A 45-year-old white man presents to your office complaining of left knee pain that started last night. He says that the pain started suddenly after dinner and was severe within a span of 3 hours. He denies any trauma, fever, systemic symptoms, or prior similar episodes. He has a history of hypertension for which he takes hydrochlorothiazide (HCTZ). He admits to consuming a great amount of wine last night with dinner Provide an evaluation of the patient including possible risk factors and treatment options, including non-pharmacologic interventions Would this patient be a candidate for prophylactic therapy?

This patient possesses a few risk factors for an occurrence of gout which include being of the male sex, alcohol consumption, hypertension, and use of HCTZ, which can cause hyperuricemia (Chisholm-burns et al., 2019). The patient’s symptoms are consistent with an attack of gout in the respect that it was sudden, occurred in a joint, and was accompanied by severe pain (Mayo Clinic Staff, 2019). However, although these symptoms are highly suggestive of gout, they are not totally indicative, particularly since it was the patient’s first occurrence. Serum uric acid (SUA) levels may be beneficial in diagnosis, however, though often elevated they may be normal during an attack and therefore are not enough for a diagnosis (Chisholm-burns et al., 2019). In order to prevent a recurrence of gout, the patient can adhere to certain recommendations to decrease the amount of uric acid in his body such as drinking plenty of fluids, limiting or avoiding alcohol (particularly beer), consuming only low-fat dairy products, limiting intake of meat, fish, poultry, organ meats, and high-fructose corn syrup, as well as using an alternative anti-hypertensive medication and maintaining a healthy weight (Chisholm-burns et al., 2019; Mayo Clinic Staff, 2019). Since this was the patient’s first attack, non-pharmacologic interventions should be implemented and future attacks monitored as gout is an episodic disease and frequency of attacks vary to where it may or may not become a long-term issue for this patient. According to Chisholm-burns et al. (2019), patients with recurrent attacks of gout, defined as 2 or more per year, show evidence of tophus, are diagnosis with stage 2 CKD or worse, or history of urolithiasis are candidates for prophylactic therapy to lower SUA, and therefore, this patient does not meet criteria for prophylactic therapy. However, this patient should be advised to medicate with NSAIDs (treatment of choice- naproxen, indomethacin, and sulindac FDA approved for treatment of gout), colchicine, or corticosteroids at the first sign of his next attack to reduce pain and inflammation (Chisholm-burns et al., 2019).ReferencesChiodini, I., & Bolland, M. J. (2018). Calcium supplementation in osteoporosis: Useful or harmful? European Journal of Endocrinology, 178(4), D13–D25. https://doi.org/10.1530/eje-18-0113Mayo Clinic Staff. (2019, March 1). Gout – symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897 less0 UnreadUnread