You are seeing a 58-year-old male in the clinic today for an acute visit related to joint pain and swelling. He has a past medical history of hypertension and hyperlipidemia and is currently taking

In 200-250 words, comment on, expand upon or question the information in the following case scenario/answers. Does the plan align with evidence-based practice and current clinical guidelines? Support with a minimum of one scholarly resource, ideally within the last 5 years. Journals and websites must be cited appropriately. Citations and references must adhere to APA format.
You are seeing a 58-year-old male in the clinic today for an acute visit related to joint pain and swelling. He has a past medical history of hypertension and hyperlipidemia and is currently taking hydrochlorothiazide 25mg daily and atorvastatin 20mg daily. He was seen last in your office for a routine physical 6 months ago and had lab work completed showing a normal CBC, CMP and lipid panel while on his current medications. He presents with pain and swelling of the right first metatarsophalangeal joint and he reports the site is red and feels hot to touch. He reports the pain is so bad he can hardly stand to have anything touch the foot and awakens at night with the pain. He reports the symptoms started suddenly about 2 days ago and he denies any injury to the foot He does not have any similar pain or swelling elsewhere. Upon examination today it is observed that the right metatarsophalangeal joint is mildly edematous, erythematous and warm to touch. There is no rash, no bruising, and no laceration on the site. The patient can move the joint through range of motion, but has pain with motion. His physical exam is otherwise unremarkable. RESPONSE: The patient’s sudden onset of severe pain, warmth, swelling, and erythema in the first metatarsophalangeal joint is most consistent with an acute gout flare. The extreme tenderness, nocturnal awakening, and monoarticular involvement of the great toe are characteristic of classic gouty arthritis. His hydrochlorothiazide use further supports this diagnosis, as thiazide diuretics increase uric acid levels and are a known trigger for gout flares (FitzGerald et al., 2020). Although he has no prior history of gout, national data show that gout and hyperuricemia remain highly prevalent and often present for the first time in older adults with cardiometabolic risk factors (Chen-Xu et al., 2019). Management should prioritize rapid control of inflammation and pain. Evidence supports NSAIDs, colchicine, or corticosteroids as first-line agents for acute gout (FitzGerald et al., 2020). Given this patient’s age and hydrochlorothiazide use, NSAIDs pose an increased risk of renal and cardiovascular adverse effects. Colchicine is most effective when started within the first 24 hours of symptoms and may be less beneficial at the 48-hour mark. Corticosteroids provide comparable relief and are frequently preferred when comorbidities make NSAIDs or colchicine less ideal (McCarty et al., 2025). A short prednisone burst is appropriate and well supported by current recommendations. Importantly, a taper is not required for this course. Short bursts of prednisone—typically 30–40 mg daily for 5–7 days—do not cause hypothalamic–pituitary–adrenal (HPA) axis suppression and therefore can be discontinued abruptly. Evidence shows that fixed-dose regimens resolve acute gout inflammation effectively, and tapering does not improve outcomes nor reduce recurrence risk (McCarty et al., 2025). Prescription: Prednisone 40 mg by mouth once daily for 5 days. Take with food. Do not use NSAIDs concurrently while taking prednisone. Patient education should include an explanation of gout as an inflammatory response to monosodium urate crystal deposition. The patient should take prednisone in the morning with food to minimize stomach upset and sleep disturbance. He should monitor for temporary increases in appetite, irritability, or blood pressure. Lifestyle counseling should include maintaining hydration, decreasing alcohol intake—especially beer—and reducing intake of high-purine foods such as red meat and shellfish. Because thiazide diuretics significantly increase the risk of gout, long-term management should include reassessing his antihypertensive regimen (FitzGerald et al., 2020). Follow-up should occur in one week to confirm symptom improvement. If symptoms persist or systemic signs appear, joint aspiration may be necessary to exclude septic arthritis. After flare resolution, an alternative antihypertensive—such as one without uric acid–raising effects—should be considered. Rheumatology referral is appropriate for recurrent flares, unclear diagnosis, or consideration of urate-lowering therapy.