RT Book, Section 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. SR Print(0) ID 1164352267 T1 Gout T2 The Color Atlas and Synopsis of Family Medicine, 3e YR 2019 FD 2019 PB McGraw-Hill Education PP New York, NY SN 9781259862045 LK accessmedicine.mhmedical.com/content.aspx?aid=1164352267 RD 2024/03/29 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.