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Rheumatology Advance Access originally published online on July 6, 2006
Rheumatology 2006 45(8):1039-1041; doi:10.1093/rheumatology/kel163a
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

GUIDELINES

BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults

G. Coakley1, C. Mathews1, M. Field2, A. Jones3, G. Kingsley4, D. Walker5, M. Phillips6, C. Bradish7, A. McLachlan8, R. Mohammed9, V. Weston10 on behalf of the British Society for Rheumatology Standards, Guidelines and Audit Working Group

1 Queen Elizabeth Hospital, Woolwich, London, 2 Centre for Rheumatic Diseases, Royal Infirmary, Glasgow, 3 City Hospital, Nottingham, 4 University Hospital Lewisham, London, 5 Freeman Hospital, Newcastle, 6 King's College Hospital, London, 7 Royal Orthopaedic Hospital, Birmingham (representing the British Orthopaedic Association), 8 Hetherington Group Practice, London SW4, 9 Arthritis Care and 10 University Hospital NHS Trust, Nottingham (representing the British Society for Antimicrobial Chemotherapy), UK

Correspondence to: Dr Gerald Coakley, Consultant Rheumatologist, Queen Elizabeth Hospital, Stadium Road, London, SE18 4QH, UK. E-mail: gerald.coakley@nhs.net

KEY WORDS: Septic arthritis, Guidelines, Management

The first 10% of the full text of this article appears below.


   Scope and purpose of the guidelines
 
The clinical presentation of a hot swollen joint is common and has wide differential diagnosis. The most serious is septic arthritis, with a case fatality of 11%. Delayed or inadequate treatment leads to joint damage. These guidelines 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.


   Guidelines for managing the hot swollen joint in adults
 
The guidelines have been developed for use with adults who develop a hot . . . [Full Text of this Article]

Symptoms and signs suggestive of septic arthritis
Investigation of synovial fluid
Other laboratory investigations
Imaging
Antibiotic treatment of septic arthritis
Summary of recommendations for initial empirical antibiotic choice in suspected septic arthritis
Joint drainage and surgical options
Recommendations specific to primary care and the Emergency Department (ED)
Mechanism for audit of the guidelines
Algorithm of guidelines

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