🧱 The First Principles of Septic Arthritis & Gout

  1. History is king. Use a structured approach: SOCRATES, traumatic vs atraumatic, monoarthritis vs polyarthritis, targeted questions about risk factors, extra-articular symptoms, medications, past medical history, etc.
  2. Acute onset of a hot, swollen, painful join is septic arthritis until proven otherwise! It requires prompt arthrocentesis, antibiotic administration and orthopaedic review.
    1. Pathophysiology: bacterial infiltration  → recruitment of inflammatory cells → release of inflammatory mediators → joint destruction → sepsis.
  3. Gout is an acute inflammatory arthropathy caused by either an increased production or decreased secretion of uric acid.
    1. ↑ concentration of uric acid in ECF → intra-articular uric acid crystal formation → phagocytosis by leukocytes → inflammatory mediators released → joint inflammation.

🌍 Epidemiology

🩺 Diagnostic Approach

🧫 Pathophysiology

🧬 Risk Factors

🔎 Investigations

💊 Management

⚠️ Complications

🌐 References & Resources

  1. Monoarthritis in adults: Etiology and evaluation. UpToDate [Internet] [cited 2025 Mar 3]. Available from: https://www.uptodate.com/contents/monoarthritis-in-adults-etiology-and-evaluation?search=acute joint pain&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3#H3
  2. Overview of soft tissue musculoskeletal disorders. UpToDate [Internet] [cited 2025 Mar 3], Avaliable from: https://www.uptodate.com/contents/overview-of-soft-tissue-musculoskeletal-disorders?search=acute joint pain&topicRef=1820&source=see_link
  3. Septic arthritis in adults. UpToDate [Internet] [cited 2025 Mar 3]. Available from: https://www.uptodate.com/contents/septic-arthritis-in-adults?search=septic arthritis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H1223252882
  4. Septic arthritis. Therapeutic Guidelines [Internet] [cited 2025 Mar 3]. Available from: https://app-tg-org-au.eu1.proxy.openathens.net/viewTopic?etgAccess=true&guidelinePage=Antibiotic&topicfile=septic-arthritis&guidelinename=Antibiotic&sectionId=toc_d1e326#toc_d1e326
  5. Oxford cases in medicine and surgery
  6. Algorithms in differential diagnosis
  7. BMJ Best Practice [Internet]. Topic: Gout. London: BMJ Publishing Group Ltd; 2022. Available from: https://bestpractice.bmj.com/topics/en-gb/13