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Septic Arthritis/Gout Overlap — SCE Rheumatology MCQ

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EasyRheumatology EmergenciesSeptic Arthritis/Gout OverlapSCE Rheumatology

A 58-year-old woman presents with a painful warm swollen knee. She has type 2 diabetes and uses insulin. The differential includes gout and septic arthritis. Synovial fluid shows WCC 35000/microL with 80% neutrophils. Gram stain is negative. Crystals are seen. Can you have BOTH gout and septic arthritis simultaneously?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Yes crystal arthropathy and septic arthritis can coexist and crystal identification does not exclude infection

Crystal arthropathy and septic arthritis can coexist. The identification of crystals in synovial fluid does NOT exclude concurrent infection. BSR hot swollen joint guidelines emphasise that Gram stain and culture should always be sent regardless of crystal findings. Up to 5% of septic joints also contain crystals. Clinical features of sepsis (fever, rigors, raised WCC, positive blood cultures) should be assessed alongside crystal analysis. If there is any clinical suspicion of sepsis, empirical antibiotics should be started pending culture results.

Reference: BSR 2006 hot swollen joint guidelines