When should I consider referring a patient with pseudogout to a rheumatologist for further evaluation and management?

When considering referring a patient with pseudogout to a rheumatologist for further evaluation and management, you should consider referral if the diagnosis of the joint condition remains uncertain ²,⁴. Referral is also appropriate for any adult with suspected persistent synovitis of undetermined cause ³,⁵.

It is crucial to assess the possibility of septic arthritis, calcium pyrophosphate crystal deposition (pseudogout), and inflammatory arthritis in people presenting with a painful, red, swollen joint ⁴. If septic arthritis is suspected, immediate referral according to the local care pathway is necessary ⁴.

While specific referral criteria for pseudogout are not detailed in the provided guidelines as they are for gout, the general principles for uncertain diagnosis and persistent inflammatory conditions apply ²,³,⁴,⁵. It is noted that if acute calcium pyrophosphate (CPP) arthritis ('pseudogout') is suspected, it may not follow the urgent referral pathway for new-onset inflammatory arthritis for spondyloarthritis assessment ⁶.