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A 70-year-old man presents with a complaint of intense pain from a red and swollen right toe. He has had no prior events such as this. He cannot recall trauma to the toe. An x-ray film of the right foot is negative for a fracture. He is taking no medications, and denies a history of alcohol abuse. He is given a diagnosis of gout and his serum is drawn for analysis. Which of the following findings would be most helpful in making the diagnosis of gout in this patient?
A. Associated right ankle effusion
B. Painless elbow nodule
C. Response to colchicine
D. Serum uric acid elevation
E. X-ray film showing first metatarsophalangeal joint erosion
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E. Tophi is pathognomonic for gouty arthrites. Colichcine , a drug which inhiibits neutrophil chemotaxis by altering microtubules polymerization......hence reducing inflammatory process is not specific to gout.
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It is definitely E. X-ray film showing first metatarsophalangeal joint erosion
Remember that Colchicine and NSAIDs are first line TREATMENTS to Gout and Pseudogout.
Serum uric acid finding is not elevated but DECREASED in Gout.
This question is asking for a finding for diagnostic purposes which is the CLASSIC painful MTP joint of the big toe (PODAGRA).
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The correct answer is C.
A good way to diagnose gout is to give oral colchicine hourly until the patient develops
improvement in joint pain and inflammation. The most specific method of diagnosis, however, is joint aspiration and identification of negatively birefringent needle shaped crystals.
A right ankle effusion (choice A) may be related to gout, or could be due to another rheumatologic problem.
Elbow nodules (choice B) are a non-specific diagnostic feature.
Uric acid levels (choice D) may be elevated in gout, as well as disorders such as tumor lysis syndrome. The results will be too non-specific.
The toe joint erosion (choice E) may be related to gout, trauma, degenerative joint disease or arthritis.
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Ohhhhh ok, I see what you are talking about. MTP is a clinical symptom, not a diagnosis.
So oral colchicine hourly until patient develops an improvement? Do we have to worry about how many hours we would need to wait? 2? 3? 5? 10?
