title: The acute hot joint in medical practice.
abstract: We have studied patients with acute hot joints presenting to general practice, casualty and inpatient rheumatology services. Their investigation, management and outcome were measured against guidelines. Different spectra of disease were seen in the different health care settings. The guidelines were not adhered to for crystal arthritis, particularly when it affected the first metatarso-phalangeal joints. The guidelines were broadly adhered to and useful for other joints, especially where septic arthritis was considered to be the likely diagnosis. We found no benefit on outcome from adhering to the guidelines. There was a tendency for the outcome to be worse where the guidelines were followed in full, suggesting that more investigations are performed in the more difficult cases. We conclude that drawing up guidelines for patient management is difficult even in an area where there is broad medical agreement.
authors.affiliation: Department of Rheumatology, Freeman Hospital, Newcastle upon Tyne.
authors.forename: D J
authors.initials: DJ
authors.lastname: Walker
authors.forename: I
authors.initials: I
authors.lastname: Young
authors.forename: G A
authors.initials: GA
authors.lastname: Hassey
authors.forename: A M
authors.initials: AM
authors.lastname: Smith
authors.forename: M
authors.initials: M
authors.lastname: Goring
authors.forename: P N
authors.initials: PN
authors.lastname: Platt
mesh_terms: D000208:Acute Disease; D001168:Arthritis / Q000175:diagnosis* / Q000628:therapy*; D004635:Emergency Medicine / Q000379:methods*; D005194:Family Practice / Q000379:methods*; D006801:Humans; D008499:Medical Records; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012219:Rheumatology / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome