When should I consider referring a patient for specialist assessment after joint aspiration?

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 ².
• Septic arthritis is suspected based on clinical features or joint aspiration results; in this case, urgent referral is required ³.
• The diagnosis remains uncertain after joint aspiration and microscopy, such as when gout is suspected but not confirmed, or other inflammatory arthritides are possible ³.
• There are atypical features such as a hot swollen joint, rapid worsening of symptoms, deformity, or concerns suggesting infection or malignancy ¹.
• There is suspicion of inflammatory arthritis such as rheumatoid arthritis or spondyloarthritis that requires specialist assessment for diagnosis and management ²,⁴.

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.