A 54-year-old man comes to the office due to severe foot pain. The patient attended a wedding reception where he drank several alcoholic beverages, then woke the following morning with pain. He has a long history of gouty arthritis, and his current symptoms are similar to previous flares of the disease. Past medical history includes type 2 diabetes mellitus and recently diagnosed peptic ulcer disease. Physical examination shows erythema, warmth, and swelling at the left first metatarsophalangeal joint. The patient is started on a new medication for gout that provides significant relief of his symptoms, but he returns to the clinic a week later with diarrhea and persistent nausea. The drug used in this patient most likely affects which of the following cell structures?

Question

A 54-year-old man comes to the office due to severe foot pain.  The patient attended a wedding reception where he drank several alcoholic beverages, then woke the following morning with pain.  He has a long history of gouty arthritis, and his current symptoms are similar to previous flares of the disease.  Past medical history includes type 2 diabetes mellitus and recently diagnosed peptic ulcer disease.  Physical examination shows erythema, warmth, and swelling at the left first metatarsophalangeal joint.  The patient is started on a new medication for gout that provides significant relief of his symptoms, but he returns to the clinic a week later with diarrhea and persistent nausea.  The drug used in this patient most likely affects which of the following cell structures?

Quizplus · Accepted Answer

The preferred first-line treatment for acute gouty arthritis is a nonsteroidal anti-inflammatory drug, but these are contraindicated in patients with a recent history of peptic ulcer. Other treatment options include colchicine and oral or intraarticular glucocorticoids. Colchicine binds to the intracellular protein tubulin and inhibits its polymerization into microtubules. This, in turn, disrupts cytoskeletal-dependent functions such as chemotaxis and phagocytosis. Colchicine is administered initially at the first signs of a gout flare and can be repeated an hour later. It may also be used for prophylaxis while initiating urate-lowering therapy (eg, allopurinol). Important adverse effects of colchicine include nausea, abdominal pain, and diarrhea, which are most common at higher doses. Colchicine should be avoided in patients who are elderly or have severe renal dysfunction. Educational objective: Colchicine inhibits tubulin polymerization into microtubules and can be used for acute treatment and prophylaxis of gout. Important side effects of colchicine include nausea, abdominal pain, and diarrhea. __________ References: Colchicine for acute gout. (http://www.ncbi.nlm.nih.gov/pubmed/25123076)

A 54-Year-Old Man Comes to the Office Due to Severe