A 46-year-old male presents to the emergency department with severe right toe
pain. The patient was in usual state of health until early in the morning when
he woke up with severe pain in his right big toe. The patient denies any trauma
to the toe and no previous history of such pain in other joints. He did say that
he had a “few too many” beers with the guys last night. On examination, he
was found to have a temperature of 38.2°C (100.8°F) and in moderate distress
secondary to the pain in his right toe. The right big toe was swollen, warm, red,
and exquisitely tender. The remainder of the examination was normal. Synovial
fluid was obtained and revealed rod- or needle-shaped crystals that were nega-
tively birefringent under polarizing microscopy, consistent with gout.
What is the likely diagnosis?
How would you make a definite diagnosis?
What is the pathophysiology of this disorder?