A 45-Year-Old Man Comes to the Office Due to Slowly

A 45-year-old man comes to the office due to slowly progressive back and joint pain.  In particular, his knee and ankle joints are stiff and painful when he walks.  Over the past year, the patient has also experienced excessive sweating, and his ring and shoe sizes have increased.  He has no prior medical issues and takes no medications.  The patient does not use tobacco, alcohol, or illicit drugs.  There is no significant family history.  Physical examination shows coarse facial features with a prominent forehead, protruding jaw, and widely separated maxillary teeth.  There is mild swelling and crepitus of the knees and ankles bilaterally. Which of the following is the most likely underlying cause of this patient's joint symptoms?

A) Accumulation of iron
B) Deposition of crystals
C) Formation of noncaseating granulomas
D) Hypertrophy of the articular cartilage
E) Infiltration of macrophages

Correct Answer:

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