An adult patient presents with a sudden onset of severe pain, redness, and swelling in the right big toe. Laboratory analysis shows an elevated uric acid level. Which underlying pathophysiologic mechanism is primarily responsible for this patient’s presentation?
Group of answer choices
- Accumulation of cholesterol crystals within the synovial fluid
- Deposition of calcium pyrophosphate dihydrate crystals in the synovium
- Immune complex deposition in the synovial lining of the joint
- Formation of monosodium urate crystals leading to neutrophil activation
The correct answer is:
Formation of monosodium urate crystals leading to neutrophil activation
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Explanation:
This patient’s symptoms — sudden onset of severe pain, redness, and swelling in the right big toe, along with elevated uric acid levels — are characteristic of gout, which is caused by the deposition of monosodium urate (MSU) crystals in the joints. These crystals trigger inflammation by activating neutrophils, leading to the acute inflammatory response and intense pain typically seen in a gout attack.
Here’s why the other options are incorrect:
Accumulation of cholesterol crystals within the synovial fluid: This is more characteristic of pseudogout, which is caused by the deposition of calcium pyrophosphate dihydrate crystals, not monosodium urate.
Deposition of calcium pyrophosphate dihydrate crystals in the synovium: This describes pseudogout, not gout. Pseudogout typically affects larger joints, such as the knee, rather than the big toe, and is caused by calcium pyrophosphate crystals.
Immune complex deposition in the synovial lining of the joint: This is seen in conditions like rheumatoid arthritis or systemic lupus erythematosus (SLE), but not in gout. Gout is due to crystal deposition, not immune complex deposition.
Thus, gout is caused by the formation of monosodium urate crystals, which lead to neutrophil activation and the subsequent inflammatory response in the joint.
