An obese 58-year-old male with a 5-year history of essential hypertension arrives at the urgent care center due to intense, throbbing pain in his left foot that began abruptly during the night. He reports that even the weight of his bedsheet on the foot causes excruciating discomfort. His vital signs are within normal limits. Examination reveals a markedly swollen, red, warm, and tender left first metatarsophalangeal joint. The overlying skin is tense but intact, with no evidence of puncture wounds or purulent drainage. Which of the following is the most appropriate next step in the management of this patient's acute symptoms?
- Initiation of oral naproxenAnswer
- BAdministration of broad-spectrum intravenous antibiotics
- CMeasurement of serum uric acid level to confirm the diagnosis
- DPrescription of daily oral furosemide
- EImmediate computed tomography scan of the affected foot
Answer
Initiation of oral naproxen is the most appropriate next step.
The patient presents with sudden, severe, monoarticular inflammation of the first metatarsophalangeal joint, which is a classic presentation of acute gout (podagra). First-line therapies for acute gout include nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen or indomethacin, colchicine, or glucocorticoids. Because this patient has no apparent contraindications (e.g., advanced chronic kidney disease or active peptic ulcer disease), an NSAID is the most appropriate initial management to rapidly reduce inflammation and provide symptom relief.
Step-by-Step Solution
Key Concept
The classic presentation of acute gouty arthritis (podagra) can often be diagnosed clinically. First-line management involves prompt initiation of a nonsteroidal anti-inflammatory drug (NSAID), colchicine, or a systemic glucocorticoid.