Joint Pain

Emergency department referrals

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) 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*

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • 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)
  • 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, eg inflammatory bowel disease, uveitis, new rashes, etc
  • Joint deformity / loss of range of movement
  • A child currently in out of home care (OOHC) or at risk of entering or leaving OOHC, where they have previously been on a waiting list for this problem and were removed without receiving a service

Category 2

Appointment within 90 days is desirable

  • 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 days is desirable

  • Known chronic musculoskeletal condition that is unlikely to deteriorate

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

  • 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
  • Clinical urgency is the dominant consideration in the prioritisation of a referral for a child currently in out of home care (OOHC), or at risk of entering or leaving OOHC.

Referral requirements

A referral may be rejected without the following information.

  • 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)

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 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, Youth Justice and Multicultural Affairs 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 FBC ESR ELFT
    • consider rheumatologic and serological investigations for autoimmune or post infectious causes if appropriate. These investigations are not required for categorisation

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

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

Send referral

Hotline: 1300 364 938

Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs

Metro North Central Patient Intake
Aspley Community Centre
776  Zillmere Road

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