Assignment: Case Study Analysis

Assignment: Case Study Analysis

Assignment: Case Study Analysis

The case study concerns a 58-year-old obese white man who comes to the ED with complaints of pain, fever, chills, and swelling in the right great toe. The symptoms were abrupt, and he could not stand on his foot. Assessment of the right first MTP joint elicits intense pain. He has a medical history of hypertension and Type II diabetes. He has elevated ESR and CRP, and uric acid is at 6.7 mg/dl. The purpose of this assignment is to describe pathophysiologic processes related to the symptoms and racial/ethnic factors that can affect physiological functioning.

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Neurological and Musculoskeletal Pathophysiologic Processes

The patient’s symptoms, physical findings, and diagnostic results are consistent with acute gouty arthritis. The patient likely has a gouty arthritis attack, which can occur without provocation or be precipitated by conditions that raise uric acid levels, like hypertriglyceridemia and diabetes mellitus. Any sudden change in the concentration of serum uric acid can trigger an acute attack of gouty arthritis (Golenbiewski & Keenan, 2019). Besides, diuretic therapy, renal insufficiency, and some chemotherapeutic agents interfere with the normal excretion of uric acid, causing elevated uric acid levels. The patient has diabetes and obesity and is on HCTZ, which may have elevated the uric acid level.

Uric acid crystals usually activate the humoral and cellular inflammatory processes causing pain and inflammation, mainly at the metatarsophalangeal joint of the great toe. The joints are common sites of gouty arthritis attacks due to lower body temperature and reduced monosodium urate solubility. This explains the patient’s excruciating pain and swelling of the right great toe. The inflammatory process results in elevated levels of ESR and CRP, which is the case in this patient (Huang et al., 2022). Besides, the inflammatory process accounts for the patient’s fever and chills.

Racial/Ethnic Variables That May Affect Physiological Functioning

Gout was historically regarded as a White man’s condition caused by overeating gamey meats. Nevertheless, emerging data indicate that gout and hyperuricemia have an even greater burden on other racial groups, like African Americans. According to Sun et al. (2018), ethnicity and hypertension are predictive risk factors for gout risk, and the connection cannot be entirely explained by serum urate. For serum urate levels close to the crystallization threshold (6–8 mg/dl), African Americans and hypertensive persons have a two to three times greater risk for developing gout. The risk of developing gout for African Americans seems to increase before the onset of severe hyperuricemia.

How the Processes Interact To Affect the Patient

The processes in acute gouty arthritis interact to cause joint inflammation, which causes excruciating pain. The pain is usually accompanied by inflammatory signs, like swelling, warmth, erythema, and tenderness. Besides, patients experience low-grade fever alongside inflammation (Huang et al., 2022). Frequent episodes of acute gout result in deposits of urate crystals under the skin and within the vital organs, especially in the renal system (Golenbiewski & Keenan, 2019). This can cause renal stones or renal dysfunction, like severe pain or changes in urinary output.

Conclusion

The patient developed an acute gouty arthritis attack caused by sudden changes in serum uric acid concentration. The uric acid crystals may have activated the humoral and cellular inflammatory processes causing pain and inflammation of the great toe, fever, and elevated ESR and CRP levels. Gout is increasingly becoming more prevalent among African Americans than Whites.

References

Golenbiewski, J., & Keenan, R. T. (2019). Moving the needle: improving the care of the gout patient. Rheumatology and Therapy, 6(2), 179-193. https://doi.org/10.1007/s40744-019-0147-5

Huang, Y., Zhou, M., & Yuan, F. (2022). Clinical Features and Risk Factors of Fever in Acute Gouty Arthritis. BioMed Research International, 2022. DOI: 10.1155/2022/8798838

Sun, M., Vazquez, A. I., Reynolds, R. J., Singh, J. A., Reeves, M., Merriman, T. R., … & los Campos, G. D. (2018). Untangling the complex relationships between incident gout risk, serum urate, and its comorbidities. Arthritis research & therapy, 20(1), 1-9. https://doi.org/10.1186/s13075-018-1558-3