Question

A 70-year-old man presents with swelling, warmth and decreased range of motion in his right knee for 24 hours. He is febrile at 38.5 °C and feels unwell. There is a large effusion. He has diabetes and osteoarthritis but no gout history. What is the most appropriate next step in management?

Accepted Answer

Perform urgent arthrocentesis for synovial fluid analysis and start empiric intravenous antibiotics if septic arthritis is suspected.

Answer

Start oral NSAIDs and review in one week.

Answer

Order an MRI of the knee.

Answer

Inject intra-articular corticosteroids without aspiration.

Answer

Reassure him that this is a flare of osteoarthritis and treat conservatively.

Practice question

A 70-year-old man presents with swelling, warmth and decreased range of motion in his right knee for 24 hours. He is febrile at 38.5 °C and feels unwell. There is a large effusion. He has diabetes and osteoarthritis but no gout history. What is the most appropriate next step in management?