An unusual case of gout in the wrist: the importance of monitoring medication dosage and interaction. A case report
Tóm tắt
Gouty arthritis of the wrist is uncommon although gout itself is the most common inflammatory arthritis in older patients. Some known risk factors for the development of gout include trauma, alcohol use, obesity, hyperuricaemia, hypertension and diabetes mellitus. As well, certain medications have been shown to promote the development of gout. These include thiazide diuretics, low dose salicylates and cyclosporine. We present a case of gouty wrist pain possibly precipitated by a medication dosage increase as well as medication interactions. A 77 year old male presented with right wrist pain. Redness and swelling was present at the dorsal aspect of his wrist and range of motion was full with pain at end range upon examination. One week prior, his anti-hypertensive medication dosage had been increased. The patient's situation continued to worsen. Radiographic examination revealed changes consistent with gouty arthritis. It is important for clinicians treating joint conditions to be aware of patients' comorbidities, medication usage and changes in dosages. Education of patients with gout is of prime importance. Clinicians should educate patients that gout may occur at any joint in the body not only the lower limb. Patients should be aware of the signs and symptoms of an acute gouty attack and be made aware that changes in certain medication dosages may precipitate an attack. Awareness of radiographic changes associated with gout is still of importance although these changes are not seen as frequently as they have been in the past due to better control of the disease.
Tài liệu tham khảo
Siva C, Velazquez C, Mody A, Brasington R: Diagnosing acute monoarthritis in adults: a practical approach for the family physician. American Family Physician. 2003, 68: 83-90.
Monu JUV, Pope TL: Gout: a clinical and radiologic review. Radiologic Clinics of North America. 2004, 42: 169-184. 10.1016/S0033-8389(03)00158-1.
Hunter DJ, York M, Chaisson CE, Woods R, Niu J, Zhang Y: Recent diuretic use and the risk of recurrent gout attacks: the online case-crossover gout study. Journal of Rheumatology. 2006, 33: 1341-5.
Ene-Stroescu D, Gorbien MJ: Gouty arthritis: a primer on late-onset gout. Geriatrics. 2005, 60: 24-31.
Li EK: Gout: a review of its aetiology and treatment. Hong Kong Medical Journal. 2004, 10: 261-70.
Ohishi T, Koide Y, Takahashi M, Miyata R, Kushida K: Scapholunate dissociation caused by gouty arthritis of the wrist. Case report. Scand J Plast Reconstr Surg Hand Surg. 2000, 34 (2): 189-191. 10.1080/02844310050160079.
Kamimura T, Hatakeyama M, Okazaki H, Minota S: Acute gout attack in the wrist joint. Internal Medicine. 2004, 43: 641-2. 10.2169/internalmedicine.43.641.
Schuind FA, van Geertruyden J, Stallenberg B, Remmelink M, Pasteels JL: A rare manifestation of gout at the wrist--a case report. Acta Orthop Scand. 2002, 73 (5): 594-596. 10.1080/000164702321022910.
Raimbeau G, Fouque PA, Cesari B, Le Bourg M, Saint-Cast Y: Arthropathie goutteuse du poignet a propos de cinq cas. Chirurgie de la Main. 2001, 20: 325-31. 10.1016/S1297-3203(01)00054-3.
Mikuls TR, Farrar JT, Bilker WB, Fernandes S, Schumacher HR, Saag KG: Gout epidemiology: results from the UK General Practice Research Database, 1990–1999. Annals of the Rheumatic Diseases. 2005, 64: 267-272. 10.1136/ard.2004.024091.
Terkeltaub RA: Gout. The New England Journal of Medicine. 2003, 349: 1647-55. 10.1056/NEJMcp030733.
Gurwitz JH, Kalish SC, Bohn RL, Glynn RJ, Monane M, Mogun H, Avorn J: Thiazide diuretics and the initiation of anti-gout therapy. Journal of Clinical Epidemiology. 1997, 50: 953-959. 10.1016/S0895-4356(97)00101-7.
Schlesinger N, Schumacher HR: Gout: can management be improved?. Current Opinion in Rheumatology. 2001, 13: 240-244. 10.1097/00002281-200105000-00016.
Yochum TR, Rowe LJ: Essentials of Skeletal Radiology. 1996, Williams and Wilkins, 2: 929-936. 2