This document presents a case study of a 55-year-old male patient diagnosed with gout. The patient presented with extreme pain, swelling, and redness in his right great toe. His medical history includes hypertension and hyperlipidemia. The provisional diagnosis was foot pain and effusion, and the final diagnosis was gout. The treatment plan includes indomethacin and allopurinol to manage the acute attack and reduce uric acid levels. Lifestyle modifications like weight loss, reducing alcohol consumption, and increased water intake are also recommended.

1. GOUT
PRESENTED BY-
VARSHA R WADNERE(PD328)

2. ■ GOUT-metabolic disorder of
purine metabolism.
■ CAUSES:
Excess uric acid, excess purine
diet, inability of kidneys to flush out
uric acid, defective purine
metabolism, urate crystals, alcohol
consumption.
■ SIGNS AND SYMPTOMS OF
GOUT:
Intense pain, swelling, warm in
joint,tendernes, tophi, inflammation.

3. S0AP ANALYSIS
PATIENT DETAILS:
■ NAME- MR.GRAND
■ AGE- 55yrs
■ SEX- MALE
■ WEIGHT-94.5kg
■ Height-179cm
■ BMI-30(OVERWEIGHT)

4. SUBJECTIVE DATA
■ PAIN,SWELLING AND REDNESS IN HIS RIGHT GREAT TOE.
■ WOKE UP IN NIGHT WITH EXTREME EXCRUCIATING PAIN IN TOE,BY
MORNING HIS TOE WAS DARK RED AND WARM.
■ SAME EPISODE WAS FACED BY HIM 3yrs Ago.

5. OBJECTIVE DATA

6. ASSESSMENT
■ PROVISIONAL DIAGNOSIS: FOOT PAIN,EFFUSION OF FOOT PAIN
■ FINAL DIAGNOSIS: GOUT

7. HISTORY
■ MAJOR CHILDHOOD ILLNESS- DENIES RHEUMATIC OR SCARLET
FEVER,MUMPS,PERTUSIS.
■ ADULTHOOD ILLNESS- HYPERTENSION,HYPERLIPIDEMIA.
■ MEDICATION: HYDROCHLOROTHIAZIDE 25MG DAILY, DILTIAZEM
CD 300MG DAILY.
■ ALLERGIES: ACE INHIBITORS.
■ FAMILY HISTORY: FATHER DIED DUE TO COMPLICATION DIABETES AND
HYPERTENSION AND BROTHER HAVE HYPERTENSION.
■ 3-4 BEER CONSUMPTION DAILY AT NIGHT.

8. GOALS OF TREATMENT
■ The three general goals of therapy in the management of gout
recommended by British Society of Rheumatology:
■ Management of the acute painful attack
■ Recommendations to change diet, lifestyle modifications and
implementation non-pharmacological modalities.
■ Management of recurrent or chronic gout

9. ASSESSMENT OF CURRENT
THERAPY
1. Indomethacin (50mg- 3 times/day.)
• INDICATION: NSAIDs.
• ADR:VERTIGO, DYSPEPSIA, POSTOPERATIVE HEMORRHAGE .
• CONTRAINDICATIONS:ASTHMA, GI DISEASE, HYPERKALEMIA.
• INTERACTIONS: DIGOXIN,VANCOMYCIN, PHENYLBUTAZONE.

10. 2. ALLOPURINOL(300MG-OD)
• INDICATION: XANTHINE OXIDASE INHIBITOR USED FOR PRIMARYAND SECONARYGOUT.
• ADR: RENAL FAILURE SYNDROME, APLASTICANEMIA, PANCREATITIS.
• CONTRAINDICATION: LESCH NYHAN SYNDROME, USE OF DIDANOSINE
• INTERACTIONS:WARFARIN, CICLOSPORIN,AZATHIOPRINE.

11. PLANNING
■ Mr. Grand is asked to follow-up in 3 months. At this visit routine
lab work will be done.
■ He is advised to follow-up if he has an attack before his next
visit.
■ If any drug doesn’t work or condition get worse contact
physician to change the drug therapy.

12. POINT TO PHYSICIAN
■ FOR HYPERTENSION HYDROCHLORTHIAZIDE WAS GIVEN BUT
THAT DRUG WORSE THE CONDITION OF GOUT SO INSTEAD OF
THAT CALCIUM CHANNEL BLOCKER SHOULD PRESCRIBED.

13. POINT TO PATIENT
■ Keep a supply of NSAIDS and take it as soon as first symptoms appear.
■ Reduce weight.
■ Reduce alcohol consumption.
■ Avoid daily intake of organ meat, especially liver.
■ Drink plenty of water preferably 10-12 glasses per day.
■ Regular follow-up at 3-month intervals
■ Report if acute attacks are frequent, not responding to NSAIDS, or if
systemic features develop.
■ Should avoid purine-rich foods (such as beer, some fish, and spinach), and
reduce their total calorie intake and cholesterol intake.
■ Pain area should be rested and use of ice may help.
■ If dose is missed do not take double dose.

14. REFERENCES
■ GOUT CASE STUDY- essentiavite1.com
■ India drug index

15. ANY QUESTONS?