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Clinical update on gout

Introduction & module overview

Diagnosis

Learning scenario 1

Management

Learning scenario 2

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module menu icon Learning scenario 1

Learning scenario

A patient, Pete Hawkins, asks for the strongest painkillers he can buy.

When you ask about his symptoms, he says he has pain in his foot. Wincing as he removes his sandal – he says it is too painful for him to wear any of his other shoes – you see that the joint around the base of the big toe is red and swollen. He has no other symptoms and cannot pinpoint anything that may have precipitated the pain. 

What do you advise?

Diagnose pseudogout due to the absence of tophi

INCORRECT. Tophi are not always present in gout and pseudogout can only be distinguished from actual gout by microscopic analysis of any crystals present in the synovial fluid of the affected joint.

Diagnose septic arthritis. Advise Pete to seek urgent medical advice

INCORRECT. This is unlikely as there are no systemic symptoms.

Diagnose cellulitis. Make Pete an appointment to get a prescription for antibiotics

INCORRECT. Cellulitis usually presents with systemic as well as local symptoms.

Diagnose gout. Sell Pete some ibuprofen and advise him to rest and ice the foot

CORRECT. The symptoms indicate gout and a NSAID plus rest and ice will help alleviate the pain – but Pete also needs to see his GP to have a full assessment.

Clinical update on gout

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