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Septic versus gout — SCE Rheumatology MCQ

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ModerateCrystal arthropathiesSeptic versus goutSCE Rheumatology

A 67-year-old woman with known gout develops fever and an acutely swollen knee. Examination shows the joint is very hot with reduced range of movement. Investigations show CRP is 198 mg/L and she is immunosuppressed. What is the most appropriate management?

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Correct answer: E — Urgent aspiration and empirical antibiotics after cultures

Urgent aspiration and empirical antibiotics after cultures is the most appropriate management because it matches the crystal diagnosis, comorbidity and infection risk. The tempting alternatives either ignore renal or drug safety, fail to lower urate long term, or delay septic arthritis treatment. Crystal arthritis care separates acute anti-inflammatory treatment from long-term urate-lowering strategy.

Reference: NICE NG219; BSR gout guideline; EULAR CPPD recommendations; BNF