A patient presents with an acutely painful, swollen, erythematous great toe. Laboratory testing shows elevated serum uric acid. What is the diagnosis?

Correct answer: C. Gout

• A. Osteoarthritis causes chronic mechanical pain with minimal inflammation and normal uric acid.
• B. Septic arthritis presents with fever, systemic toxicity and a purulent joint aspirate — uric acid is not elevated.
• C. Correct. GOUT is caused by deposition of monosodium urate crystals in a joint, classically the first metatarsophalangeal joint (podagra), producing an exquisitely painful, red, hot, swollen toe with hyperuricaemia. Dental relevance: patients on ALLOPURINOL or colchicine may have altered drug handling, and NSAIDs used for dental pain can interact with the urate-lowering regimen. Aspirin at low doses actually raises urate and can precipitate an attack.
• D. Rheumatoid arthritis is a symmetrical polyarthritis of the small hand joints with morning stiffness, not an isolated hot toe.