Case 065: Gout and Hyperuricemia

PATIENT PRESENTATION

Chief Complaint

“My toe pain keeps coming back and is spreading despite taking the medicine.”

History of Present Illness

Patient returns to clinic with recurring podagra following two previous episodes over the past ten months.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What signs and symptoms of gout does the patient have?

   Hint: See Clinical Presentation and Diagnosis in PPP

2. What risk factors for the development of gout are present in the patient?

   Hint: See Epidemiology and Etiology in PPP

3. What would be the best treatment regimen for management of gout in this patient?

   Hint: See Urate-Lowering Therapy for Gout Prophylaxis in PPP

4. What risks and adverse effects of therapy would you discuss with the patient?

   Hint: See Urate-Lowering Therapy for Gout Prophylaxis in PPP

5. What lifestyle modification education points should be discussed with the patient regarding the prevention of future gout attacks?

   Hint: See Urate-Lowering Therapy for Gout Prophylaxis in PPP

FOLLOW-UP

What therapy changes would you consider if the patient continues to present with elevated serum uric acid levels?

Hint: See Urate-Lowering Therapy for Gout Prophylaxis in PPP

CASE SUMMARY

Global Perspective

Gout is a common type of inflammatory arthritis caused by hyperuricemia through an abnormality of uric acid metabolism or excretion. The prevalence of gout in the United States remains high due to several factors, including unhealthy dietary habits, increased use of medications associated with the development of gout, increased rates of cardiometabolic conditions and renal impairment, and an increase in the overall population life expectancy. To help decrease the incidence of gout and hyperuricemia, it is important for health care professionals to educate patients at risk for developing gout on the signs and symptoms of gout, comparison of pharmacotherapy options, and therapeutic lifestyle changes, including weight reduction and low consumption of foods high in purine content. Multiple pharmacotherapy options exist, and selection is based on several patient-specific factors.

Key References