Urgent Care Clinician | December 2023
A 25-year-old previously healthy man presents to urgent care with sudden-onset swelling and severe pain in his left big toe. The symptoms started the previous day and have progressively worsened. He denies any recent injury. His vital signs are normal. He has no known drug allergies or comorbidities. On exam, there is pronounced swelling, erythema, and exquisite tenderness over the metatarsophalangeal joint of his left big toe. He admits to eating fast food almost daily and occasional binge drinking, including on the previous weekend. An x-ray of the left foot shows soft-tissue swelling around the big toe. Which of the following is the preferred initial treatment for this patient?
a. 1 g IM ceftriaxone
b. Oral colchicine
c. Oral NSAIDs
d. Topical corticosteroid cream
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Answer: C. This clinical presentation is highly suggestive of acute gouty arthritis. Arthrocentesis and synovial fluid analysis are indicated to confirm the diagnosis of new-onset gout, but pain control should not be reserved in the meantime. In acute, uncomplicated gout attacks, the first-line therapy is an oral NSAID; oral colchicine may be used if NSAID administration is not appropriate. Rest, ice, and elevation can be used in conjunction with medication administration for successful pain relief. Bracing or splinting and crutches or a cane may also be of benefit. In addition, alcohol and dietary counseling should be provided at this teachable moment.
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Last Updated on December 18, 2023
Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
