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Septic arthritis in immunosuppressed patient — SCE Acute Medicine MCQ

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ModerateMusculoskeletal systemSeptic arthritis in immunosuppressed patientSCE Acute Medicine

A 40-year-old man is reviewed on the acute medical unit for fever and a painful swollen knee. He has psoriasis and takes adalimumab. Temperature is 38.8°C, knee aspiration shows turbid fluid, WCC 92,000/mm3 with 94% neutrophils and no crystals seen on polarised microscopy. What is the most appropriate next step in management?

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Correct answer: D — Start empiric intravenous antibiotics after cultures and arrange urgent joint washout discussion

Septic arthritis is likely with fever, immunosuppression and highly inflammatory purulent synovial fluid without crystals. Treatment requires cultures, prompt IV antibiotics and orthopaedic/rheumatology discussion about drainage or washout. Steroid injection or increasing biologic immunosuppression before excluding infection risks joint destruction and sepsis.

Reference: BSR Hot Swollen Joint Guidance; NICE CKS Septic arthritis