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AE.33. Manikanta Thota - Mr. James Seymour


Dr. Malcom Still

The Rheumatologist

5 Grant St



Dear Dr. Still,

Re: MR. James Seymour, 60-years-old

I am writing to refer Mr. Seymour to your care who requests seeing a rheumatologist as he is not satisfied with his treatment of gout and suspects himself to have rheumatoid arthritis due to family history.

Mr. Seymour is a heavy drinker. He has 4 years history of gout with multiple flares during this period. One week ago, he again presented with 4 weeks history of painful, red, swollen left first toe and trouble sleeping. In the past, he has never been compliant to treatment; hence, he was advised to strictly adhere to medications (colchicine, indomethacin, paracetamol and oxycodone) as prescribed along with some investigations and dietary modifications.

Today, Mr. Seymour came to discuss his reports which indicate: mild degeneration of left fist metatarsophalangeal joint on x-ray and raised CRP. He has been advised to add tablet allopurinol, reduce alcohol intake and incorporate massage in treatment. The need of synovial fluid sample test has also been discussed in case he has another episode of gout.

Mr. Seymour’s current episode of gout is resolving; however, he still demands referral to rheumatologist. Therefore, he is being sent to your service for further investigations and treatment. The copy of pathology report is attached with the letter.

Please feel free to contact in case of any queries.

Yours sincerely,



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