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2. A 60-year-old male with a diagnosis of chronic mye-
Mid leukemia is treated with intensive chemotherapy. He
goes into remission bu! develops inflammation of the wrist
joint. Aspiration of the swollen wrist joint reveals needle-
shaped crystals. Which of the following processes played
an important role in the pathogenesis of joint inflammation?
O (A) Damage to the articular caxtilage by chemothera-
peutic agents
O (B) Infiltration of the synovium by leukemic cells
O © Synovial proliferation from cytokine secretion by
leukemic cells
O (D) Excessive production of uric acid from dying leuke-
mic cells
0 (E) Hemorrhages into the joint because of deranged
platelet function

DD

is it bb?

dd

d..

(D) This patient has secondary gout. When patients
with leukemia, especially those with a high leukocyte
count (as occurs in chronic myeloid leukemia), are treated
with chemotherapeutic agents, there is massive lysis of
nuclei, and large amounts of urate are produced. The hy-
peruricemia leads to deposition of crystals in the joint
space that triggers a local inflammatory response. Articular
cartilage damage can be seen in any form of chronic arthri-
tis, but is a prominent feature of osteoarthritis. Synovial
proliferation is also a nonspecific change that is prominent
in rheumatoid arthritis. Joint hemorrhages can be seen in
patients with thrombocytopenia, but they typically occur in
patients with hemophilia.