Question

Mr. Parnelli, age 49, arrives at your office in significant pain (8 out of 10 on the pain scale, for 2 days). He is limping. He had acute onset of pain in his left great toe two nights ago. He is a truck driver, drives long shifts, and rests only during his required rest periods. On physical exam, he has a significantly enlarged metatarsophalangeal (MTP) joint of the left toe. The joint and nearby dorsum of the foot are red, inflamed, very tender, and warm to the touch. There is no evidence of cellulitis. Pedal pulse is palpable.

Answer the questions below to explore your understanding of Mr. Parnelli’s condition.

1. A serum uric acid test was performed and was typical for gout. Was the uric acid normal, elevated, or decreased? Why?

2. What caused the acute inflammation in Mr. Parnelli’s great toe joint?

3. What is the technical name for this acute episode?

4. If it is typical, will this inflammation persist for several months, or will it resolve?

5. Once the inflammation is gone, is Mr. Parnelli cured, or is he likely to have future episodes? Why?

6. Why is Mr. Parnelli at high risk for renal calculi?

7. Does Mr. Parnelli have chronic tophaceous gout? Why, or why not?

Answer 1

1).

Uric acid is not soluble in water as like urea, so excess catabolism of uric nucleic acids causes accumulation of uric acid crystals in joints. This condition is known as “gout.”

The characteristic of gout is the inflammation of the first metatarsal joint of the great toe (gouty arthritis), and increased uric acid levels in the blood (hyperuricemia). Some of the medications used in the treatment of gout are probenecid, sulfinpyrazone, or allopurinol.

The elevated uric acid level is characteristic of gout. The normal range of uric acid is 250-750 mg/day. So, allopurinol can be used to control the symptoms as it helps to reduce the uric acid levels, accumulation of which causes gout.

2).

The acute inflammation of joints in gout is due to the accumulation of uric acid in the joints.

3).

This episode is called, "gout attack."

4).

If treatment is provided, acute gout or gout attack can resolve in 3-4 days, and it takes about 14 days if no treatment is provided.

5).

Gout cannot be cured. The gout patients have repeated events of gout attacks, and the repeated events of gout lead to gouty arthritis.

6).

Gout patients are at high risk of renal calculi as the high uric acid levels cause accumulation of the same in the kidneys and lead to renal calculi.