Joint Pain

PAEDIATRIC

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

    • Acute joint pain with fever
    • Acute joint pain unable to weight bear
    • Lower limb joint pain persistently unable to weight bear
    • Joint pain in a child from a population at high risk of acute rheumatic fever*

    *Refer also to Rheumatic Heart Disease CPC

    • Refer to local HealthPathways or local guidelines
    • Children with hip pain and potential orthopaedic diagnosis (e.g. perthe's disease, slipped epiphysis, hip dysplasia and others) should be referred directly to orthopaedics/local pathways
    • Focal bony lesions are unusual in rheumatology and referral to other specialities should be considered
    • In the majority of cases, it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
    • Next of kin or person(s) who is legally responsible for patient consent, with the exception of children under guardianship orders with the Department of Child Safety, Seniors and Disability Services, should be present at the first outpatient appointment.
    • If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services
    • Statement of intent – the prioritisation of health services for children and young people in the child protection system
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Suspected hip dysplasia in an infant <6 months
  • History of joint pain without current arthritis where ARF is considered as a possible diagnosis (if current see as emergency) see Rheumatic Heart Disease CPC
  • 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, e.g. inflammatory bowel disease, uveitis, new rashes, etc
  • Joint deformity / loss of range of movement
  • A child:
    • at risk of entering the child protection system (0 – 18 years of age)
    • currently in out of home care (OOHC) (0 – 18 years of age), or
    • Adolescents transitioning to adult healthcare following an out of home care experience (15 – 25 years of age)

    where they have previously been on a waiting list for this problem and were removed without receiving a service
Category 2
(appointment within 90 calendar days)
  • Undiagnosed cause of joint or musculoskeletal pain that is not listed in Category 1
  • Children with hip pain following orthopaedic consultation and excluding orthopaedic conditions
Category 3
(appointment within 365 calendar days)
  • Known chronic musculoskeletal condition that is unlikely to deteriorate
  • Joint hypermobility without evidence of underlying connective tissue disorder

Please insert the below information and minimum referral criteria into referral

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 joint symptoms. Note duration, joints or regions involved
  • Report presence or absence of concerning features
    • Persistent fevers
    • Weight loss (how much?)
    • Rash
    • Diarrhoea or bloody stools
    • Abdominal pain
    • Focal neurological signs
    • Muscle wasting
    • Recent visual symptoms e.g. photophobia, erythema, blurring
  • Confirmation of OOHC (where appropriate)

3. Additional referral information Useful for processing the referral

Highly desirable Information – may change triage category.

  • Detailed history of joint pain - diurnal or day to day variation, exercise symptoms
  • Family history of joint problems, autoimmune disease or inflammatory bowel disease
  • Recent respiratory or skin infections or systemic viral illness
  • Physical examination including heart sounds if rheumatic fever or post streptococcal arthritis considered
  • Burden of disease; school missed, ability to participate in usual activities, dependency for activities of daily living/hygiene/dressing
  • Joint examination findings – swelling, range of motion, erythema, heat

Desirable Information- will assist at consultation

  • Other past medical history
  • Immunisation history
  • Developmental history
  • Medication history
  • Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, Department of Children, Safety, Seniors and Disability Services involvement)
  • Height/weight/head circumference and growth charts with prior measurements if available.
  • Other physical examination findings inclusive of CNS, birth marks or dysmorphology
  • Investigations as appropriate to clinical presentation:
    • consider XR of hips or knees if involved
    • consider joint ultrasound if synovitis / effusion / arthritis suspected
    • consider FBC, ESR, ELFT, CRP
    • consider rheumatologic and serological investigations for autoimmune or post infectious causes if appropriate. These investigations are not required for categorisation

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.)

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

    • 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.

Last updated: 4 December 2024

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