8th September 2020

An 81-year-old care home resident presents with an acute onset oligoarticular arthropathy

An 81-year-old care home resident presents with an acute onset oligoarticular arthropathy affecting his left big toe and left midfoot joints. The care home staff explain to you that he has a history of Alzheimer’s dementia and a “recurrent joint problem” that flares up intermittently. On examination, you notice hard, subcutaneous nodules over the dorsum of his hands and feet. The joints affected are erythematous, swollen, warm and tender. Radiographs show evidence of joint damage.  A joint arthrocentesis is performed and synovial fluid analysis reveals strongly negative birefringent needle-shaped crystals under polarised light.

For the patient above, please select the SINGLE most likely diagnosis. Select ONE option from the list above.