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Septic arthritis — SCE Rheumatology MCQ

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HardMusculoskeletal InvestigationsSeptic arthritisSCE Rheumatology

A 36-year-old man has a hot swollen knee, fever, inability to weight-bear and turbid synovial fluid with WCC 92000/mm3 and Gram-positive cocci. What is the most appropriate management?

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Correct answer: EUrgent joint drainage and intravenous antibiotics

Urgent joint drainage and intravenous antibiotics is the single best answer because organisms in neutrophil-predominant synovial fluid diagnose septic arthritis. The stem is testing management choice, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Start methotrexate with folic acid and monitoring is less suitable because it fits a different clinical pattern or a different treatment threshold; Begin high-dose glucocorticoids immediately, Urgent joint aspiration and culture and Use NSAID therapy and physiotherapy do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: BSR hot swollen joint guidance; EULAR imaging/autoantibody recommendations