Knee Pain Evaluation

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.

APA.

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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:

Knee Pain Evaluation

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

Knee Pain Evaluation

Medication
1. - Joint aspiration if indicated, to analyze synovial fluid.
2. Imaging:
  - An X-ray of the knee to rule out fractures or other structural issues.
3. Management:
  - If gout is confirmed, initiate treatment with NSAIDs or colchicine.
  - If septic arthritis is suspected, consider urgent referral to orthopedics for aspiration and potential antibiotic therapy.
Conclusion

This patient’s presentation is highly suggestive of gout, especially given the acute nature of symptoms following alcohol consumption and the presence of obesity and diuretic use. Further evaluation and management should focus on confirming the diagnosis and providing appropriate treatment.