A 54?year?old male presents to the clinic with severe pain in his left wrist and

ID: 272503 • Letter: A

Question

A 54?year?old male presents to the clinic with severe pain in his left wrist and right great toe. The affected joints are swollen, erythematous and painful. The patient has limited range of motion of these joints. He denies injury to these areas. The patient is afebrile with a temperature of 98.8, all vital signs are within normal limits.

The patient has a history of hypertension and hyperlipidemia. He has been steadily gaining weight over the past few years and is now about 50 pounds overweight. He states that he drinks four to five beers each night and loves his steaks!

Serum Lab values:

WBC 5,400 Glucose 85 mg/dL Uric Acid 10.7 mg/dL BUN 8 mg/dL Creatinine 0.9 mg/dL Synovial fluid analysis showed many intracellular needle?shaped crystals; negative birefringence.

1) Which of the lab values is the most likely cause of this patient’s swelling in his wrist and toe? Explain why this can cause pain.

2. Describe the metabolic steps that produce the compound that is responsible for the pain in his joints.

3. What is the most likely diagnosis?

4. What is the most likely mechanism causing the abnormal lab value in this case?

5. Describe the coupled enzymatic method for measurement of the elevated lab value. List any interfering substances.

Explanation / Answer

ans- the patient must be suffering from Acute Gouty Arthritis.it is an inflammatory arthritis of metabilic origin triggered by crystallization of uric acids with oints.It occur when uric acid builds up in the joints or abnormal metabolism of uric acid resulting in excess uric acid in blood and tissues (Lab report-Uric Acid 10.7 mg/dL,Normal range->7.0) which lead to gout and kidney stones.

when purine consumed in diet (meat, sea food,beer), in the liver purines are metabolised to uric acid.Purine metabolism involves an enzyme called xanthine oxidase which produced the uric acid.High levels of uric acid circulating in the blood which can cause needle shaped urate crystals to settle in the tissue of the joint as well as the kidney.

Diagnosis- shaped crystals; negative birefringence. in joint fluid test

blood test

Xray imaging

Ulytasound

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A 54?year?old male presents to the clinic with severe pain in his left wrist and

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