A 55-Year-Old Woman Comes to the Physician with Worsening Left

question 537

Multiple Choice

A 55-year-old woman comes to the physician with worsening left knee pain.  She has had intermittent pain and stiffness in her left knee for the past 5 years.  The pain is aggravated by prolonged standing, but her knee also feels stiff if she sits in 1 place for too long.  She was diagnosed with ulcerative colitis 3 years ago.  The patient initially was treated with systemic steroids, and the disease is currently in remission on oral sulfasalazine.  Her other medical problems include hypertension, impaired glucose tolerance, and hypothyroidism.
The patient's vital signs are normal.  Her BMI is 31 kg/m².  On physical examination, flexion and extension of the left knee joint elicit pain, but there is no instability.  There is a small joint effusion.  Knee joint aspiration yields 3 mL of synovial fluid.  Synovial fluid analysis shows a total cell count of 2000/µL with 25% polymorphonuclear cells.
An x-ray of the left knee is shown below.

Which of the following is the most likely diagnosis?

• A)Arthritis associated with inflammatory bowel disease
• B)Avascular necrosis of femur
• C)Calcium pyrophosphate crystal deposition disease
• D)Osteoarthritis
• E)Patellofemoral pain syndrome

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