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Gout Classification Imaging — SCE Rheumatology MCQ

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HardMusculoskeletal ImagingGout Classification ImagingSCE Rheumatology

A patient with crystal-proven gout presents with fever and a newly hot prosthetic knee. Ultrasound again shows a double-contour sign and DECT demonstrates urate deposition. What is the most appropriate diagnostic action?

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

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Correct answer: B — Perform urgent synovial-fluid microscopy and bacterial culture

Explanation lettering: C = shown as A · A = shown as B · B = shown as C · E = shown as D · D = shown as E

A is correct. EULAR accepts ultrasound or DECT evidence as support for gout, but neither excludes coexisting septic arthritis. A febrile prosthetic joint therefore requires urgent aspiration for microbiology as well as crystal and cell analysis. Repeating DECT or obtaining plain films delays source diagnosis, and glucocorticoid treatment before appropriate sampling may worsen occult infection.

Reference: 2023 EULAR recommendations on imaging in crystal-induced arthropathies. https://ard.bmj.com/content/83/6/752