A 58-year-old male patient with no significant medical history presents with severe joint pain and swelling in the left ankle. He describes the pain as excruciating and mentions that it started suddenly. On examination, the joint is warm to the touch, and there is visible redness. Which of the following best describes the most likely mechanism underlying this patient’s joint symptoms?
Group of answer choices
- Inflammatory response due to autoimmune disease
- Degeneration of joint cartilage
- Deposition of urate crystals
- Accumulation of calcium pyrophosphate crystals
The correct answer is: Deposition of urate crystals
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Explanation:
The patient’s presentation—sudden onset of severe joint pain, redness, warmth, and swelling (monoarthritis) in the left ankle—is classic for acute gouty arthritis, caused by:
- Urate crystal deposition (monosodium urate crystals) in the joint, triggering a neutrophil-driven inflammatory response.
Key Features Supporting Gout:
- Sudden, excruciating pain (often waking the patient at night).
- First metatarsophalangeal (MTP) joint is most common, but ankle, knee, or other joints can be affected.
- Risk factors: Male sex, older age, dietary purines (red meat, alcohol), obesity, diuretic use.
Why Not the Others?
- Autoimmune inflammation (e.g., rheumatoid arthritis): Typically causes symmetrical polyarthritis, not sudden monoarthritis.
- Cartilage degeneration (osteoarthritis): Gradual onset, no redness/heat, and less severe pain.
- Calcium pyrophosphate (CPP) crystals (pseudogout): Usually affects the knee or wrist, not the ankle; associated with older age and metabolic disorders.
Diagnostic Confirmation:
- Joint aspiration showing negatively birefringent needle-shaped crystals (urate) under polarized microscopy.
Thus, urate crystal deposition is the most likely mechanism.
