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Septic arthritis — RCPSC IM MCQ

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HardInfectious DiseasesSeptic arthritisRCPSC IM

A 67-year-old receiving methotrexate has fever and an acutely swollen knee. Synovial fluid contains 94,000 leukocytes/microlitre, Gram-positive cocci and no crystals. What is the most appropriate next step?

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

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Correct answer: B — Drain the joint and start intravenous antistaphylococcal therapy

The best answer is “Drain the joint and start intravenous antistaphylococcal therapy”. This is septic arthritis until proved otherwise and requires prompt source control plus empiric antimicrobial therapy after appropriate cultures. Anti-inflammatory or urate-lowering treatment does not eradicate infection, and delay risks cartilage destruction and sepsis.

Reference: Emergency Care BC, emergency-department sepsis guideline: https://emergencycarebc.ca/wp-content/uploads/2022/03/2022-Emergency-Department-Guidelines-FINAL.pdf