A 58-year-old obese white male presents to ED with the chief complaint of fever, chills, pain, and swelling in the right great toe. He states the symptoms came on very suddenly and he cannot put any weight on his foot. Physical exam reveals exquisite pain on any attempt to assess the right first metatarsophalangeal (MTP) joint. Past medical history is positive for hypertension and Type II diabetes mellitus. Current medications include hydrochlorothiazide 50 mg po q am, and metformin 500 mg po bid. CBC normal except for elevated sedimentation rate (ESR) of 33 mm/hr and C-reactive protein (CRP) 24 mg/L. Metabolic panel normal. Uric acid level 6.7 mg/dl.(Gout Case Analysis)
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Gout is a form of inflammatory arthritis typically characterized by intense pain on one joint at a time, swelling, and stiffness of the joint. The patient’s symptoms hint on the occurrence of acute gout triggered by the patient’s medications as well as other risk factors such as hypertension and obesity. It is imperative to examine the neurological and musculoskeletal pathophysiologic processes that account for the symptoms, any variables that may verse physiological functioning, and how the process interactions affect the patient.(Gout Case Analysis)
Gout symptoms manifest due to the formation of uric acid crystals in the joints and the body’s response to the accumulation of the crystals in tissues of the body (Singh, 2013). The deposits of uric acids on the joints cause inflammation of the joints leading to pain, heat (fever), and swelling. Typically, uric acid is a byproduct of purine protein break down. Hyperuricemia, too much uric acid in the body, leads to deposition on joints as assessed on the patient’s right first metatarsophalangeal (MTP) joint. Acute gout occurs when urate crystal deposits suddenly cause acute inflammation and intense pain. Labeled as ‘flares,’ acute gout takes up to 10 days to subside and can be triggered by stressful events, alcohol, and drugs, as well as cold weather (Williams, 2019).(Gout Case Analysis)
Hydrochlorothiazide (HCTZ), one of the patient’s antihypertensive medications, is also known to increase uric acid levels and elevate the risk for gout (Ala-Mutka et al., 2018). HCTZ and uric acid use the same cell membrane transporter, organic anion transporter 1 (OAT1). Competition between the two organic acids partly contributes to the increase in uric acid levels, leading to an increased risk for gout (Ala-Mutka et al., 2018). Secondly, the patient is obese and has a history of Type 2 Diabetes Mellitus (T2DM) (Evans et al., 2018). T2DM is a chronic condition characterized by high levels of sugar in the blood due to insulin resistance. T2DM happens when the body’s cells resist insulin’s effect, which drives glucose in the blood into the cells. In the patient’s case, T2DM and hypertension increased the risk of gout, as the body creates more insulin, and the kidneys find it challenging to dispose of uric acid.(Gout Case Analysis)
On a national scale, gout affects up to 4% of the American population. However, there are ethnic variables with African Africans having a 5.0% prevalence compared to whites 4.0% due to a high prevalence of hyperuricemia (Evans et al., 2018). Furthermore, gout is found to be more prevalent among males than females due to high serum urate levels in men across all ages. However, the difference decreases among men and women above 70 years (Singh, 2013).(Gout Case Analysis)
The patient’s history and present medication, as well as obesity, led to acute gout. Obesity, hypertension, and T2DM increased the risk of gout by increasing serum urate levels and uric acid concentrations (Wilson, & Saseen, 2016). Consequently, HCTZ medication also increased uric acid and serum urate levels, elevating the risk of disease. The patient’s gender contributed but not ethnicity as minority groups are associated with high serum rates compared to whites with European ancestry. The increased levels of uric acid led to more the accumulation on the right first metatarsophalangeal (MTP) joint, leading to intense pain, inflammation on the right great toe and fever and chills.(Gout Case Analysis)
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Gout Case Analysis
For the patient, acute gout is manifested through intense pain and stiffness on the right first MTP joint. The patient’s antihypertensive medications are increasing the risk of disease, as well as hypertension, obesity, and T2DM. It is imperative to treat the patient by addressing the underlying causes of gout.(Gout Case Analysis)
References
Ala-Mutka, E. M., Rimpelä, J. M., Fyhrquist, F., Kontula, K. K., & Hiltunen, T. P. (2018). Effect of hydrochlorothiazide on serum uric acid concentration: a genome-wide association study. Pharmacogenomics, 19(6), 517-527.
Evans, P. L., Prior, J. A., Belcher, J., Mallen, C. D., Hay, C. A., & Roddy, E. (2018). Obesity, hypertension and diuretic use as risk factors for incident gout: a systematic review and meta-analysis of cohort studies. Arthritis research & therapy, 20(1), 136.(Gout Case Analysis)
Singh J. A. (2013). Racial and gender disparities among patients with gout. Current rheumatology reports, 15(2), 307. https://doi.org/10.1007/s11926-012-0307-x
Williams, L. A. (2019). The History, Symptoms, Causes, Risk Factors, Types, Diagnosis, Treatments, and Prevention of Gout, Part 2. International Journal of Pharmaceutical Compounding, 23(1), 14-21.(Gout Case Analysis)
Wilson, L., & Saseen, J. J. (2016). Gouty arthritis: a review of acute management and prevention. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 36(8), 906-922.
Question
A 58-year-old obese white male presents to ED with the chief complaint of fever, chills, pain, and swelling in the right great toe. He states the symptoms came on very suddenly and he cannot put any weight on his foot. Physical exam reveals exquisite pain on any attempt to assess the right first metatarsophalangeal (MTP) joint. Past medical history is positive for hypertension and Type II diabetes mellitus. Current medications include hydrochlorothiazide 50 mg po q am, and metformin 500 mg po bid. CBC normal except for elevated sedimentation rate (ESR) of 33 mm/hr and C-reactive protein (CRP) 24 mg/L. Metabolic panel normal. Uric acid level 6.7 mg/dl.
As you continue, premiumacademicaffiates.com has the top and most qualified writers to help with any of your assignments. All you need to do is place an order with us. (Gout Case Analysis)
Gout Case Analysis
Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following:
Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
Any racial/ethnic variables that may impact physiological functioning.
How these processes interact to affect the patient.
A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
Case Study: An African American Child Suffering From Depression.
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