Patients Presenting with a Hot, Swollen Joint: A Single-Centre Retrospective Analysis

The Use of Ultrasound to Differentiate Between Gout and Infection in the Wrist

Background:

Gout is a common condition and its prevalence is increasing. In the wrist, acute gouty arthritis is difficult to distinguish from infection and may occur concomitantly. Though aspiration is helpful, it is not always technically feasible or definitive. Imaging may assist in the differential diagnosis.

Case Presentation:

Two cases are described in which the use of ultrasound evaluation assisted in the diagnosis and ultimate treatment.

Conclusion:

Ultrasound can be a helpful adjunct in the diagnosis of arthritis of the wrist, helping to tailor treatment in complex cases.

Management of a Hot Swollen Joint in the Acute Setting

BACKGROUND

The presentation of a hot swollen joint is common in the emergency department, general practice, rheumatology and orthopedic clinics. There is a wide set of differential diagnoses for a hot swollen joint, thus making it difficult to diagnose and manage, especially for junior doctors. Initially, it is pertinent to exclude/diagnose medical and surgical emergencies.

OBJECTIVE

This paper aims to summarize the key indications within the history, examination and investigations in order to quickly and effectively diagnose a hot swollen joint based on the original 2006 management guidelines and the papers discussing other possible indications and management strategies published since.

RESULTS

Currently, the management of crystal and non-infectious arthropathies are well recognized with little disparity. However, the treatment of infectious arthritis is not concrete and there are discrepancies in management between doctors.

CONCLUSION

We have summarized the key indications and provided a diagnostic flow chart to aid with the management.