Chronic Inflammatory Knee Pain

Red flags

 

Send to Emergency Department or discuss with Orthopaedic SpR on call

·         High impact trauma

·         Knee dislocation

·         Significant haemarthrosis

·         Quadriceps / patella tendon rupture

·         Sepsis and NEW onset knee pain         

·         Unable to weight bear

·         Systemically unwell and NEW onset knee pain

·         Unremitting knee pain

·         If concern regarding suspected new malignancy please refer via 2 Week Wait Criteria.

o    Suspected or confirmed malignancy

o    Localised hard mass adjacent to knee/unexplained weight loss/severe night pain not controlled by analgesia  

 

Only refer to rheumatology if:

·         Synovitis

·         History of inflammatory disease

·         Consider inflammatory screen if there is significant pain with good volume of joint space on X ray imaging

 

Information to include when referring

·         Previous or current history of inflammatory disease

o    Psoriasis

o    Inflammatory bowel disease

o    Dry eyes and mouth

o    Symptoms of connective tissue disease

o    Family history of ankylosis spondylitis

·         Consider Reactive arthritis – e.g. Chlamydia/ Non-specific urethritis symptoms

·         Synovitis

 

If recurrent / known inflammatory arthritis:

·         Consider knee aspiration / steroid injection

·         Physiotherapy may be appropriate

·         Suspected inflammatory pain requiring specialist management should be referred to rheumatology not orthopaedics

 

 Investigations prior to referral

·         FBC, U&E, CRP, ESR, Rheumatoid Factor, Bone Chemistry, Urate

·         If reactive arthritis consider Chlamydia test

 

 

 

Date reviewed                     25/06/2019

Next review due                  25/06/2020

Sifter name                          Dr Rebecca Hopkins

 

Version No. 1.1