A confession reveals the cause of debilitating knee pain

Julian, 32, presents with a painful left knee that he can’t explain. When his partner leaves the exam room, he reveals something that might help your diagnosis

Julian is 32 and works as a bartender at a club.

Sore knee

Over the past week, he has noticed steadily increasing pain and swelling in his left knee, which is now extremely painful, preventing him from working.

He is unable to weight bear and is feeling generally unwell, with fever, nausea, lack of appetite and some weight loss.

He has never experienced an episode like it before. There is no family history of arthritis and specifically of gout.

Apart from an appendicectomy in childhood Julian has had no prior medical problems