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Septic arthritis — SCE Acute Medicine MCQ

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ModerateAcute Rheumatological EmergenciesSeptic arthritisSCE Acute Medicine

A 62-year-old man with rheumatoid arthritis presents with a hot swollen right knee and fever. He takes methotrexate and prednisolone. Synovial fluid is cloudy and Gram stain is pending. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Send synovial culture and start intravenous antibiotics after aspiration

A febrile hot joint in an immunosuppressed patient is septic arthritis until proved otherwise; aspiration for microscopy and culture should be followed by IV antibiotics. Steroid injection risks worsening infection. Gout and rheumatoid flare remain differentials but cannot be assumed without excluding sepsis. The pearl is that native joint infection can destroy cartilage rapidly.

Reference: BSR hot swollen joint guidance; NICE CKS septic arthritis