03 June 2025
A new BSR guideline is now in development for hot, swollen or stiff joints in children and young people (CYP), which will complement the update to our hot swollen joints guideline for adults.
Although we are moving toward a life-course approach for our clinical guidelines, for this particular topic, our Guideline Steering Group felt that the treatment is so distinct in adult and paediatric populations that this warranted development of two separate guidelines, so that the scope could be better tailored to the requirements of each.
This new guideline for children and young people will be developed by a multi-professional working group consisting of paediatric rheumatologists, paediatricians, orthopaedic surgeons, infectious disease experts, general practitioners, specialist nurses, physiotherapists, and other healthcare professionals, together with CYP who have experienced hot, swollen or stiff joints and their families.
The guideline scope, just published in Rheumatology Advances in Practice, lays out the need for a guideline in this area and outlines the key issues and questions that will be addressed through systematic literature review and consensus of the expert working group members. The issues that will be investigated by the group, following the BSR clinical guidelines protocol, include:
- referral pathways, including for ophthalmology
- effectiveness of non-pharmacological interventions (e.g., physiotherapy, occupational therapy, exercise, splinting, hydrotherapy)
- effectiveness of pharmacological interventions, including NSAIDs and paracetamol
- tools or investigations that can best distinguish between septic arthritis and inflammatory pathology.
The guideline working group is being co-chaired by consultant paediatric rheumatologists, Lisa Bray and Alice Leahy. The full guideline is expected to be published in 2026 and we will be welcoming participation in a public consultation of the draft recommendations prior to publication.
Our updated guideline for the management of septic arthritis in adults with a hot swollen joint is also in development and the scope will be published in June 2025.