Case Presentation A 54-year-old male presents to your clinic with severe pain in
ID: 137339 • Letter: C
Question
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.
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?
Explanation / Answer
What is the the main treatment for an acute gout attack?
Mitigating operators are compelling for the treatment of the gout flare, including foundational and intraarticular glucocorticoids, nonsteroidal calming drugs (NSAIDs), colchicine, and biologic specialists that repress the activity beta [1-3]. An arrangement of general standards is imperative in the influential management of the gout flare, paying little heed to the particular mitigating specialist utilized. These incorporate the accompanying:
Early treatment – Treatment should begin at the earliest opportunity after the patient sees the start of a flare, ideally inside a few long periods of indication beginning. More quick and finish determination of indications happens the prior that treatment is presented, particularly if treatment is started at the full suggested measurements of the picked mitigating operator. Patients ought to be proceeded on treatment for the span of the flare, as a rule at diminished measurements once a noteworthy lessening in side effects is accomplished.
Length of treatment – Complete discontinuance of treatment for the gout flare can as a rule be securely done inside a few long stretches of finish determination of the flare; be that as it may, on account of oral glucocorticoids, we now and then decrease all the more gradually to bring down the danger of a repetitive flare.
The term of treatment for the gout flare may extend from just a couple of days (eg, in a patient treated inside long stretches of manifestation beginning) to a little while (eg, in a patient started on treatment following four or five long periods of side effects). Numerous patients require calming treatment for a gout flare for close to 5 to 7 days if started on treatment inside 12 to 36 long stretches of manifestation beginning.
When should you should be offered preventative therapy?
Adjunctive measures, none of which are of demonstrated viability, are frequently controlled for manifestation alleviation and incorporate what tops off an already good thing [9], resting the joint that is included, and regulating pain relieving solutions. In the rare patient who requires opioid treatment, these specialists ought to be utilized as a part of the most minimal dosages and for the briefest span important. These measures don't substitute for viable calming treatment of the gout flare.
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?
The over-all principles of a gout eating regimen take after route of the mill solid eating routine suggestions:
Weight reduction. Being overweight builds the danger of creating gout, and getting in shape brings down the danger of gout. Research recommends that diminishing the amount of calories and in receipt of in shape straight deprived of a purine limited consumption routine bring despondent uric eroding stages and lessen the quantity of gout assaults. Getting more fit additionally diminishes the general weight on joints.
Complex carbs. Eat more organic products, vegetables and entire grains, which give complex sugars. Keep away from sustenances and refreshments with cutoff utilization of normally sweet organic product juices.
Water. Remain very much hydrated by drinking water.
Fats. Amended posterior on immersed fats from red meat, greasy fowl besides great fat dairy items.
Proteins. Spotlight on slender meat and fowl, little fat dairy besides lentils as wellsprings of protein..