19th January 2024

A 32-year-old female presents to A&E with a one-week history of pain, swelling and stiffness in her left knee and ankle.

A 32-year-old female presents to A&E with a one-week history of pain, swelling and stiffness in her left knee and ankle. She has also noticed pain and redness in her right eye for the past day, and a rash on the soles of her feet. She is normally fit and well and has no past medical history. Upon further questioning, she reports having a 3-day history of diarrhoea and vomiting 3 weeks ago, and at the time tested positive for Campylobacter jejuni. She has since recovered and has had no further gastrointestinal symptoms. Blood test results showed the following.

Hb 140 g/L (130-180)

MCV 92fL (80-96)

WCC 5.0 x 10⁹/L (4.0-11.0)

CRP 96 mg/L (<10)

Sodium 138 (133–146 mmol/L)

Potassium 4.9 (3.5–5.3 mmol/L)

Creatinine 68 (45–84 μmol/ L)

EGFR >90 

ESR 3

LFTs normal 

Rheumatoid factor 8 (0-20 u/mL)

Anti-CCP negative 

Stool culture negative 

A joint aspiration revealed a white cell count of 1000 cells/mm3 and a neutrophil count of 50%, but no organisms were isolated. 

What is the most appropriate first-line management for this woman? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.