NEW GOUT EXPERIENCE

I walked into the long-term care facility and set my bag on the table where I usually charted about my patients medical histories. Not a minute later one of the LPN’s came into the room and said, “You need to see Mrs. O’s hand. It is red, swollen, and is the strangest I have ever seen.” That got my interest and I quickly walked into the room where Mrs. O was lying in her bed. I said my hello and she smiled but did not say anything. 

“What hand do you want me to look at?” I asked John, the LPN. 

“The left. I noticed it this morning. I have never seen anything like this before,” he responded. I could tell he was a little upset about his finding. I totally depended on the nursing staff to report anything unusual because they spent most of their time with the residents. 

“Mrs. O, I need to look at your left hand. John tells me there is something wrong,” I told her. She smiled at me and lifted her hand for me to see. What I saw was something I had never seen before. The one thing I knew about medicine was I would encounter something new pretty regularly, especially for a new NP. This indeed was something new to me. These were my findings: 

I saw Mrs. O’s second and third MIP’s and DIP’s to be swollen, red, and what appeared to be white pearls underneath her skin. They looked like they were going to explode. I had to admit this was something I had never seen before. I knew this was a phone call to my doctor. 

After the call and the doctor’s examination she determined it was gout with tophi. She told me this was the worst case she had ever seen. This was another reason why I was glad I contacted her since I had no experience with this. The tophi were the white pearls underneath the skin which apparently were accumulation of urates. They were painful and Mrs. O needed to be medicated with narcotics until she saw the rheumatologist. 

This picture is very similar to Mrs. O’s hand. The white pearls are the tophi. I will update you once she sees the rheumatologist. We put her on Allopurinol and steroids per my doc’s orders. We will see where this will go.