Neurological and Musculoskeletal Disorders Discussion Paper

Case Overview

Neurological and musculoskeletal disorders are common consequences of aging, resulting in reduced quality of life and increased mortality. The assignment is a case analysis of a 58-year-old obese white male with sudden onset symptoms of fever, chills, swelling and pain in the right great toe, and inability to bear weight. On examination, there is tenderness on the right first metatarsophalangeal joint. He is a known diabetic and hypertensive patient on treatment. This paper will explain the musculoskeletal and neurologic pathophysiologic processes, how physiologic functioning is affected by racial/ethnic variables, and how these processes affect the patient. Neurological and Musculoskeletal Disorders Discussion Paper

Neurologic and Musculoskeletal Pathophysiologic Processes

The most probable diagnosis from the patient’s presentation is gout. It is a systemic disorder caused by monosodium urate crystals (MSU) deposition in joints, leading to repeated acute or chronic arthritis (Yip & Berman, 2021). Serum uric acid levels are influenced by the balance between production from endogenous production by cellular turnover or purine intake in diet and excretion by GIT and kidneys.

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The deposition of the urate crystals triggers gout. The deposited crystals trigger the inflammatory process by phagocytosis by synovial phagocytic cells, producing inflammatory chemokines and releasing lysosomal enzymes (Pascart et al., 2022). This results in the classical signs of redness, swelling, loss of function and tenderness. Gout has a preference for lower extremities including the first MTP. Other affected joints include the wrists, ankles, metatarsal joints, knees, and interphalangeal joints of the hands. Some triggers include alcohol, purine-rich food, drugs such as thiazide-like diuretics and probenecid, trauma, and surgery.

Racial/Ethnic Variables That May Impact Physiologic Functioning

Research show that black adults are prone to suffer from gout than their white counterparts. Findings suggest that the racial disparities may be explained by low social economic status, barriers to healthcare services, diet, high prevalence of CKD, poor health-seeking behaviors, and higher medication non-adherence. Genetic studies have shown that blacks have the same loci that contribute to hyperuricemia compared to whites (McCormick et al., 2022). Studies reported that the majority of African Americans have an increased prevalence of obesity, hypertension, hyperlipidemia, and renal disease were all associated with a higher risk of gout. Neurological and Musculoskeletal Disorders Discussion Paper

Hypertension, obesity, diabetes, and use of thiazide diuretics contribute to the pathophysiology of gout. According to Chen-Xu et al. (2018), high blood pressure predisposes to gout by decreasing the excretion of the urate by the kidney secondary to glomerulosclerosis and glomerular arteriolar damage. Thiazide diuretics increases the serum uric acid levels by increasing SUA reabsorption and decreasing uric acid secretion in the kidneys. However, researchers propose that the increased risk is associated with diuretic use and the underlying co-morbidities that are used to treat heart failure, hypertension, and renal disease commonly. Studies show that weight gain is associated with hyperuricemia.

References

Chen-Xu, M., Yokose, C., & Choi, H. K. (2018). SAT0703 Racial disparities in gout and hyperuricemia – a united states general population study. Annals of the Rheumatic Diseases, 77(Suppl 2), 1199–1200. https://doi.org/10.1136/annrheumdis-2018-eular.6059 Neurological and Musculoskeletal Disorders Discussion Paper

McCormick, N., Lu, N., Yokose, C., Joshi, A. D., Sheehy, S., Rosenberg, L., Warner, E. T., Dalbeth, N., Merriman, T. R., Saag, K. G., Zhang, Y., & Choi, H. K. (2022). Racial and Sex Disparities in Gout Prevalence Among US Adults. JAMA Network Open, 5(8), e2226804. https://doi.org/10.1001/jamanetworkopen.2022.26804

Pascart, T., Merriman, T. R., Choi, H. K., & Terkeltaub, R. (2022). Gout, Urate, and Crystal Deposition Disease: Launch of the First Journal Dedicated to a Rapidly Growing Field. Gout, Urate, and Crystal Deposition Disease, 1(1), 1–6. https://doi.org/10.3390/gucdd1010001

Yip, K., & Berman, J. (2021). What Is Gout? JAMA, 326(24), 2541. https://doi.org/10.1001/jama.2021.19770

Case study assignment

Assignment (1 to 2 page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:
• Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
• Any racial/ethnic variables that may impact physiological functioning.
• How these processes interact to affect the patient. Neurological and Musculoskeletal Disorders Discussion Paper

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. (APA would include running head and page numbers)

Scenario:

A 58-year-old obese white male presents to ED with a chief complaint of fever, chills, pain, and swelling in the right great toe. He states the symptoms came on very suddenly and he cannot put any weight on his foot. Physical exam reveals exquisite pain on any attempt to assess the right first metatarsophalangeal (MTP) joint. Past medical history was positive for hypertension and Type II diabetes mellitus. Current medications include hydrochlorothiazide 50 mg po q am, and metformin 500 mg po bid. CBC normal except for elevated sedimentation rate (ESR) of 33 mm/hr and C-reactive protein (CRP) 24 mg/L. Metabolic panel normal. Uric acid level 6.7 mg/dl. Neurological and Musculoskeletal Disorders Discussion Paper