M10.24

Clinical Causes: Use of medications that increase uric acid production, such as certain diuretics (e.g., thiazides, loop diuretics). Drugs that decrease uric acid elimination, including salicylates in high doses. Immunosuppressant medications like cyclosporine and azathioprine. Chemotherapy drugs that cause rapid cell turnover increasing uric acid production. Excessive intake of alcohol or purine-rich foods might exacerbate medication effects. Underlying kidney dysfunction reducing uric acid clearance when combined with these medications.

Key Symptoms: Sudden onset of intense joint pain in the hand, often affecting the fingers, thumb, or wrist. Swelling and tenderness around the affected joints. Redness and warmth of the skin over the joint. Limited joint movement due to pain and swelling. Possible formation of tophi (urate crystal deposits) if gout persists. Repeated attacks can lead to chronic joint damage.

Diagnosis Path: Medical history review focusing on medication use and symptom onset. Physical examination of the affected hand for signs of inflammation. Blood tests to measure uric acid levels in the blood. Joint fluid analysis through aspiration to detect urate crystals under microscopy. Imaging studies, such as X-rays, to identify joint damage or tophi. Excluding other causes of arthritis or joint inflammation.

Treatment Protocols: Discontinuation or adjustment of the medication identified as the cause, under medical supervision. Use of anti-inflammatory drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling. Colchicine may be prescribed to manage acute gout attacks. Corticosteroids could be used in cases where NSAIDs are contraindicated. Lifestyle modifications including reducing alcohol consumption and limiting purine-rich foods. Hydration therapy to help eliminate uric acid from the body. Monitoring uric acid levels regularly to prevent recurrence. Long-term management may include medications like allopurinol or febuxostat to control uric acid levels.