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Case Study Injudicious Food Intake Can Lead to Pain

T. D. arrives in your office complaining of pain in his toe. He woke up in the middle of the night with the feeling that his large toe had been set on fire. He has inflammation over the ankle and toes of his right foot and complains of severe pain when you put slight pressure on the ankle. The patient is about 60 lb overweight. He consumes red meat at least 6 times a week, always with three or more glasses of red wine. You suspect that T. D. may be having an attack of acute gout. What do you do?

Answer: You first take a blood sample for determination of serum urate levels to substantiate your preliminary diagnosis. Pending the results of the serum urate determination, you prescribe an NSAID. Upon finding a serum urate level of 12 mg/dL and continuing pain, you prescribe colchicine. You tell your patient that he must strongly consider dietary restriction, particularly of meat and meat products. Furthermore, he should decrease his alcohol intake. Inform him that if his attacks return in spite of changes in lifestyle, you are likely going to institute other drug measures. Point out the long-term consequences of gout.

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