By vgreene, 18 May, 2017

IE

By vgreene, 18 May, 2017

L

By vgreene, 18 May, 2017

M

By vgreene, 18 May, 2017

H

By vgreene, 18 May, 2017

C

By vgreene, 18 May, 2017

S

(BMJ)—An 81-yo woman w/ hx of DM and HTN presented w/ a red, swollen index finger of a few days’ duration. She was treated w/ abx for a similar event a few wks prior, w/ only partial response. Meds: glimepiride, fosinopril, chlorothiazide, amlodipine, atorvastatin. Exam: red, swollen R index finger distal interphalangeal and distal phalanx; limited ROM. What is the dx?
Septic arthritis
Osteoarthritis
Gout
Drug reaction
Psoriatic arthritis
You are correct. Joint aspiration revealed monosodium urate crystals, diagnostic of gout. About 25% of gout pts have DM, and >70% suffer from HTN. Pts on loop and thiazide diuretics have a higher risk of acute gouty arthritis. A causal relationship between gouty arthritis and certain foods (eg, a purine-rich diet, alcohol, and sugar-sweetened soft drinks) is presumed. Osteoarthritis of distal interphalangeal joint usually has less prominent redness and swelling, and Heberden's nodes may be present. Psoriatic arthritis typically has associated nail findings. Septic arthritis tends to affect large joints.

BMJ 2017;356:j734