Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Consider referring a patient for specialist assessment following joint aspiration if:
- There is suspected persistent synovitis of undetermined cause, especially if multiple small joints of the hands or feet are affected, or if symptoms have persisted for 3 months or longer NICE NG100.
- Septic arthritis is suspected based on clinical features or joint aspiration results; in this case, urgent referral is required NICE NG219.
- The diagnosis remains uncertain after joint aspiration and microscopy, such as when gout is suspected but not confirmed, or other inflammatory arthritides are possible NICE NG219.
- There are atypical features such as a hot swollen joint, rapid worsening of symptoms, deformity, or concerns suggesting infection or malignancy NICE NG226.
- There is suspicion of inflammatory arthritis such as rheumatoid arthritis or spondyloarthritis that requires specialist assessment for diagnosis and management NICE NG100,NICE NG65.
In summary, referral should be considered when joint aspiration does not clarify diagnosis, when infection is suspected, or when inflammatory arthritis is persistent or atypical, to ensure timely specialist evaluation and management.