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Abstract: The patient in this case, a 71-year-old male, recently presented with symptoms of pain and swelling behind the left calcaneus, often evident at night and recurrent, and therefore, came to our hospital. Through the renal function test and combined with the patient’s clinical symptoms, a clear diagnosis of gout attack was made. After giving the patient medication, the patient’s pain and swelling symptoms have been reduced and his condition is stable, and he was discharged from the hospital.
Basic information】Male, 71 years old
Disease Type】Gout, diabetes mellitus
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of consultation】November 2021
Treatment plan】Medication (selegiline metformin tablets, dagliflozin tablets, indomethacin enteric soluble tablets, febuxostat tablets, sodium bicarbonate injection)
Treatment period】Hospitalization for 15 days, regular outpatient review
Treatment effect】The condition was basically controlled and the pain of the lesser toe was reduced.
I. Initial interview
When we first saw the patient, we could observe that the patient did not show any abnormalities. He reported recurrent pain and swelling behind the left lesser toe for 5 years, with aggravation for 4 days, heavier at night, and recurrent attacks. The patient’s oral treatment with febuxostat tablets to lower uric acid was not effective, and a physical examination was given showing painful swelling of the left posterior calcaneal joint, with a preliminary diagnosis of gout. The patient’s gout condition belongs to a relatively mild type of this type of disease, which may be related to his own diabetes mellitus, and the symptoms often recur and persist.
II. Treatment history
After admission, the patient underwent further renal function tests, which showed that the urea level was 8.6 mmol/L, creatinine was 125.0 μmol/L, uric acid level was 382.6 μmol/L, and cystatin C was 1.53 mg/L. Combined with the patient’s clinical symptoms, the diagnosis of gout could be made. The patient was advised to continue to take febuxostat tablets to reduce the patient’s uric acid level and indomethacin enteric tablets for pain relief treatment, which can better control the gout condition. The patient was also given selegiline metformin tablets and dagliflozin tablets to lower the blood sugar level. After 15 days of hospitalization, the patient’s condition was basically controlled and he was discharged from the hospital. The patient was advised to pay attention to the diet in daily life and keep a happy mood, to take hypoglycemic drugs after discharge, and to consult the doctor at any time if any uncomfortable symptoms appeared.
III. Treatment effect
On the third day of admission, the swelling and pain of the left posterior calcaneus decreased, and the blood glucose control was acceptable. On the 6th day of admission, the swelling and pain of the left posterior lesser toe worsened, and the blood glucose control was acceptable. Sodium bicarbonate injection was given to alkalize the urine to avoid uric acid kidney stones. At 12 days of admission, the swelling and pain of the left posterior lesser toe decreased, and the blood uric acid level decreased to 236.9 umol/L, which was more obvious, while the pain symptoms were significantly relieved during 15 days of hospitalization. In addition, for the patient’s diabetic condition, he also needed to be actively given glucose-lowering medication, i.e., selegiline metformin tablets and dagliflozin tablets, and the blood glucose level was better controlled and the treatment effect was more satisfactory, and he was given discharge treatment. Patients need to go to the hospital regularly for follow-up after discharge to avoid aggravation of the disease.
IV. Precautions
I am sincerely happy for the patient because of his stable condition and improved mood. However, since the patient is taking more medications, it is recommended that the patient should also take medications regularly under the guidance of the doctor after discharge to better control his condition and avoid stopping or reducing the dosage by himself. Patients also need to pay attention to controlling their diet while taking medication, and try to choose low purine, low carbohydrate and low sugar foods, such as celery.
In addition, it is necessary to closely monitor the changes of the disease, and if there are uncomfortable symptoms, go to the hospital in time. For gout, it is a chronic disease, and the treatment time is relatively long, so patients should be advised to avoid excessive anxiety, and keep a relaxed and calm mood, which is beneficial to the treatment of the disease.
V. Personal insight
For gout disease, the course of the disease is long and can be recurrent, so patients need to actively take drugs to better control the disease. However, in the process of disease treatment, attention should be paid to avoid excessive anxiety, as it is not conducive to disease control. In this case, because of the chronic disease of diabetes mellitus, complications such as diabetic peripheral vasculopathy and nephropathy may occur if the disease is not well controlled, so it is necessary to actively control blood glucose and monitor blood glucose levels daily. The population also needs to be given a diet strictly in accordance with the disease condition, which can help to better control the disease.