Acute monoarthritis
One hot swollen joint is septic until the aspirate says otherwise. Aspirate first, read the fluid (cells, Gram stain, culture, crystals), then work through gout, CPPD, haemarthrosis, reactive and early inflammatory arthritis, with the traps in older people.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- An acutely hot, swollen, painful joint is septic arthritis until proven otherwise. Infection destroys cartilage within days, and mortality is around 10% even with treatment.
- Aspirate before antibiotics or steroids, then send fluid for cell count, Gram stain, culture and crystals.
- Crystals don't exclude infection. Gout or CPPD and sepsis coexist, especially in older people.
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Sources
- Therapeutic Guidelines: Rheumatology (gout, calcium pyrophosphate deposition) and Antibiotic (bone and joint infections)AU/NZTherapeutic Guidelines Limited (eTG complete), gout topic December 2024; current online versions accessed November 2026
- Coakley G et al. BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatology 2006;45:1039-41British Society for Rheumatology, 2006 (update in development)
- Arumalla N et al. Management of septic arthritis in adults with a hot swollen joint: British Society for Rheumatology guideline scope. Rheumatol Adv Pract 2025;9(3):rkaf058British Society for Rheumatology, 2025 (scope for the guideline update)
- Guideline for management of septic arthritis in native joints (SANJO)European Bone and Joint Infection Society (Journal of Bone and Joint Infection 2023;8:29-37), 2023
- FitzGerald JD et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res 2020;72:744-60American College of Rheumatology, 2020 (current as of November 2026)
- Abhishek A et al. The 2023 ACR/EULAR classification criteria for calcium pyrophosphate deposition disease. Ann Rheum Dis 2023;82:1248-57American College of Rheumatology and EULAR, 2023
- The Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition)AU/NZRHDAustralia (Menzies School of Health Research), 3rd edition, October 2026 update
- Last updated
- 14 November 2026
What changed
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