Metatarsal phalangeal joint

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Gout James Willis is a 62-year-old man who presents at his GP's surgery complaining of pain and swelling over his left big toe at the metatarsal phalangeal joint. When James's foot is examined by the practice nurse, Arthur, he finds the big toe is erythematous, warm, swollen and tender to touch. James has had at least three other episodes of this type of pain, usually lasting for about 2-3 days, but he says that the pain is now worse, and he has had it for 6 days. During the examination, Arthur also notices a small rounded, subcutaneous nodule, which is tender and rubbery to the touch. The patient has a history of type 2 diabetes mellitus (controlled by diet) and of hypertension (controlled with hydrochlorothiazide). A tentative diagnosis of gout is made.

Reference no: EM133751262

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