PDF(Pubmed)
Abstract：
Gout is a common inflammatory arthritis caused by increased uric acid crystals in and around various joints, mainly the big toe in adults. It happens due to the increase of urate or uric acid levels either because of increased production or decreased excretion from the body. Uric acid is the final product of purine metabolism, and many patients with hyperuricemia may remain asymptomatic. We present a case of a 46-year-old male who presented to the ambulatory care unit with the clinical features of acute pharyngitis and left toe pain for the past three days. On further questioning, he added that he had pain in the left lumber region and left side of the toe for the past few months. He also had a known case of type 2 diabetes mellitus, hypertension, and gastritis, for which he has been taking the thiazide diuretic, angiotensin-converting enzyme (ACE) inhibitors, metformin, sitagliptin, aspirin, and atorvastatin. Laboratory tests showed elevated uric acid along with raised inflammatory markers. As a result, he was referred to the specialist for arthrocentesis in order to confirm the diagnosis, and the thiazide diuretic was replaced with calcium channel blockers. He also suffered from nonalcoholic steatohepatitis (NASH) based on his ultrasound abdomen. On the follow-up visit, his symptoms had resolved, and his uric acid level had normalized.
摘要：
痛风是一种常见的炎症性关节炎，由各种关节内和周围的尿酸结晶增加引起，主要是成年人的大脚趾。它是由于尿酸或尿酸水平的增加而发生的，这是因为身体的生产增加或排泄减少。尿酸是嘌呤代谢的最终产物,许多高尿酸血症患者可能仍然无症状。我们介绍了一例46岁的男性，该男性在过去三天内出现急性咽炎和左脚趾疼痛的临床特征。在进一步的提问中，他补充说，在过去的几个月中，他的左木材区域和脚趾左侧都有疼痛。他还有一个已知的2型糖尿病病例，高血压,和胃炎,他一直在服用噻嗪类利尿剂，血管紧张素转换酶（ACE）抑制剂，二甲双胍,西格列汀,阿司匹林,和阿托伐他汀.实验室检查显示尿酸升高以及炎症标志物升高。因此,他被转诊为关节穿刺术专家以确认诊断，噻嗪类利尿剂被钙通道阻滞剂替代。根据腹部超声检查，他还患有非酒精性脂肪性肝炎（NASH）。关于后续访问，他的症状已经缓解,尿酸水平恢复正常.
