peer response with references: The patient presented here is exhibiting signs of an acute gout attack. The patient has PMH of hypertension and hyperlipidemia. He is currently on hydrochlorothiazide 25mg daily and atorvastatin 20mg daily. The patient is reporting pain and swelling in his right first metatarsophalangeal joint. The increase in gout incidence is thought to be due to the improved diagnosis but also the increasing numbers of patients with obesity, HTN, thiazide diuretic use and alcohol intake (Arcangelo & Peterson, 2021). This patient is currently on hydrochlorothiazide for his HTN which puts him at risk for gout. The most common joint affected is the metatarsophalangeal joint (Arcangelo & Peterson, 2021). Acute gouty arthritis presents with intense articular inflammation, and the involved joints are extremely painful with associated redness, swelling and disability (Practitioner, 2002). This patient complains of pain in this joint that happened suddenly 2 days ago without injury specifically which leads me to my diagnosis. Non-steroidal anti-inflammatory drugs (NSAIDS) are the first line of therapy in acute gouty arthritis. Full doses of a rapid-acting NSAID such as indomethacin or naproxen sodium should be administered unless specifically contraindicated by peptic ulcer disease, renal impairment or congestive cardiac failure (Practitioner, 2002). My prescription for this patient would be: Naproxen 750mg Orally initially followed by 250mg every 8 hours until at