{
  "schema_version": 1,
  "kind": "condition",
  "id": "septic-arthritis-referral",
  "name": "Septic Arthritis (Emergency Referral)",
  "category": "infectious",
  "sources": "BSR guideline scope: Management of septic arthritis in adults with a hot swollen joint (Rheumatol Adv Pract 2025;9(3):rkaf058) · BSR/BHPR/BOA/RCGP/BSAC guideline for management of the hot swollen joint in adults (Coakley et al, Rheumatology 2006;45:1039-41) · Knee Arthrocentesis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470229/ · No dose - emergency referral pathway, no medicine given in primary care · Septic Arthritis: Diagnosis and Treatment (Am Fam Physician 2021;104(6):589-597)",
  "review_status": "reviewed",
  "verified_against": "No dose - emergency referral pathway, no medicine given in primary care",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 1618,
      "generic": "No drug therapy in primary care (Emergency Referral)",
      "line": 1,
      "is_adjunct": false,
      "form": null,
      "strength_mg": null,
      "adult_dose": "Same-day referral to a hospital specialist who can aspirate the joint. Do NOT start an antibiotic in the clinic first.",
      "adult_duration": "Immediate same-day referral",
      "dose_source": "No dose - emergency referral pathway, no medicine given in primary care",
      "rationale": "BSR 2006 grade B: the synovial fluid must be aspirated, Gram-stained and cultured prior to starting antibiotics. An antibiotic given before aspiration can sterilise the sample, so the organism is never identified and the six-week course cannot be targeted. BSR 2006 grade C: GPs should refer to a specialist within the hospital who has the expertise to aspirate the joint. Untreated or delayed, the joint is destroyed; the 2006 guideline reports a case fatality of 11%.",
      "cautions": [
        "DO NOT give an antibiotic before the joint is aspirated - it sterilises the sample and the organism is then never identified (BSR 2006, grade B).",
        "TIME-CRITICAL: treat any acutely hot, swollen, painful joint as septic until aspiration proves otherwise, even when gout or a flare of known arthritis looks more likely.",
        "Normal CRP, ESR or white cell count DO NOT exclude septic arthritis, and neither does the absence of fever (BSR 2025 scope).",
        "A prosthetic or otherwise non-native joint must go to an orthopaedic surgeon, and must not be aspirated outside a sterile environment (BSR 2006 grade C; BSR 2025 scope).",
        "Risk is higher with previous joint surgery, prosthetic joint, recent joint injection, rheumatoid arthritis, skin infection or ulcer, diabetes, and immunosuppression.",
        "If the patient is also systemically unwell with signs of sepsis, the sepsis pathway takes priority - see Suspected Sepsis - and antibiotics should not be withheld waiting for aspiration.",
        "In a sexually active adult consider gonococcal septic arthritis, which can present with migratory joint pain, tenosynovitis and a rash (Am Fam Physician 2021)."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "The BSR guideline covers adults only; a separate BSR guideline for the hot, swollen or stiff joint in children and young people is still in development. Refer any child with a hot, swollen, painful joint, or a limp with fever, the same day. Do not start an antibiotic first.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "septic-arthritis-referral"
    }
  ]
}