Case Study:
A 58-year-old obese white male presents to ED with chief
complaint of fever, chills, pain, and swelling in the right
great toe. He states the symptoms came on very
suddenly and he cannot put any weight on his foot.
Physical exam reveals exquisite pain on any attempt to
assess the right first metatarsophalangeal (MTP) joint.
Past medical history positive for hypertension and Type Il
diabetes mellitus. Current medications include
hydrochlorothiazide 50 mg po q am, and metformin 500
mg po bid. CBC normal except for elevated sedimentation
rate (ESR) of 33 mm/hr and C-reactive protein (CRP) 24
mg/L. Metabolic panel normal. Uric acid level 6.7 mg/dl.  Neurological and Musculoskeletal Pathophysiologic Processes Essay

Neurological and Musculoskeletal Pathophysiologic Processes

The clinical findings indicated are similar to those associated with gouty arthritis. It is a kind of inflammatory arthritis that is extremely painful. There are flare-ups and remissions, with the big toe joint being the most often affected (Cabău et al., 2020). Inflammatory cytokines such as IL-1b, which are responsible for gouty arthritis, are implicated. Neutrophil numbers grow as a result of these increased cytokines. When gouty arthritis flares up for a lengthy period of time, tophi develop as a clinical manifestation. Urate crystals build up in the joints, causing gout tophi. The big toe joint is the most common location for this condition. When urate crystal levels rise, it raises the possibility of neurological problems. Neurological and Musculoskeletal Pathophysiologic Processes Essay

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Racial/Ethnic

Gouty arthritis is most common among African-Americans, who are the most susceptible group. There is evidence that pre-existing conditions like renal and liver diseases, obesity, and diabetes, enhance the chance of developing gouty arthritis (Mattiuzzi & Lippi, 2019). There are additional factors that put Black Americans at risk, such as a dearth of high-quality gout treatment, which results in a higher than average incidence of gouty arthritis.

Diagnostic variables

Increased uric acid synthesis or decreased uric acid elimination may both lead to the development of gouty arthritis. A lot of factors may contribute to this occurrence. For example, a genetic defect in organic anion transporters in the renal function results in a large amount of uric acid being reabsorbed from the renal tubules and, as a result, an excessive amount of uric acid in the bloodstream (Lin et al., 2017). Additionally, alcohol, low-dose aspirin, and diuretics may create issues with uric acid excretion in the body. Men between the ages of 30 and 50 comprise the highly at-risk population. Gout may be triggered by an injury in rare situations.

References

Cabău, G., Crișan, T. O., Klück, V., Popp, R. A., & Joosten, L. A. (2019). Urate‐induced immune programming: Consequences for gouty arthritis and hyperuricemia. Immunological Reviews, 294(1), 92-105. https://doi.org/10.1111/imr.12833

Lin, W., Tang, H., Lai, C., & Chao, C. (2017). Clinical manifestations and bacteriological features of culture-proven Gram-negative bacterial arthritis. Journal of Microbiology, Immunology and Infection, 50(4), 527-531. https://doi.org/10.1016/j.jmii.2015.08.026

Mattiuzzi, C., & Lippi, G. (2019). Recent updates on worldwide gout epidemiology. Clinical Rheumatology, 39(4), 1061-1063. https://doi.org/10.1007/s10067-019-04868-9

Neurological and Musculoskeletal Pathophysiologic Processes Essay