Gout and Pseudogout: The Daily PANCE Blueprint
A 60-year-old male presents with a red, swollen, and very painful right ankle. Joint aspiration is performed. What would you most likely see under the microscope?
A. Rhomboid-shaped, positively birefringent crystals
B. Needle-shaped, negatively birefringent crystals
C. Cloudy fluid with high white blood cell count and bacteria
D. Calcium hydroxyapatite crystals
E. None of the above
Answer and topic summary
The answer is B. Needle-shaped, negatively birefringent crystals
Gout is an inflammatory arthritis that occurs due to the crystallization of monosodium urate in joints. It’s most common in men. Onset is usually sudden. Clinical features of acute gouty arthritis include sudden pain, swelling/erythema of the joint, and possible fever. Precipitants include dehydration, stress, and excessive alcohol intake. Common locations where gout impacts include the great toe, ankles, knees, and elbows. On joint aspiration, you will see needle-shaped and negatively birefringent urate crystals. Serum uric acid level is NOT helpful. Management of acute gout includes NSAID therapy, colchicine, oral prednisone, or intraarticular glucocorticoids. Prophylactic therapy is offered for patients with at least 2 gouty attacks; options include probenecid, sulfinpyrazone, allopurinol, and febuxostat.
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Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ ⇒
