Goutte

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍severe joint painjoint swelling

Location is on ‍rightleft ‍footgreat toe ‍

Symptoms include:

‍pain

‍redness

‍warmth

‍swelling

‍decreased joint movement

‍joint stiffness

‍inability to bear weight

‍fever, up to ‍°, over ‍ ‍hoursdays



Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍diet high in purines

‍overweight

‍alcohol consumption

no history of: ‍gout, ‍obesity, ‍hyperlipidemia, ‍diabetes, ‍hypertension, ‍renal insufficiency

no use of: ‍diuretics, ‍aspirin, ‍levodopa, ‍cyclosporine, ‍ethambutol, ‍pyrazinamide

no family history of: ‍gout





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Foot: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Skin: ‍rashlesions on ‍





ASSESSMENT:

‍Acute gout ‍likelysuspectedpossible

DDx: gout flare, pseudogout, hydroxyapatite periarthritis, septic arthritis, cellulitis, contusion, fracture, osteoarthritis, rheumatoid arthritis, bursitis, tendonitis, deep vein thrombosis, peripheral arterial disease, complex regional pain syndrome, sickle cell crisis, hemarthrosis





PLAN:

Investigations:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍CRP, ‍uric acid

- Joint aspiration

- X-ray

Treatments:

- ‍NSAIDs

- ‍Colchicine

- ‍Corticosteroids

- ‍Allopurinol to start 4 weeks after resolution of acute attack

- Advise to start medication as soon as symptoms start

- Ice packs (advised that may worsen pain in some cases)

- Increase fluid intake

- Avoid high-purine foods, like red meat, shellfish, cheese, and corn syrup

- Avoid alcohol

Further care:

- Referral to rheumatologist

- Referral to dietician

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as fever, joint redness, or severe joint pain