45-year-old man presented to outpatient depament with hot, swollen left big toe and a painful lesion on the rim of his left pinna. Polarized light microscopy of the synol fluid shows dense neutrophilic infiltrate and crystals that are negatively birefringent. Patient is likely to be suffering from?
Gout More common in males, post-menopausal females who are on diuretics (thiazides). Other risk factors - hyperuricemia, obesity, X-linked HGP abnormalities. Usually joint involved is metatarsophalangeal (MTP) joint, knee joint involvement possible. Metabolic disease characterized by episodic acute ahritis or chronic ahritis caused by deposition of monosodium urate (MSU) crystals in joints and connective tissue tophi. Tophi are the pathognomonic hallmark of gout. They are formed by large aggregations of urate crystals surrounded by an intense inflammatory reaction of foreign-body giant cells. Synol fluid analysis is diagnostic. Polarized light microscopy of the synol fluid shows crystals of monosodium urate (MSU) which are needle-shaped intracellular and extracellular and are negatively birefringent.
Seronegative ahritis
Ankylosing spondylitis
Gout
Rheumatoid ahritis
General Concepts