ID: 67y/o ♀, multiple medical comorbidities, brought in by EMS due to inability to walk due to joint pain.
HPI: Hx of a mechanical fall one week ago; no ↓LOC; no head trauma; gradual onset of pain, erythema, warmth, and swelling in multiple large joints (Rt elbow and knee, Lt wrist) past 2/7. Lost ROM in the involved joints due to sever pain; unable to mobilize; no fever/chills; ROS otherwise noncontributory.
PMH: gouty arthritis 1-2 attacks/yr on allopurinol; always Lt 1st MTP joint; last episode 2mo ago; CKD eGFR=35; stable angina on medical Rx; controlled HTN;
E/O: A+O ✗ 3 - NAD - ⊘ill/toxic
VSSA
HEENT: no oral mucosal ulcerations; pupils 3mm symmetric, reactive, ⊘RAPD
MSK: Rt elbow, Rt knee, Lt wrist: erythematous, swollen, warm, extremely tender to touch; no active/passive ROM due to severe pain;
The rest of the exam noncontributory.
I/P: 67 y/o ♀ with gouty arthritis involving multiple joints precipitated by recent blunt trauma.
CBC, rapid metabolic panel (RMP), INR, serum uric acid (sUA), ESR; X ray involved joints; medicine/rheumatology consult regarding admission; Rx as acute gouty arthritis with prednisone 50mg PO daily taper to a total course of 7d;
Discussion;
Acute gouty arthritis can be precipitated by trauma, fatty foods, beer and spirits (NOT wine), dehydration, starvation, low-dose aspirin.
Always consider the possibility of septic arthritis, even in pt with long-standing Hx of gout. Septic and gouty arthritis can occur simultaneously in a joint.
Release of cytokines may cause lower sUA during an attack. For most accurate sUA measurements, wait at least 2wk after complete resolution of Sx(1).
Reference:
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