A 50-year-old male presents with severe pain and swelling in his big toe that began overnight. He has a history of hypertension and his diet is rich in red meat and alcohol. On examination, the toe is red, swollen, and tender. What are the possible diagnoses and the next steps?
This presentation is typical for gout, a form of inflammatory arthritis characterized by hyperuricemia leading to the deposition of urate crystals in joints, causing acute inflammation. The classic presentation is severe pain in the big toe (podagra). Differential diagnoses may include other types of arthritis, infection, or trauma. The next steps would include blood tests to assess uric acid levels and possibly joint aspiration to confirm the presence of urate crystals. Management would likely involve non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids to manage the acute attack, and lifestyle modifications to prevent future attacks.