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Case Study AnalysisA 58-year-old obese white male presents to ED with 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 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 pathophysiologic processesThe above symptoms are in similar to the diagnosis of gouty arthritis. Gouty arthritis include aproinflammatory cytokine named IL-1β. These mediators are responsible for an increased amount of neutrophils. Tophi is formed with chronic flares of gouty arthritis. Tophi is an accumulation of MSU crystals in the joints. It is mostly found