A 60-year-old male with a history of poorly controlled gout presents with a fever and severe pain in his right knee, which is swollen and red. What are the potential diagnoses, and what are the next steps?
While this presentation could be consistent with a gout flare, the presence of a fever also raises concern for septic arthritis, which is a serious condition requiring urgent management. Other potential causes could include other forms of inflammatory arthritis or a crystal-induced arthritis other than gout (like pseudogout). As it can be challenging to differentiate between a severe gout attack and septic arthritis, the next step should involve joint aspiration to analyze the synovial fluid for crystals, white blood cell count, and bacterial culture. Broad-spectrum antibiotics should be started empirically if septic arthritis is suspected, pending culture results.