History A 57-year-old man presented with pain and swelling of his left big toe. He reported that this had been a long-standing problem over the last 7 years but had attributed it to ‘old age’ and did not get it examined. The pain and swelling would come and go in waves. These episodes were now more frequent and he would struggle to weight bear on that side at times. On this occasion, the pain had suddenly started at night and had been getting worse in flares ever since.
Medical history He had a hernia operation 14 years ago. He was on treatment for hypertension and hyperlipidaemia with bendroflumethiazide and simvastatin, respectively. He is an ex-smoker and drinks 14 units of alcohol per week. He is not aware of any history of trauma. Examination Examination revealed a tender, erythematous right big toe with a markedly reduced range of motion at the first metatarsophalangeal joint.…
