TY - CHAP M1 - Book, Section TI - Gout A1 - Chumley, Heidi S. A1 - Smith, Mindy A. A2 - Usatine, Richard P. A2 - Smith, Mindy A. A2 - Mayeaux, Jr., E.J. A2 - Chumley, Heidi S. PY - 2019 T2 - The Color Atlas and Synopsis of Family Medicine, 3e AB - A 91-year-old woman arrives by ambulance to the emergency department because she was experiencing severe pain in her right middle finger (Figure 102-1). History reveals that she has had swelling of her finger for approximately 1 year. Palpation of the distal interphalangeal joint demonstrated firmness rather than fluctuance. A radiograph of the finger was ordered (Figure 102-2). The radiograph and physical examination are consistent with acute gouty arthritis superimposed on tophaceous gout. The diagnosis was confirmed by an aspirate of the finger that demonstrated negatively birefringent, needle-like crystals, both intracellularly and extracellularly. She was given 1.2 mg of colchicine followed by a second dose of 0.6 mg after 1 hour. Her pain was markedly decreased in 4 hours. Her serum uric acid level was determined to be 10.7 mg/dL. Colchicine was used in this case because the risk of using nonsteroidal anti-inflammatory drugs (NSAIDs) was considered to be high because of her previous history of gastric bleeding secondary to NSAIDs. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1164352267 ER -