Medical history

Potential previous flare

• Sione reports having had similar symptoms in his first metatarsophalangeal (MTP) joint on his left foot five months ago
• He did not seek medical attention for this event as his older brother told him that he sometimes gets the same pain and it “goes away after a few days if you take lots of ibuprofen"
• Sione’s symptoms resolved completely after five days of over-the-counter ibuprofen-use

Hypertension

• Sione was diagnosed with hypertension three years ago after a routine blood pressure check; his blood pressure was 148/94 mmHg at the time
• You assessed his HbA_1C and lipids at the time of this diagnosis and every six months since; these measurements have remained at the high end of normal limits
• After trialling lifestyle changes for six months, a decision was made to initiate antihypertensive treatment; Sione has consistently achieved blood pressure measurements <140/90 mmHg for the past year and a half

Medicines

• Quinapril + hydrochlorothiazide 10/12.5 mg daily

Family history

• Based on your discussion today, Sione calls his older brother for clarification, who confirms that he has been diagnosed with gout and hypertension
  • Sione’s brother is taking an antihypertensive medicine but has not been prescribed a urate-lowering medicine
• No known family history of diabetes or ischaemic heart disease

Social history

• Sione works as a chef in a local seafood restaurant
• He describes being “on-the-go” at work, but is sedentary in his spare time
• During a discussion about his diet, Sione says he eats a diverse range of food because of his job and general interest in cooking, however, seafood constitutes a large proportion of his diet
• Sione was a daily smoker during his twenties and thirties, but has been a non-smoker for the past 15 years
• He usually has between 10–12 standard drinks per week and he is largely a beer drinker; he sometimes has more if it is a special occasion