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