A 54-year-old male presents to your clinic with severe pain in his left wrist and right great toe.

Case Presentation
A 54-year-old male presents to your clinic with severe pain in his left wrist and right great toe. The affected joints are swollen, erythematous and exquisitely painful. He denies injury to these areas as well as fever. The patient is afebrile with a temperature of 98.8, all vital signs are within normal limits.

The patient has a history of hypertension and hyperlipidemia. He has been steadily gaining weight over the past few years and is now about 50 pounds overweight. He states that he drinks four to five beers each night.

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On exam, you find that the patient’s wrist and first MTP joint are erythematous and very tender to even light touch. The patient has limited range of motion of these joints related to pain. Sensation and capillary refill are intact. Lab values show a WBC of 5,400 (Normal 4,300-10,800) and a Uric Acid level of 9.7 (Normal >7.0).

Based on exam and lab results, you diagnose this patient with gout. Arthrocentisis of the affected joint can be used to confirm your diagnosis. Differential diagnoses you should rule out in a patient with an erythematous, inflamed joint include but are not limited to cellulitis, bursitis, rheumatoid arthritis, trauma and septic arthritis.

Discussion Questions

What is the the main treatment for an acute gout attack?

When should you should be offered preventative therapy?

How does diet plays a role in the management of Gout?

What should patients avoid in the diet? What should they incorporate into their diet?