![]() When the patient is systemically unwell, it is common practice to start empirical antibiotic treatment after joint aspiration for the fear of septic arthritis. Untreated crystal-induced arthropathy has been shown to cause degenerative joint disease and disability leading to a considerable health economic burden. In addition, some patients are misdiagnosed and treated as septic arthritis with inappropriate antibiotics. It is often under-diagnosed and subsequently patients do not receive rheumatology referral for appropriate treatment and follow-up. Crystal arthritis (Gout/Pseudogout) is the second most common differential diagnosis. Inpatient mortality due to septic arthritis has been reported as between 7-15%, despite improvement in antibiotic therapy 3,4. Accurate and swift diagnosis of septic arthritis in the acute setting is vital to prevent joint destruction, since cartilage loss occurs within hours of onset 1,2. ![]() It can involve any joint the knee is the most frequently affected. Septic arthritis is the most common and serious etiology. Keywords: Crystal arthritis, gout, hot swollen knee, Pseudogout, polarized light microscopy.Īcute non-traumatic knee effusion is a common condition presenting to the Orthopaedic department which can be caused by a wide variety of diseases(Table 1). All patients with confirmed crystal arthritis should receive a rheumatology referral for further management and follow up. Prompt diagnosis can avoid unnecessary antibiotic therapy and surgical intervention. We should always remember to follow up the results of polarized light microscopy of joint aspirates. Seven patients developed complications during their hospital stay.Ĭonclusion: Crystal arthritis is a common and serious cause of acute painful knee that can lead to joint damage if not treated properly. Only two (25%) patients with crystal arthropathy received appropriate treatment and a rheumatology referral. Four patients showed positive microscopic growth while eight had crystals identified on polarized light microscopy of joint aspirate. Twenty six patients were admitted and received antibiotic therapy based on clinical suspicion of infection, arthroscopic washout was performed on eight. Results: All joints were aspirated and samples were sent for microscopy, culture and antibiotic sensitivity, and polarized light microscopy. A total of 180 patients were identified 60 patients were included in the study. Materials and methods: We performed a retrospective study of patients presenting to the emergency department with acute non-traumatic knee effusion. ![]() Objectives: To review our management of patients with hot swollen knees, especially those due to crystal arthritis. Crystal-induced arthritis can easily be overlooked or misdiagnosed as septic arthritis resulting in patients having unnecessary antibiotic therapy and surgical procedures. The two most common causes of this presentation are septic and crystal arthritis. A S Eid, V Burrows, J R M Murray, P Smitham, R Ahmad, R Miller and U ButtĬite this article as: BJMP 2012 5(1):a504īackground: Non-traumatic knee effusion is a common referral to the on-call Orthopaedic team.
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