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Medical Case Study
Transcript of Medical Case Study
Block 2B - Katherine Thomas, M.D.
- Department of Rheumatology
- University Of Massachusetts School of Medicine
- Residency at Brigham and Women's Hospital in Boston, MA Patient X is a 42-year-old white male who is 6'2'' 230 lbs. He directly came from the physician's office with complaints of swelling and severe pain located in the metatarsal-phalangeal joint of the big toe on the left foot.
The patient has been experiencing excruciating pain of the big toe for over 36 hours.
Joint can be described as warm, red, and very tender. Patient Symptoms Clinical History Patient X suffers from chronic kidney disease, high cholesterol, and hypertension.
Daily use of medications Lisinopril and Zocor to treat all three conditions.
Works as a plumber.
Married for twenty years with no children.
Does not smoke or consume alcohol.
Both his father and older brother suffer from arthritis. Synovial Fluid Test- Doctor uses a needle to draw fluid from the affected joint and examines the fluid under the microscope to reveal if urate crystals are present.
Blood Test- Measures uric acid level in the blood.
Foot X-ray Diagnostic Tests Synovial fluid test reveals urate crystals present.
Blood test- Normal uric acid levels in the blood ranges from 3.5-7.2 mg/dL. Results of the blood test shows that patient X has a uric acid level of 9.2 mg/dL. Results Diagnosis The high uric acid in the blood and the presence of urate crystals in the joints indicates that patient X suffers from Gouty Arthritis, also known as Gout. What is Gout? Gout is a painful form of arthritis that is caused by high uric acid levels in the blood (hyperuricemia).
Uric acid forms crystals that causes inflammation in joints, leading to swelling and pain.
Acute gout attacks can last from three to ten days. Some people have gout attacks only once in their lifetime. Without treatment or changes in lifestyle, attacks can occur several times a year.
When uric acid levels increase, so does the potential for gout flares. Causes Gouty Arthritis is caused by hyperuricemia.
Hyperuricemia can occur due to diet, genetic predisposition, under excretion of urate, and renal insufficiency. Pathophysiology A Diet high in purine (seafood and red meat) or the kidneys inability to break down waste products lead to excess uric acid.
Excess amounts of uric acid causes hyperuricemia.
Formation of monosodium urate crystals.
The crystals in the synovial fluid triggers IgG, which stimulates leukocytes.
The Leukocytes cause the release of a wide range of inflammation mediators, such as chemotactic factors, lysosomal enzymes, Prostaglandin E2 (PGE2), interleukin (IL), and oxygen radicals.
Leads to inflammation and tissue damage. Signs and Symptoms Excruciating Joint Pain
Tenderness of the joint
Inflammation and redness of the joint
Fever Risk Factors History of gout in the family
Diet high in purine-rich foods
Excess alcohol consumption
Taking diuretics Treatment Nonsteroidal anti-inflammatory drugs (NSAIDs)- Controls inflammation and pain with gout.
Colchicine- Pain reliever that reduces gout symptoms.
Corticosteroids- Controls inflammation and pain. Prognosis Without proper treatment, an acute gout attack can last up to seven days. Lack of treatment also causes multiple acute gout attacks within the year, and will eventually lead to chronic gouty arthritis.
If treated properly, uric acid in the blood decreases, which also decrease the chance of future gout flares.