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Clinical Case 8
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Objectives:

  • Evaluate recurrent monoarthritis
  • Describe the diagnostic implications of synovial fluid findings
  • Define diagnostic criteria for gout and calcium pyrophosphate dihydrate deposition disease
  • Manage a patient with gout and describe adverse effects of the medications used to treat gout
  • Implement appropriate therapy for calcium pyrophosphate dihydrate deposition disease



1

Citing your characteristic compassion and attention to detail, your patient refers a friend he met at Empowered Gouty Arthritic Dynamos (EGADs). This friend of his is a 65-year-old male who reports a history of joint swelling, pain, and redness, usually involving his knees, wrists, and hands; he has never had first MTP joint involvement. Although he has never had a joint aspiration performed, he has been treated for gout for 5 years. He faithfully takes his medication but has found allopurinol and probenecid unhelpful. He is currently asymptomatic, but uses ibuprofen for acute attacks. The joint exam is unremarkable, without joint effusion (remember that he is currently asymptomatic, however).

Which of the following studies is most appropriate for this patient?

A)“Diagnostic” knee injection with steroids.
B)CBC.
C)Rheumatoid factor.
D)Radiographs of the knees.
2

Your new patient’s knee radiographs demonstrate chondrocalcinosis. Examination of synovial fluid from the knee shows positively birefringent, rhomboid crystals consistent with CPPD (pseudogout).

Which of the following do you recommend to decrease his risk of recurrent acute attacks of pseudogout?

A)Serial joint aspiration.
B)Daily allopurinol.
C)Twice-daily colchicine.
D)Serial intra-articular steroid injections.
E)Chondroitin sulfate.
3

CPPD (pseudogout) is associated with which of the following?
A)Hypothyroidism.
B)Hyperparathyroidism.
C)Amyloidosis.
D)Hemochromatosis.
E)All of the above.







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