By Adolfo Rubinstein, Sergio Terrasa
MEDICINA popular Y PRACTICA AMBULATORIA (2ª ED) (CARTONE)
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Extra info for Medicina Familiar Y Practica Ambulatoria Family Medicine and Ambulatory Practice Spanish
No other joints are involved. His white blood cell count is not indicative of an acute infectious process. ➤ Next diagnostic step: Joint aspiration for examination of joint fluid to identify crystals and exclude infection ➤ Most likely diagnosis: Crystal-induced gout of the left knee ➤ Next step in therapy: Nonsteroidal anti-inflammatory drug (NSAID) and provide analgesia; may consider using colchicine ANALYSIS Objectives 1. Have a differential diagnosis for nontraumatic joint pain, based on clinical presentation.
What is the next step in therapy? 36 CASE FILES: Fa m i l y M e d i c i n e ANSWERS TO CASE 3: Joint Pain Summary: This is a 45-year-old man who presents with the sudden onset of monoarticular, nontraumatic joint pain. Evolution from onset to severe pain was rapid. The patient denies any trauma, systemic signs of illness, or any prior episodes. That he takes hydrochlorothiazide and drank a lot of alcohol the night that his symptoms started are important. His vital signs are stable, and he does not appear to be systemically ill.
First, the disease should be of high enough prevalence in the population to make the screening effort worthwhile. There should be a time frame during which the person is asymptomatic, but during which the disease or risk factor can be identified. There needs to be a test available for the disease that has sufficient sensitivity and specificity, is cost-effective, and is acceptable to patients. Finally, there must be an intervention that can be made during the asymptomatic period that will prevent the development of the disease or reduce the morbidity/mortality of the disease process.