A 52-year-old female with rheumatoid arthritis complains of severe pain in her left big toe that began overnight. She describes the pain as the worst she's ever felt, and the toe is red and swollen. What could be the cause, and what are the next steps?
While this patient has rheumatoid arthritis, her current presentation is more suggestive of an acute gout attack, characterized by severe joint pain, redness, and swelling, often involving the big toe. This could be confirmed by joint fluid analysis showing monosodium urate crystals. Initial management typically involves NSAIDs, corticosteroids, or colchicine to reduce inflammation and pain. If gout is confirmed, long-term management might involve lifestyle modifications and medications like allopurinol to prevent future attacks.