Case Study- Neurological and Musculoskeletal

Neurological and musculoskeletal disorders are common companions of aging. They are a spectrum of disorders characterized by impairments in muscular, neurologic, skeletal, and cognitive functionalities. These disorders include but are not limited to Parkinson’s disease, multiple sclerosis, arthritic disorders, and osteoporosis. They remain one of the leading causes of functional disability, mortality, and deterioration in the quality of life. This paper analyzes a case presentation emphasizing the neurological and musculoskeletal pathophysiological processes and factors that may impact the physiological functioning of individuals with these disorders.

Case Analysis

The case study is of a 58-year-old male presenting to the ED with pain and swelling in his right great toe, fever, and chills. He notes that his symptoms came suddenly and that he cannot put any weight on his foot. A physical examination of the patient revealed pain on the right first metatarsophalangeal (MTP) joint. The patient has a history of hypertension and type 2 diabetes mellitus and is currently on hydrochlorothiazide and metformin. Laboratory findings revealed normal CBC except for elevated erythrocyte sedimentation rate (ESR) and C-reactive protein of 33mm/hr and 24mg/L, respectively. His metabolic panel was normal, and his uric acid level was 6.7mg/dL.

The patient’s manifestations are suggestive of acute gouty arthritis. Acute gouty arthritis is characterized by the sudden onset of severe pain and swelling on a joint. Acute gouty attacks are mostly monoarticular, affecting only one joint. The most commonly affected joints are those of the lower extremities, especially the first metatarsophalangeal joint. The ankle, talar, and subtalar joints may also be affected. Gouty attacks are often acute, manifesting as pain and swelling of the affected joint within 3-24 hours. The pain experienced in acute gout attacks is often severe and excruciatingly painful to even touch. Gout flares often elicit inflammatory responses. Erythema, warmth, and swelling are evident in the affected region (Yip & Berman, 2021). The patient in the case study presented with symptoms suggestive of acute gout attacks. He had a sudden onset swelling on his right great toe. Additionally, the swollen region was excruciatingly painful and could not bear any weight or touch. This is indicative of a gout attack on his great toe.

An acute gouty attack may also present with systemic features. These include fever, chills, malaise, and fatigue (Yip & Berman, 2021). These manifestations are attributed to the inflammatory responses that accompany gouty attacks and gout flares. The patient in the case study had a fever and chills. This further confirmed the acute gout diagnosis.

Gout has a multi-factorial etiology. Genetics, medical comorbidities such as type 2 diabetes mellitus, obesity/overweight, medications, and dietary factors such as consumption of high proteinaceous foods are risk factors for the disease (Yip & Berman, 2021). Individuals with type 2 DM have a higher chance of developing gout. Hypertension also increases an individual’s chances of developing gout (Evans et al., 2019). Hypertension causes glomerulosclerosis and damage to the glomerular arteriolar, lowering the efficiency of glomerular urate excretion. The consequent accumulation of urate predisposes individuals to hyperuricemia and, consequently, gout attacks (Evans et al., 2019). The patient in the case study had type 2 diabetes mellitus and hypertension. These may have contributed to his presentation. He was also obese. Obesity increases an individual’s chances of developing gout and other forms of arthritis. According to Evans et al. (2019), obesity lessens the work efficiency of the kidneys, lowering the kidney’s ability to excrete urate effectively. This may lead to hyperuricemia and gout. The patient in the case study was obese. This may have contributed to his suffering. The patient was also on hydrochlorothiazide for the management of his hypertension. Thiazide diuretics predispose individuals to hyperuricemia and gout (Evans et al., 2019). This may have contributed to this disease.

Although acute gout is sometimes self-limiting, the pain that often accompanies inflammatory responses may warrant therapeutic interventions. Physical examination aligned with subjective findings on the patients is critical in accurately diagnosing the disease. Laboratory findings are also critical in this regard. Lab findings in gout attacks revealed elevated ESR and C-reactive proteins. While hyperuricemia is highly predictive of gout, acute gouty attacks may occur even in normal uric acid levels. Laboratory findings in the patient, accompanied by subjective findings, pointed towards an acute gout diagnosis. Lab work revealed elevations of ESR and C-reactive protein. This is confi