Management of a Hot Swollen Joint in the Acute Setting

Abstract

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 then.

Results: Currently, the management of crystal and non-infectious arthropathies is 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 of a hot swollen joint.

Keywords: Hot swollen joint; acute management; crystal arthropathy; gout; joint pain; monoarticular arthritis; septic arthritis.