A 50 year old male presents to the ER complaining of severe pain in his left...

A 50 year old male presents to the ER complaining of severe pain in his left toe. The pain was sudden in onset and he describes the pain as sharp and non radiating. He is having difficulty bearing weight on his foot. His past medical history is significant for essential hypertension which is well controlled with an Ace inhibitor. Examination is significant for an inflamed first metatarsal phalangeal joint. In passing, he states that he enjoys a good meal, like to dine on game of meat, and," I have to have my 20 ounce steak at least twice a week."
1) what is the term used to describe the condition?
2)which serum value would you obtain?
3)what is the pathogenesis os this disease?
4)how is this condition diagnosed?
5)what pharmacological agents are used to treat this condition? (Hint:there are four.) Which agent is used during an acute attack? What is the mechanism of action for each of the drugs listed?

Solutions

Expert Solution

1. This patient is suffering from gout as he is suffering from extreme pain in the left toe which is due to the buildup of the urate crystals there.

2. It is associated with elevated serum uric acid levels.

3. An elevated serum urate level, leading to the deposition of urate crystals into the joints also leading to progressive joint damage.

4. Joint fluid test-this is done by taking the fluid from the affected joint to look for the urate crystals.

Blood test- to measure the levels of uric acid and creatinine in the blood.

X-ray imaging- Joint X-rays can be helpful to rule out other causes of joint inflammation.

5. Nonsteroidal anti-inflammatory drugs (NSAIDs)- These agents act through the reduction of prostaglandin formation and the inhibition of crystal phagocytosis by macrophages which are the cause of gout.

Colchicine-works by decreasing swelling and lessening the build-up of uric acid crystals that cause pain in the affected joint(s).

Corticosteroids- lowers serum uric acid levels by increasing renal uric acid clearance thereby reducing gout.

Allopurinol- decreases the formation of uric acid by the body and is a very reliable way to lower the blood uric acid level.

gladiator answered 1 year ago

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