Author | Gregory R. Emkey, MD

The 45-year-old woman turned up in the emergency room with an acutely painful, swollen thumb. Aspiration results were uninformative. What's the diagnosis?

A 45-year-old woman presented to the emergency department with a 3-day history of an acutely painful, swollen, and erythematous thumb. Ordinary x-ray was central to the correct diagnosis.

As the population ages and persons live longer with more medical comorbidities, the incidences of both gout and pseudogout will continue to increase. Uric acid metabolism is crucial to the pathogenesis of gout. Patients who have the arthritis associated with crystal-deposition disease typically present clinically with acute attacks of joint pain, swelling, and erythema and have asymptomatic periods between acute attacks.