Gout vs Septic Arthritis
Gout and Septic Arthritis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Gout vs Septic Arthritis at a glance
- Gout: Acute monoarticular crystal arthritis from monosodium urate deposition; classically the first MTP joint.
- Septic Arthritis: Bacterial infection of a joint — orthopedic emergency requiring urgent arthrocentesis and drainage.
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Side-by-side comparison
| Feature | Gout | Septic Arthritis |
|---|---|---|
| At a glance | Acute monoarticular crystal arthritis from monosodium urate deposition; classically the first MTP joint. | Bacterial infection of a joint — orthopedic emergency requiring urgent arthrocentesis and drainage. |
| Classic presentation | Podagra: red, hot, exquisitely tender first MTP joint.; Sudden onset (often nocturnal) severe monoarticular pain peaking within 12-24 hours; Classic site: first metatarsophalangeal joint (podagra) in ~50% of first attacks; Other sites: midfoot, ankle, knee, wrist, elbow, fingers; Self-limited untreated attacks resolve in 7-14 days;… | Acute monoarticular pain, swelling, warmth, erythema; Markedly reduced range of motion; Fever, chills (variable — fever absent in up to 40%); Migratory polyarthralgia, tenosynovitis, and pustular rash suggest disseminated gonococcal infection; Joint effusion with warmth and erythema; Extreme pain on passive motion (vs bursitis where… |
| Workup / key labs | Definitive: identification of MSU crystals in joint fluid or tophus. 2015 ACR/EULAR classification criteria available for cases where aspiration is not feasible.; Arthrocentesis with polarized microscopy — gold standard: needle-shaped, NEGATIVELY birefringent MSU crystals; inflammatory fluid (WBC 20,000-100,000, neutrophil-predominant);… | Arthrocentesis BEFORE antibiotics when possible (do not delay antibiotics if patient septic):; • WBC count, differential (typically >50,000 with >75% PMNs; gonococcal often lower); • Gram stain (sensitivity ~50%); • Bacterial culture (aerobic and anaerobic); • Crystals on polarized microscopy; Blood cultures × 2 sets (positive in ~50%);… |
| Imaging | Plain radiographs — early attacks usually normal; chronic disease shows 'rat-bite' periarticular erosions with overhanging edges, sparing of joint space until late; Dual-energy CT (DECT) — color-codes MSU deposition (research/specialty use); Ultrasound — 'double-contour sign' along articular cartilage is highly specific | Plain radiographs — baseline; usually unremarkable acutely; soft tissue swelling, joint effusion; Ultrasound — guides aspiration, especially for deep joints (hip); MRI — if osteomyelitis suspected or to evaluate axial joints (SI, sternoclavicular) |
| First-line treatment | Acute flare (treat ASAP, ideally within 24 h of onset):; • NSAIDs — indomethacin, naproxen, ibuprofen at full anti-inflammatory dose × 5-7 days (avoid in CKD, HF, GI bleed); • Colchicine 1.2 mg PO, then 0.6 mg one hour later, then 0.6 mg daily-BID (renal dose adjustment; avoid in severe CKD or with strong CYP3A4/P-gp inhibitors); •… | Empiric antibiotics: Vancomycin to cover MRSA (or daptomycin/linezolid if vancomycin contraindicated); Empiric antibiotics: Add gram-negative coverage based on host: ceftriaxone (community), cefepime or pip-tazo (immunocompromised, healthcare-associated); Empiric antibiotics: Sexually active young adult with disseminated features:… |
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