This morning, we discussed an interesting case of an older gentleman presenting with acute asymmetric polyarthritis and fever. Rheumatologist Dr. Paul Hsu gave his expert perspective and clinical pearls! We reviewed the differential diagnosis for acute polyarthritis and were most concerned about septic arthritis vs reactive arthritis vs gout in this particular patient. We agreed that an expedited arthrocentesis and empiric antibiotics were important parts of this patient’s initial management, given the suspicion for septic arthritis. Ultimately, the patient was diagnosed with reactive arthritis, likely related to his preceding UTI and diarrheal illnesses. His symptoms improved with steroids.
- When evaluating a patient with arthritis, it is important to characterize the time course and distribution of the joint involvement. This will really inform your differential diagnosis!
- When you are concerned about a possible septic arthritis, urgent arthrocentesis and empiric antibiotics are imperative! Also get blood cultures and consider the possibility of underlying endocarditis, particularly when multiple joints are involved.
- Remember to send synovial fluid for gram stain, culture, cell counts, and crystal analysis. If you have a limited amount of synovial fluid, prioritize the sample for:
Culture > Crystal analysis > Cell counts
Medical Spanish Word of the Day: joint = articulación