A 25-year-old female patient complains of erythema nodosum, accompanied by low-grade fever and bilateral ankle arthritis. She has no medical history and is not taking any medication. There is no record of her traveling abroad. What would be the most suitable test to conduct for this patient?
A 16-year-old Arabic male presents with a high temperature, abdominal pain, and a fixed erythematous rash on his ankle. Upon examination, his abdomen is tender, but other systems appear normal. Upon questioning, he admits to several similar episodes in the past that have resolved spontaneously after three to seven days. Blood tests reveal leukocytosis, neutrophilia, high ESR, CRP, and a normal UE&C, amylase, and LFTs. A mild polyclonal increase in serum immunoglobulin is also present. A chest x-ray is normal, and a CT scan of the abdomen reveals a scanty amount of free fluid. Recent blood tests show Hb 111 g/L (130-180), WBC 18.8 ×109/L (4-11), Neutrophils 90% (40-75), Lymphocytes 10% (20-45), Eosinophils 30% (1-6), Platelet 270 ×109/L (150-400), ESR 86 mm/hr (0-15), and CRP 143 mg/L (<10). What is the diagnosis?
A 67-year-old man presents to the rheumatology clinic with recurrent gout. He was previously started on allopurinol but developed a rash and gastrointestinal upset, and his eGFR limits an increase in dosage. On examination, he is obese and reports previous gout attacks in his left foot and right knee. He also has hypertension, type II diabetes mellitus, and a history of myocardial infarction. His current medications include aspirin, ramipril, amlodipine, atorvastatin, bisoprolol, and metformin. His recent blood work shows an increase in urea and creatinine levels. What are the available options for managing his gout in the long-term?
A 65-year-old man comes in with a sudden onset of a hot, red, swollen, and painful right big toe. He has experienced this twice before in the past but never sought medical attention. His serum urate level is elevated and joint fluid analysis reveals negatively birefringent needle-shaped crystals. After his symptoms subside, he is prescribed allopurinol but experiences a severe hypersensitivity reaction. What alternative medication should be considered for long-term treatment?
A 60-year-old woman presents to the rheumatology clinic with complaints of increasing joint pain and stiffness despite being on a combination of methotrexate, folic acid, and azathioprine for her rheumatoid arthritis. She has also been experiencing fatigue and respiratory tract infections, as well as easy bruising. On examination, she appears well but has a mass in the left upper quadrant of her abdomen. Her joint examination is unremarkable. Her recent blood work shows a low hemoglobin, low platelets, and low white blood cell count with a predominance of eosinophils. Her liver function tests are mildly elevated. What is the most likely cause of her symptoms and abnormalities?
A 56-year-old woman with a history of rheumatoid arthritis is currently receiving a weekly dose of 15mg of methotrexate. During her routine check-up, her blood tests reveal a significant decrease in her cell counts, indicating methotrexate induced bone marrow failure.
Hemoglobin: 110 g/l
Platelets: 135* 109/l
White blood cells: 3 * 109/l
Neutrophils: 1.9*109/l
What is the most appropriate course of action for managing this patient’s condition?
A 75-year-old male falls while walking his dog. He experiences severe left hip pain and his left leg is shortened and externally rotated. He is rushed to the Emergency Department where an X-ray confirms a left-sided intracapsular neck of femur fracture. The patient undergoes surgery the next day. What measures should be taken to manage his bone health and reduce the risk of future fragility fractures?
A 50-year-old man presents to rheumatology with severe tophaceous gout. He has been experiencing intermittent gout attacks affecting his first metatarsophalangeal joints for the past few years. However, over the last two months, he has developed inflammation of multiple small joints in his hands, which has prevented him from continuing his work as a train driver. His General Practitioner prescribed Colchicine, but it was discontinued due to severe diarrhoea. The patient’s medical history includes an upper GI bleed from a duodenal ulcer six months ago.
On examination, the patient has severe asymmetrical inflammation of multiple metacarpalphalangeal, distal interphalangeal, and proximal interphalangeal joints in both hands. Yellow-white tophi are present across the inflamed joints. Blood tests taken prior to clinic attendance show:
Hb 15.2 g/dl
Platelets 265 * 109/l
WBC 6.5 * 109/l
Na+ 134 mmol/l
K+ 4.2 mmol/l
Urea 9.5 mmol/l
Creatinine 175 µmol/l
eGFR 62 ml/min
Urate 370 µmol/l
What is the most appropriate treatment for this patient’s acute gout?
A 42-year-old woman who has taken up gardening recently complains of pain on the lateral side of her left wrist. The pain is aggravated by gripping objects tightly and using heavy gardening tools. Upon examination, there is swelling and tenderness around the lateral margin of the left wrist, extending a few centimeters proximally. Finkelstein’s test is positive. The patient’s recent FBC, UEC, LFTs, and rheumatoid factor have all been negative. What is the diagnosis?
A 30-year-old Caucasian farmer presents to the outpatient department with a complaint of generalised aches and pains that have been bothering him for the past two months. He used to be an active runner but had to give up competitive running a year ago due to a hip injury. Two years ago, he had a painful red eye for which he received treatment with eye drops in the Emergency department. He is a heavy smoker, consuming 45 cigarettes a day, and drinks five pints of beer every weekend. He denies any skin rashes or mucosal ulceration. His mother had rheumatoid arthritis, and his father had severe gout. On examination, the left first metatarsophalangeal joint was swollen and tense, but all the other joints were unremarkable. Rotation of the lumbar spine was restricted. What test would be most useful in establishing the diagnosis?