Adult Medical Emergency Handbook - Scottish Intensive Care Society

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Chapter 11
ACUTE RHEUMATOLOGY
ACUTE MONO OR OLIGOARTHRITIS
Commonest causes are summarised by the abbreviation
GRASP. Acute arthritis in > 1 joint should be considered to be
sepsis until proven otherwise.
• Every effort should be made to aspirate involved joints, involving
on-site orthopaedic teams/radiology for ultrasound guided
aspiration if necessary.
• It is imperative to send blood cultures on admission.
• Once aspirates and blood cultures are sent, empirical IV
antibiotics (see below) should be commenced. Err on side of
diagnosis of sepsis until proven otherwise.
GOUT
• 1 st MTPJ > ankle > knee > upper limb: tophi.
• Middle age to elderly.
• Men > women.
• Polyarticular in 10%.
• Can mimic sepsis: see above.
• Atypical subacute onset in hands in elderly women with renal
impairment on diuretics.
• History of previous attacks, alcohol or diuretic intake, obesity,
renal disease.
• Family history.
REACTIVE ARTHRITIS
• Young male > female.
• Large joint, lower limb: usually more than one.
• Can mimic sepsis: see above.
• History must include GI, Genito-urinary and sexual information.
• Balanitis, keratoderma blenorrhagicum, nail changes.
• Conjunctivitis, iritis.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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