Description

T.G. is a 57-year-old male who presents with acute, non-traumatic, increasing left knee pain x2 days, like a prior incident one year ago. Reports pain 6- 8/10, throbbing, non-weight bearing, and limping. PMH includes hypertension recently started on HCTZ 25 mg PO daily and osteoarthritis relieved by ibuprofen. Ibuprofen is not alleviating his current knee pain. Reports high- purine diet and episodic left first metatarsophalangeal inflammation. Denies asthma, chest pain, palpitations, numbness, fever, chills, gastrointestinal (GI)/genitourinary symptoms (GU), recent illness, sick contacts, or travel. Afebrile, cardiac, respiratory, GI, and GU exams are unremarkable. Positive findings include limping gait, left knee erythematous, warm, edema, limited range of motion with pain, and a tophus on the left big toe. Pertinent history includes maternal rheumatoid arthritis, obesity, and NSAID overuse.