ABSTRACT
A 45-year-old sailor comes into your GP practice with a painful left toe. The receptionist informs you that she has had to tell him to extinguish his pipe several times and you make a note to refer him to the smoking cessation service. He reports a several hour history of a red, painful and swollen toe. He denies any trauma to it and does not feel feverish. On lifestyle questioning he reports a diet consisting mainly of spinach and he drinks upwards of 20 units per week of rum. On examination the metatarsophalangeal joint of the left toe is red, hot, shiny and inflamed. You suspect gout.
