[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-26961-105":3,"detail-sidebar-cat-0-en-105":64,"doc-detail-26961-en":114},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":56,"head_meta":59,"extra_data":61,"updated_unix":63},105,"en","letter-to-dr-malcolm-still-mr-james-seymour","Letter to Dr Malcolm Still - Mr James Seymour","","This document is a medical referral letter dated March 5, 2014, from one doctor to Dr. Malcolm Still, a rheumatologist, concerning patient Mr. James Seymour. The referring doctor requests further investigations and management for Mr. Seymour, who is exhibiting signs and symptoms presumptive of gout. The patient has experienced recurrent inflammatory attacks since 2010 and is currently managed with colchicine, indomethacin, and allopurinol. He has a history of excessive alcohol consumption and is a former smoker. The letter details his recent presentation on April 25, 2014, with the third gout attack in eight months, characterized by inflammation of the first left toe. Treatment at that time included paracetamol and oxycodone, along with ongoing medication, and advice on diet and alcohol intake. Subsequent X-rays revealed mild degenerative changes in the left first metatarsophalangeal joint, and laboratory results showed slightly increased MCH, urate, and CRP levels. Allopurinol was initiated, and oxycodone dosage adjusted. Given the patient's father's history of rheumatoid arthritis, he insisted on referral. The referring doctor asks Dr. Still to review the enclosed synovial fluid pathology results and discuss them with the patient. 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