stiffness
    • aggravating and relieving factors
    • treatments used/sought so far including response to nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy or any other treatments
    • symptoms — bony tenderness or swelling
  • examination findings
    • reduced range of motion
    • deformity
    • swelling
    • evidence of lymphadenopathy, pharyngitis, otitis or other recent infection

Additional information to assist triage categorisation

  • relevant diagnostic/imaging reports including location of company and accession number
  • any blood test results if available

Clinical management advice

  • consider non-steroidal anti-inflammatory drugs for symptom relief unless contraindicated
  • antibiotics may be required if the original infection is bacterial in origin
  • generally, no other specific management is required prior to assessment
  • in children, the most common cause of reactive arthritis is post-viral

Clinical resources

Consumer resources