A 55-year-old woman presents with pain and swelling in her right big toe that woke her up from sleep. The pain is severe and the joint is red and tender. She has a history of untreated hypertension. What are the potential diagnoses and next steps?
The sudden onset of severe pain, redness, and swelling in the big toe, particularly with her history of untreated hypertension, is suggestive of gout, a form of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints. Initial tests should include serum uric acid level, although it may not be elevated during an acute attack. The definitive diagnosis of gout is made by joint aspiration showing negatively birefringent urate crystals. Initial management includes nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids to control the acute inflammation.