HOW TO CITE THIS ARTICLE: Santhoshkumar MN. Atypical chronic multiple joint swelling-a case report. A 64-year old male patient had recurrent episodes of pain and swelling, predominantly involving bilateral knees with right knee more involved than left over a period of about 4-5 years. Occasionally, he had multiple joint involvement including small joints of hands. There was no characteristic morning stiffness. Clinically, there was effusion in both knees with right knee more involved than left. The yearly recurrence or exacerbations were 3-4 on an average. The aspirations from the joint had an appearance similar to septic arthritis with turbid appearance and on most occasions the quantity was over 60-80 ml in each leg. The more symptomatic side at the time of presentation was often right which alone was surgically interfered with.Apart from non-specific complaints, patient had no significant symptoms to suggest urinary tract infection or GIT infection to consider the possibility of reactive arthritis. However, a turbid knee aspirate along with high total leucocyte count (TLC) with more than 90% PMN and elevated ESR with a negative culture report made a conclusion of reactive arthritis. The chronicity and multiple early recurrence and non-deterioration to the expected level even in absence of antibiotic therapy ruled out a septic arthritic possibility at the same time favouring more chance of reactive arthritis. Moreover, picture of chronicity is not in favour of septic arthritis. Financial or Other, Competing Interest: None. Submission