Questions and Answers
- A 40-year-old man with a history of recurrent painful attacks affecting the right big toe,
was diagnosed with gout and started on allopurinol. He is also a known case of psoriasis for
several years. He presented to the clinic with recurrent joint pain affecting the right big toe, left
ankle, and bilateral knees. He is using allopurinol regularly as prescribed but has no
improvement in his joint pain. Examinations revealed he has active arthritis at the left ankle and
knee joints bilaterally (see lab results).
Which of the following is the most likely cause for his joint pain?
Which of the following is the most appropriate test to be done immediately?
Which of the following is the most appropriate treatment?
Which of the following is the most likely cause of hip pain?
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Which of the following is the most appropriate to confirm the diagnosis of osteoarthritis?
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Which of the following is the most appropriate action to be taken on this visit?
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Which of the following is the most likely type of the crystals seen in gout?
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Which of the following is the most appropriate action at this time for a woman with systemic lupus erythematosus planning to get pregnant?
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Which of the following is the most likely cause for his joint pain?
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Which of the following is the most appropriate test to be done immediately?
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Which of the following is the most appropriate treatment?
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Which of the following is the most likely cause of hip pain?
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Which of the following is the most appropriate to confirm the diagnosis of osteoarthritis?
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Which of the following is the most appropriate action to be taken in this visit?
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What condition is indicated by the presence of crystals in the synovial fluid during joint aspiration?
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Study Notes
Gout and Joint Pain
- A 40-year-old male with a history of recurrent gout attacks presented with pain in the right big toe, left ankle, and bilateral knees despite regular allopurinol use.
- Active arthritis was confirmed in the left ankle and both knees.
- The most likely cause of joint pain is psoriatic arthritis.
Systemic Lupus Erythematosus and Neurological Symptoms
- A 28-year-old female with systemic lupus erythematosus experienced sudden lower limb weakness and urinary incontinence, leading to a diagnosis of paraplegia.
- Immediate lumbar puncture and MRI of the spinal cord are essential to assess potential neurological complications.
Treatment of Active Arthritis
- A 50-year-old male with bilateral wrist and PIP joint pain for 4 months was found to have active arthritis.
- The recommended treatment is a combination of methotrexate, hydroxychloroquine, and prednisone.
Hip Pain in Lupus Patient
- A 30-year-old female with systemic lupus erythematosus reported right hip pain, particularly at night and during walking, after 3 weeks.
- Normal lab tests suggest the hip pain is likely due to avascular necrosis.
Osteoarthritis Diagnosis Confirmation
- A 60-year-old male with chronic right knee pain and clicks was suspected to have osteoarthritis.
- No further investigation is needed for diagnosis confirmation, based on clinical presentation.
Managing Infection in Rheumatoid Arthritis
- A 52-year-old male with long-standing rheumatoid arthritis presented with fever and respiratory symptoms while on methotrexate and adalimumab.
- The appropriate action is to hold all current treatments and initiate antibiotics for suspected infection.
Gout Crystal Analysis
- A monoarthritis patient diagnosed with gout showed crystals in synovial fluid via joint aspiration.
- The identified crystals are needle-shaped and negatively birefringent.
Pregnancy Considerations in Lupus Management
- A 30-year-old female with stable systemic lupus erythematosus on immunosuppressive therapy is planning pregnancy.
- It is crucial to discontinue mycophenolate mofetil and switch to azathioprine for safer management during pregnancy.
Pulmonary Nodule Evaluation
- A 61-year-old female was found to have a left pulmonary nodule incidentally without any significant symptoms or risk factors.
- Asymptomatic presentation with no associated systemic symptoms warrants further assessment of the nodule’s nature.
Gout and Related Conditions
- 40-year-old man diagnosed with gout after recurrent painful attacks in the right big toe.
- Currently using allopurinol but experiencing persistent joint pain in the right big toe, left ankle, and both knees.
- Physical examination shows active arthritis in the left ankle and bilateral knee joints.
- Differential diagnosis indicates psoriatic arthritis as the most likely cause of the current joint pain.
Lupus and Neurological Symptoms
- 28-year-old woman with systemic lupus erythematosus on hydroxychloroquine, prednisone, and azathioprine.
- Sudden onset of lower limb weakness and urinary incontinence leading to emergency presentation.
- Clinical examination reveals paraplegia and hyperreflexia.
- Immediate testing with lumbar puncture and MRI of the spinal cord is warranted.
Rheumatoid Arthritis Management
- 50-year-old man with bilateral wrist joint pain and involvement of proximal interphalangeal joints.
- Presents with active arthritis for the last four months.
- The best treatment plan involves methotrexate alone, which is crucial for controlling symptoms and progression.
Hip Pain Evaluation in Lupus
- 30-year-old woman with systemic lupus erythematosus experiences right hip pain, especially at night and with walking.
- Normal findings in physical examination and radiographs.
- Avascular necrosis of the right hip is the most likely cause due to prolonged steroid use and underlying lupus.
Confirmation of Osteoarthritis
- 60-year-old man with right knee pain and increasing symptoms over several months.
- Notable for frequent knee clicks; osteoarthritis suspected.
- Confirmation of diagnosis is most appropriately done via bilateral knee X-rays.
Infection Risk with RA Treatment
- 52-year-old man with rheumatoid arthritis treated with methotrexate and adalimumab.
- Presenting symptoms include fever and shortness of breath, suggesting a possible infection.
- The most appropriate action includes holding adalimumab and starting antibiotics as a precautionary measure.
Acute Gout Diagnosis
- 30-year-old man presenting with acute monoarthritis; joint aspiration performed.
- Diagnosis of acute gout established through the identification of crystals in synovial fluid.
- Immediate management involves anti-inflammatory medications typically used for gout attacks.
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Description
This quiz assesses knowledge on the management of a patient with gout who is also suffering from psoriasis and experiencing recurrent joint pain despite allopurinol treatment. It involves understanding the complexities of treatment adherence and potential underlying issues. Evaluate your understanding of comorbidities and their effects on gout management.
