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Acute gout infection differential — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsAcute gout infection differentialGPhC CRA

A 61-year-old with previous podagra asks for colchicine for a rapidly painful swollen knee. Temperature is 38.4°C, he feels shivery and cannot weight-bear. The knee has not previously been affected by gout. What is the most appropriate action?

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Correct answer: B — Arrange urgent same-day hospital assessment for possible septic arthritis

A previous diagnosis of gout does not exclude joint infection. Rapid severe monoarthritis with fever, rigors and inability to weight-bear is compatible with septic arthritis, which can rapidly damage the joint and cause sepsis. Urgent hospital assessment is needed for aspiration, cultures and timely antimicrobial treatment. Empirical self-care for gout, delayed urate testing or initiation of allopurinol would postpone assessment of a potentially limb- and life-threatening infection.

Reference: NHS: Septic arthritis: https://www.nhs.uk/conditions/septic-arthritis/