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SLE pregnancy — SCE Rheumatology MCQ

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HardPregnancy in Rheumatic Disease, Rare ConditionsSLE pregnancySCE Rheumatology

A febrile patient has an acutely swollen prosthesis-free knee. Aspirate contains abundant calcium-pyrophosphate crystals, 95,000 leukocytes/mm³ and Gram-positive cocci on Gram stain. What is the correct interpretation?

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Correct answer: E — Joint drainage and antibiotics guided by bacterial cultures

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

A is correct. Crystal identification can explain acute inflammation but does not exclude bacterial infection; visible Gram-positive cocci and systemic illness make septic arthritis the immediate priority. SANJO supports synovial Gram stain and culture, blood cultures when febrile, rapid drainage planning and prompt antimicrobial therapy after appropriate sampling. B and C delay source control. D risks injecting an infected joint. E invents mutual exclusivity between crystals and organisms. Antibiotics are narrowed to culture and susceptibility, but anti-inflammatory crystal treatment is considered only after infection is being controlled.

Reference: European guideline for septic arthritis in native joints: https://jbji.copernicus.org/articles/8/29/2023/