Is it cellulitis, gout or a septic joint?
MAX MEYER, MD, of Victoria, BC, wonders, "When examining a red, warm, swollen, tender joint -- say, a toe or ankle -- how can one clinically differentiate between cellulitis, gout or a septic joint?"
By definition, cellulitis shouldn't affect the range of joint movement, although in some cases the degree of swelling may impair some aspects of range. Besides, joint line tenderness isn't a feature of cellulitis. Simply from appearances, telling apart gout from a septic joint might be quite difficult. Both are inflammatory synovitides, but the history and clinical scenario may help, including the triggering events, and associated physical findings, such as evidence of tophi rather than a readily identifiable source of infection. Ultimately, joint aspiration, gram stain and culture, and compensated polarizing light microscopic examination will help clarify matters, but remember that the two can coexist! After all, infection may be one of the precipitants of acute gouty arthritis. LR