A 59-year-old man started hydrochlorothiazide 2 months ago for hypertension. He now has acute swelling and pain of the first metatarsophalangeal

Question

A 59-year-old man started hydrochlorothiazide 2 months ago for hypertension. He now has acute swelling and pain of the first metatarsophalangeal joint. Serum urate is elevated, and joint aspirate shows negatively birefringent crystals. Which of the following is the most likely explanation for this patient's findings?

Accepted Answer

Reduced renal urate excretion from thiazide therapy

Answer

Immune complex vasculitis from amlodipine

Answer

Direct bacterial invasion of the toe joint

Answer

Calcium pyrophosphate deposition from sodium loss

Answer

Purine deficiency from diuretic use

Thiazide-induced hyperuricemia — USMLE Step 3 MCQ