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Septic arthritis — MCCQE Part 1 MCQ

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EasyJoint PainSeptic arthritisMCCQE Part 1

A patient with severe haemophilia A and no known factor VIII inhibitor develops sudden atraumatic pain, warmth and restricted movement of one knee. There is no fever or overlying wound, and this feels identical to previous joint bleeds. What is the best immediate management?

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Correct answer: E — Give factor VIII promptly using the haemophilia treatment plan and contact the treatment centre

In a person with severe haemophilia, an acute painful swollen joint should be treated as a hemarthrosis without waiting for imaging. Give the prescribed factor VIII replacement promptly and involve the haemophilia treatment centre; delayed haemostasis increases pain, synovial damage and recurrent bleeding. Rest, protected weight bearing, appropriate analgesia and later rehabilitation are useful adjuncts. Routine aspiration before haemostatic coverage can provoke further bleeding and is reserved for selected tense, very painful joints or concern for infection under specialist guidance. Intramuscular injections and nonsteroidal anti-inflammatory drugs can increase bleeding risk, and forced activity during active bleeding is inappropriate.

Reference: WFH Guidelines for the Management of Hemophilia: https://www1.wfh.org/publication/files/pdf-1863.pdf