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RA with suspected septic arthritis — SCE Rheumatology MCQ

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ModerateRheumatoid arthritisRA with suspected septic arthritisSCE Rheumatology

A 70-year-old man with RA taking prednisolone and methotrexate develops an acutely painful swollen prosthetic knee. Examination shows fever, warmth and marked restriction of movement are present. Investigations show CRP 184 mg/L and neutrophils 15.2 x 10^9/L. What is the most appropriate management?

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Correct answer: D — Urgent joint aspiration before antibiotics if feasible

An acutely hot prosthetic joint in an immunosuppressed patient is septic arthritis until proved otherwise, so urgent aspiration and microbiology are required. Intra-articular steroid before infection exclusion risks worsening sepsis. RA patients can have crystal disease or flare, but infection has priority because delayed treatment threatens life and joint integrity.

Reference: NICE NG100; BSR biologic DMARD safety guideline; BNF