Bone Ache and Stiffness

1. This patient presented with rapid onset of severe pain in the MTP joint of the great toe accompanied swelling, redness, and fever. The pain was most severe in the first two to 24 hours and peaked within 24 hours. The history was remarkable for a trauma to the toe and a first-degree relative who had experienced the same symptoms. The patient admitted to drinking alcohol regularly.

Diagnosis: A presumptive diagnosis of gout may be acceptable in a patient with the classic presentation: rapid onset of severe pain in a swollen, erythematous joint (classically described in Latin as calor, rubor, dolor, et tumor) and symptoms peaking within 24 hours. The presence of tophi is pathognomonic for chronic tophaceous gout. In cases of questionable or unusual manifestation of gout, however, various imaging techniques and crystal visualization may be indicated.

For more information, see “Gout: A Clinical Overview.” Clin Rev. 2011;21(7):29-35.

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