Concluded Case

54 years male patient complains of pain and swelling in the right lower thumb. since 6 months he is a diabetic patient hba1c is 8.3 cbc is normal uric acid is increased a bit no other systemic disease he is a driver by occupation doppler reports are attached. he is a chronic smoker. there is change in colour at the thumb region compared to the normal side what cud be the provisional diagnosis

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? Gout of Rt Great toe (most common site). Doppler report shows mild atherosclerosis of Rt Lower extremity vasculature. He is a Diabetic & uncontrolled glycemic status. Further Investigation required :- FBS PPBS Lipid Profile Urea Creatinine Urinalysis Micral Digital X-ray Rt foot especially 1st MTP joint Febuxostat 40mg OD along with statin, antiplatelet Maintain euglycemia Avoid high protein diet, especially Non-veg

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? Gout of Rt Great toe (most common site). Doppler report shows mild atherosclerosis of Rt Lower extremity vasculature. He is a Diabetic & uncontrolled glycemic status. Further Investigation required :- FBS PPBS Lipid Profile Urea Creatinine Urinalysis Micral Digital X-ray Rt foot especially 1st MTP joint Febuxostat 40mg OD along with statin, antiplatelet Maintain euglycemia Avoid high protein diet, especially Non-veg

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Gouty arthritis X-ray affected toe Tab Emanzen D BD x 7 days Tab pan 40mg BD x 7 days Tab mahacortDz 6mg BD x 7 days Tab febustat / febunate 40mg OD x 1 month Avoid highly Proteins diet chicken, meat, oily and spicy food egg fish chicken burger fast food pizza Intake Plenty of more water orally

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Acute gouty arthritis. Osteoarthritis- next common cause of arthritis that affect the big toe include rheumatoid arthritis and psoriatic arthritis. Localised infections may cause pain and swelling.

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Pt is a case of uncontrolled diabetes and infection of great toe is due to diabetes only. Control diabetes other wise it will lead to serious consequences like amputation of the toe

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? Ischeamic disease Stop smoking Control diabetes

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Ischaemia, Doppler study refer to vascular surgeon

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Ischemia due burger's disease

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Gout is recurrent episodes of arthritis. This seems to be chronic on. Gout takes years to become chronic. Though the patient has risk factors for the development of gout but I differ. We have to rule out inflammatory osteoarthritis or psoriasis arthritis. I would do a radiograph of mtp joints and an ultrasound of the joint. That will tell me whether the disease is inflammatory or non inflammatory . Also double contour sign will be seen in gout.

Chronic monoarthritis ...causes can be infection or crystal arthropathy but need to see for osteoarthritis and inflammatory arthritis History should be more elaborative ... Whether it is persistent or episodic , any early morning stiffness, aggregating and relieving factor for pain and swelling, any history of trauma , fever, Get ray of foot and USG of the toe... ESR, CRP.

It’s diabetic  microangiopathy and Doppler is showing plus there is colour change of skin  What’s the temperature of the site  How much is uric acid For confirmation u can go for aspirate of the swelling and sent for crystal evaluation

osteoarthritis,could be inflamatory arthritis following uncontrol diabetes
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