A 77-year-old woman presented to the rheumatology clinic with a primary complaint of joint pain in the hands, digits, knees, and right ankle to initiate medical management. Medical history The patient's past medical history included end-stage renal disease (ESRD), congestive heart failure and a parathyroidectomy for a parathyroid adenoma a year prior to the initial presentation at the clinic. Laboratory examination Inflammatory synovial aspirate of the right knee containing CPP crystals and 4203 nucleated cells/μ L.
Corrected calcium: 8.7 mg/dL (normal 8.9–10.2) Ionized calcium: 2.9 mg/dL (normal 4.6–5.1) Phosphorous 4.1 mg/dL (normal 2.5–4.5) Magnesium 2.0 mg/dL (normal 1.9–2.4) Liver studies and a complete blood count (CBC) was reported to be fully within reference range. Radiological examination Radiographs of the hands and wrists: Figures 1A, B and C Radiographs of the knees: Figure…
