Clinical Case Database / Category: Patient Management
Management of the hot swollen joint H in adults in the Emergency Department
Ali S M Jawad MSc, FRCP, Jamie Fairweather MSc, MRCS
Foundation Years Journal, volume 9, issue 10, p.38 (123Doc Education, London, November 2015)
Though septic arthritis needs to be excluded when a patient is seen as an emergency, other causes of the hot red swollen joint such as gout, pyrophosphate and psoriatic arthritis, palindromic rheumatism and acute sarcoidosis, can be diagnosed with careful history, physical examination and simple investigations. The joint aspirate needs to be Gram stained, cultured and sent for polarised microscopy. Intra-articular corticosteroids should not be injected unless septic arthritis is confidently excluded. Swollen prosthetic joints are best referred urgently to the orthopaedic team.
Access the Clinical Cases Database
A subscription is required to read the full article. Please subscribe using one of the options below.
|Foundation Years Clinical Cases Database||£29.00||6 months|
|Foundation Years Clinical Cases Database||£39.00||12 months|
Ali S M Jawad MSc, FRCP (Corresponding author)
The Royal London Hospital,
Bancroft Road, London E1 4DG
Jamie Fairweather MSc, MRCS
Whipps Cross Hospital
Whipps Cross Road
London, E11 1NR
1. Coakley G, Mathews C, Field M, Jones A, Kingsley G, Walker D et al. BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatology 2006; 45:1039–1041.
2. Mikuls T R, Farrar J T, Bilker WB, Fernandes S, Schumacher HR Jr, Saag, KG. Goutepidemiology: results from the UK General Practice Research Database, 1990-1999. Ann Rheum Dis 2005; 64: 267-272.
3. Schumacher H R. palindromic onset of rheumatoid arthritis. Clinical, synovial fluid and biopsy studies. Arthritis Rheum 1982;25:361-369.
4. Zhang W, Doherty M, Pascual E, Barskova V, Guerne PA,, Jansen TL, et al. EULAR recommendations for calcium pyrophosphate deposition.Part II: management. Ann Rheum Dis 2011; 70:571-575.
5. Yosipovitch G, Yosipovitch Z. Acute calcific periarthritis of the hand and elbows in women: a study and review of the literature. J Rheumatol 1993; 20:1533–8.
6. Doumas C, Vazirani RM, Clifford PD et al. Acute calcific periarthritis of the hand and wrist: a series and review of the literature. Emerg Radiol 2007; 14:199–203.
7. Jawad F, Jawad A S M. Calcific periarthritis of the elbow presenting as acute tennis elbow. J R Coll Physicians Edinb 2014; 44:27-8.
8. Mana J, Gomez-Vaquero C, Montero A, Salazar A, Marcoval J, Valverde J, et al. Löfgren's syndrome revisited: a study of 186 patients. Am J Med 1999: 107: 240-245?
Conflict Of Interest
The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (http://www.icmje.org/urm_full.pdf).
The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.
Patient Consent statement
All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts (http://www.icmje.org/urm_full.pdf). The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.
Animal & Human Rights
When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.
About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.