58-year-old obese white shows signs of fever, chills, pain, and swelling in the right great toe

1 Neurological and Musculoskeletal Pathophysiologic Processes Chronic illnesses predispose patients to a wide range of health complications that can cause pain in the toes, fever, chills, and swelling in the toe. The 58-year-old obese white shows signs of fever, chills, pain, and swelling in the right great toe. The right first metatarsophalangeal joint is very painful on adding any weight. The patient has a history of hypertension and Type II diabetes mellitus and is using hydrochlorothiazide 50 mg and metformin 500 mg to manage the disease. The simultaneous use of hydrochlorothiazide and metformin impacts the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms. Neurological processes linked to pain in the toe are associated with damage to nerve cells in the area due to side effects of elevated uric acid levels in the blood. The use of hydrochlorothiazide 50 mg is associated with elevated serum uric acid levels in the body (Skoczyńska et al., 2020). As the acid increases, the rate of direct urate reabsorption in the proximal renal tubules grows, predisposing the patient to gout. Diuretics result in elevated urination, which leads to a decline in the amount of fluid in the patient’s body (Chekka et al., 2021). Reduced body fluid means that the remaining fluid is more concentrated and can form uric acid crystals in the joint tissue and the synovial fluid. The crystals are responsible for gout. The disease mainly affects toe joints, ankles, and knees, which explains the swollen toe joint and pain in the right first metatarsophalangeal joint (Rogers & Allen, 2021). Gout is also associated with chills and fever, explaining the manifestation of these signs by the patient. The musculoskeletal pathophysiologic processes that may lead to the symptoms reported by the patient include the development of MSU crystals in tissues around the joint and joint inflammation caused by a surge in acid in the body. The buildup of uric acid leads to the formation of sharp needlelike urate crystals that affect the joint and surrounding tissue, causing pain, inflammation, and swelling (Chekka et al., 2022). It should be noted that