Rheumatology Case Challenge: Statin Use and Gout in a Man Put on NSAIDs by Locum Tenens Doc

Bruce M. Rothschild, MD


February 13, 2023

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 60-year-old man presents to a rheumatologist for institution of appropriate therapy to address his previously diagnosed chronic tophaceous gout with intermittent flares. He had waited 9 months for the rheumatology appointment.

His symptoms are limited to tophi and minimal joint pain related predominantly to osteoarthritis of the knee. He has coronary artery disease, hypertension, hyperlipidemia, hypothyroidism, and gastroesophageal reflux disease (GERD) and a past history of gastric ulcer. He had received a diagnosis of chronic kidney disease because of an abnormal creatinine level.

His current medications are colchicine (0.6 mg/d), allopurinol (200 mg/d), and acetaminophen for gout; amlodipine, nebivolol, and metoprolol for hypertension; aspirin (81 mg/d, with its serum uric acid elevating effect) and clopidogrel for coronary artery disease; levothyroxine for hypothyroidism; and pantoprazole for GERD. The patient reports consistent adherence to the prescribed medication regimen. He does not use tobacco or illicit drugs and consumes less than one drink per week. He is employed in a clerical position.