"Analysis of Gout Arthritis" is a perfect example of a paper on symptoms. The case scenario involves a 58-year-old patient who presented with complaints of fever, pain, chills, and swelling of the right great toe. The pain is too intense such that he cannot place any weight on the toe. Also, the patient has a past medical history of hypertension and type II diabetes mellitus and has been on hydrochlorothiazide 50mg PO QID and metformin 500mg PO BID. Laboratory tests also indicate elevated uric acid levels, ESR levels, and creatinine protein levels.
However, CBC levels are normal. According to the symptoms above, the differential diagnosis for the case patient is gout arthritis. Symptoms of gout arthritis result due to neurologic and musculoskeletal pathophysiologic processes. Also, racial/ethnic variables may contribute to the physiological functioning of the case patient. Neurologic and Musculoskeletal Pathophysiologic ProcessesNeurologic pathophysiologic processes contribute highly to the perception of chronic pain in the right great toe. In gout arthritis, the hard urate crystals deposited in the toe stimulates the "pain" nerve fibers located in the region (Fenando & Widrich, 2020). The "pain" nerve fibers usually connect to the spinal cord and the cerebral cortex.
As such, the stimulation sensitizes neurons in the dorsal horn of the spinal cord leading to the perception of pain. Also, the stimulation may cause sensitization of the peripheral and central nervous system, causing sustained synaptic changes in the cortical receptive fields (Chen et al. , 2020). Furthermore, synaptic changes enhance central sensitization, i.e. , remodeling of central nociceptive receptors and pathways, which causes excessive pain perception in the right great toe. Also, musculoskeletal pathophysiologic processes contribute to the symptoms of gout arthritis.
In this case, urate crystals accumulate in the synovial joints of the right great toe. Urate crystals may result due to the use of thiazide diuretics or illness. The accumulated crystals lead to inflammation of the toe, which presents with pain, swelling, chills, and fever (Towiwat et al. , 2019). Racial/Ethnic Variables Contributing to the ConditionAccording to the study done by Chen-Xu (2018), the black race has a higher prevalence of developing gout arthritis since they bear most of the risk factors of the disease, including obesity, hypertension, and chronic kidney disease.
Still, Singh (2013) did genetic studies to determine the loci that caused gout in African-Americans and Europeans. The study confirmed that the hyperuricemia-loci that caused the disease were similar in both races. How the Processes Interact to Affect the PatientNeurologic and musculoskeletal pathophysiologic processes interact to cause the swelling, pain, and chills felt by the patient. Accumulation of urate crystals in the synovial joints of the toe causes inflammation. As a result, the neurologic processes intervention due to the stimulation of the “ pain” nerve fibers located in the toe.
The interaction leads to physical and psychological effects felt by the case patient. Also, the race or ethnicity of an individual contributes highly to the development of the disease. Although the hyperuricemia loci that cause gout is similar among African-Americans and Europeans, the high number of risk factors among African-Americans increases the prevalence among individuals in the race. ConclusionAnalysis of the patient's complaints showed that the case patient is suffering from gout arthritis. The disease is caused by a combination of neurologic and musculoskeletal pathophysiologic processes. Also, ethnic factors play a crucial in individual infection with the disease due to genetic differences.
Therefore, patients presenting with symptoms as those of the case-patient need to undergo a comprehensive assessment to determine the major diagnosis.
Chen, J., Kandle, P. F., Murray, I., & Sehdev, J. S. (2020). Physiology, Pain. In StatPearls. StatPearls Publishing.
Chen-Xu, M., Yokose, C., & Choi, H. K. (2018). SAT0703 Racial disparities in gout and hyperuricemia–a united states general population study.
Fenando, A., & Widrich, J. (2020). Gout (Podagra). In StatPearls. StatPearls Publishing.
Singh, J. A. (2013). Racial and gender disparities among patients with gout. Current rheumatology reports, 15(2), 307.
Towiwat, P., Chhana, A., & Dalbeth, N. (2019). The anatomical pathology of gout: a systematic literature review. BMC musculoskeletal disorders, 20(1), 140.