A 55-year-old American Indian truck driver presented with a 2-day history of right wrist swelling and pain. He denied previous trauma to the wrist or having performed unusual activities. He did not have fever or chills. His medical history was significant for hypercholesterolemia; obstructive sleep apnea; and degenerative arthritis of the shoulders, spine, and knees.
On physical examination, the man’s right wrist appeared swollen; it was tender to touch with limited flexion and extension because of the pain and swelling. The patient also had limited bilateral shoulder abduction and forward flexion without pain. There was limited lumbar flexion and extension without findings of radiculopathy. Other findings included hyperpigmentation of the left conjunctiva (photograph, above left), both pinnae, and both hands (photograph, above right).
Laboratory study results showed a normal complete blood cell count and metabolic profile. The patient’s uric acid level was 2.2 mg/dL (normal range, 4.8 to 8.7 mg/dL). X-ray films of the patient’s right wrist (anteroposterior [AP] and oblique views, bottom left and right, respectively) showed radiocarpal osteoarthrosis without evidence of chondrocalcinosis.
What is your diagnosis? How would you confirm this diagnosis?
(Find the answer on the next page.)