Been having increasing pain in my L knee all night until it became unbearable. Can no longer weight bear on that side and it's really sore to touch here (pointing at medial aspect of knee). It came on all of a sudden. Hadnt bumped it or anything.
Hx: Gout on Allopurinol, IHD, CRF (eGFR in the 20s), OA w reduced joint space in both knees.
O/E: (L knee) No obvious swelling, erythema, or deformity noted. Has gouty tophi on hands. Otherwise stable, afebrile.
Ix: WCC 13 (10) CRP 2.1 Urate 42 (n<20), ESR 52 (n<20), eGFR 18, Urea 18, Cr 292.
Does this patient need a joint MRI and aspirate?
...to rule out septic arthritis.
Ortho Reg: Likelihood of septic arthritis - ESR>40, WBC>12, Pain on weight bearing, No ROM. Score 1 for each. 1=25%, 2=33%, 3=65%, 4=99%. Having no ROM at all and pain+++ on weight bearing is strong indication for a joint aspirate.
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