Patient is a 44 year old male presenting with swollen, painful, red left knee for 2 days. Reports he is unable to bear weight on that leg. He is now also having toe pain. Symptoms started after the weekend when he attended a BBQ where he had 4 beers with his meal. He denies fever, rash or injury. BMI is 32. History of HTN, takes Hydrochlorothiazide, and works as a floor installer.
Aspiration of synovial fluid:
Monosodium urate (MSU) crystals positive
Lab results
Lab Result Reference Range
Uric Acid 8 3.5 and 7.2 mg/dL
ESR 65 0-15 mm/hr
CRP 10.5 <0.3 mg/dL
Questions:
Identify key symptoms presented that will help to determine the diagnosis.
– Swollen, painful red knee joint
– No related injury
– Recent alcohol consumption
– Labs support acute gout flare
Explain the musculoskeletal pathophysiologic processes of why the patient presents these symptoms.
– Excess uric acid in the bloodstream from renal issues, purine-rich diet, alcohol, etc
– Urate crystals travel to and stay in the joint spaces
– The accumulation of crystals in the joints causes inflammation and severe pain
Explain how obesity plays a role in the progression of osteoarthritis/gout in the knee joints.
– Hx of installing flooring can lead to osteoarthritis
– Excess weight leads to more stress on the joints
– Excess weight shown to be directly related to higher serum urate levels
– Obesity can stress the kidneys, which makes it more difficult for the body to eliminate uric acid
Explain risk factors that may contribute to the development of the disease.
– Obesity
– Diet high in purines
– Male
- Medication