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:… | Acute monoarticular pain, swelling, warmth, erythema; Markedly reduced range of motion; Fever, chills (variable — fever absent in up to 40%); Migratory… |
| 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… | Arthrocentesis BEFORE antibiotics when possible (do not delay antibiotics if patient septic):; • WBC count, differential (typically >50,000 with >75% PMNs;… |
| Imaging | Plain radiographs — early attacks usually normal; chronic disease shows 'rat-bite' periarticular erosions with overhanging edges, sparing of joint space until… | Plain radiographs — baseline; usually unremarkable acutely; soft tissue swelling, joint effusion; Ultrasound — guides aspiration, especially for deep joints… |
| 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,… | — |
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