Several published recommendations for management of the acute swollen joint exist: the 2006 British Society for Rheumatology recommendations for management of the hot swollen joint; and the EULAR/EFORT 2009 recommendations for management of acute knee swelling. Common to these recommendations are that affected patients undergo history taking, examination of musculoskeletal system, blood tests to include full blood count, inflammatory markers and renal function, plain X-rays of the affected

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... and aspiration of the swollen joint. In this audit, we therefore set a standard of expecting management of 90% of patients with acute swollen joints to be in line with these recommendations. The importance of joint aspiration is acknowledged by the fact that knee joint aspiration is deemed an essential GIM procedure by the JRCPTB (Joint Royal Colleges Postgraduate Training Board) for all registrars training in General Internal Medicine, and competence is desirable at core medical trainee (CMT or medical SHO) level. Therefore, in cases of knee swelling, we documented whether knee aspiration was performed, prior to rheumatology referral. Methods: Over 3 months, case notes of medical inpatients referred to the rheumatology registrar with acute joint swelling (less than 6 weeks onset) were reviewed. Results: 23 patients were identified. History was documented in 18/23, examination of joints in 2/23. 16/23 had appropriate blood tests. 5/23 patients had X-rays of the affected joints. No aspiration of joints other than knees was undertaken prior to rheumatology referral. 15/23 patients had knee swelling. 3 had knee aspiration prior to rheumatology referral: one was done by orthopaedics, and two knee aspiration procedures were done by a renal CMT. Median time to rheumatology referral was 4 days.