on behalf of the British Society for Rheumatology Standards, Guidelines and Audit Working Group Scope and purpose Background to the disease The clinical presentation of a hot swollen joint is common and has a wide differential diagnosis. The most serious is septic arthritis, which accounts for significant morbidity, and has a case fatality of 11% [1]. Delayed or inadequate treatment leads to irreversible joint damage [2]. Rapid diagnosis and treatment is vital to prevent permanent joint dysfunction. This guideline will focus on the diagnosis and management of septic arthritis. Hot swollen joints commonly have other underlying diagnoses, including crystal arthritis, reactive arthritis and a monoarticular presentation of polyarthritis. The need for a guideline The hot swollen joint presents to many different clinicians in primary or secondary care. Poor outcomes including permanent joint destruction and death can occur if the diagnosis of sepsis is not made rapidly and treatment instigated appropriately. Septic arthritis can be difficult to recognize even for experienced clinicians, yet such patients frequently present to doctors unfamiliar with the assessment and management of joint disease. We hope that this guideline will aid accurate diagnosis and appropriate treatment when a joint is hot because of sepsis, whilst also ensuring that other causes such as crystal arthritis are recognized and not over-treated. Objectives of the guideline This guideline sets out recommendations for the diagnosis and initial management of septic arthritis presenting clinically as a hot swollen joint. These recommendations are based on a systematic review of the literature and evaluation of the evidence using standardized criteria.
There is a striking paucity of high-quality evidence upon which to base guidelines on the management of the hot-swollen joint. Ultimately, the diagnosis of septic arthritis rests on the opinion of a clinician experienced in the assessment of musculoskeletal disease. Future research may provide alternative investigative and treatment strategies to improve the accuracy of diagnosis as well as the outcome in this group of patients.
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