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Acute CPP crystal arthritis — SCE Rheumatology MCQ

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EasyCrystal arthropathiesAcute CPP crystal arthritisSCE Rheumatology

A 29-year-old man has acute painful knee swelling after an intercurrent illness. Examination shows there is a warm effusion without trauma. Investigations show synovial fluid shows rhomboid weakly positively birefringent crystals. The diagnosis is established and symptoms remain clinically important despite initial supportive measures. There is no contraindication to disease-modifying or anti-inflammatory escalation. What is the most appropriate management?

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Correct answer: C — Intra-articular corticosteroid injection

Intra-articular corticosteroid injection is the best answer because intra-articular corticosteroid injection is the most appropriate next step for acute cpp crystal arthritis in this clinical setting. Therapeutic exercise is a plausible distractor, but it does not account for the key discriminator in the stem. Increase NSAID therapy and NSAID therapy with gastroprotection would be more appropriate in a different clinical pattern or at another point in the pathway, while Bisphosphonate therapy is suboptimal for this presentation. Clinical pearl: rheumatology management is generally treat-to-target, but infection risk, pregnancy plans and shared-care monitoring often determine the safest answer.

Reference: NICE NG219; BSR hot swollen joint guideline; EULAR crystal arthropathy recommendations