Clinical Case Database / Category: Patient Management

Management of the hot swollen joint H in adults in the Emergency Department

Publication details

Ali S M Jawad MSc, FRCP, Jamie Fairweather MSc, MRCS
Foundation Years Journal, volume 9, issue 10, p.38 (123Doc Education, London, November 2015)


Though septic arthritis needs to be excluded when a patient is seen as an emergency, other causes of the hot red swollen joint such as gout, pyrophosphate and psoriatic arthritis, palindromic rheumatism and acute sarcoidosis, can be diagnosed with careful history, physical examination and simple investigations. The joint aspirate needs to be Gram stained, cultured and sent for polarised microscopy. Intra-articular corticosteroids should not be injected unless septic arthritis is confidently excluded. Swollen prosthetic joints are best referred urgently to the orthopaedic team.

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Ali S M Jawad MSc, FRCP (Corresponding author)

Rheumatology Department
The Royal London Hospital,
Bancroft Road, London E1 4DG

Jamie Fairweather MSc, MRCS

Whipps Cross Hospital
Whipps Cross Road
London, E11 1NR


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