53M with right lower back pain since 1yr , painful joints , painful swelling below knee since 15days

Patient came to OPD with C/O Right lower back pain since 1yr , joint pains and painful swelling below the knee since 15days.
He is a k /c/o gouty arthritis referred from general surgery department.
*Back pain was sudden in onset gradually progressive, dull type, which relieves on micturition and aggrevates on urine retention, he feels giddy on bending.
*Joint pain since 5 yrs which relieves on medication. 
*Pain below knee was of pinprick type.
*In case of severe joint pains he suffers from fever , chills which releive on taking medication (dolo-650, paracetamol) 

Patient is known hypertensive since 5yrs and is on medication ( amlodipin-5mg + telmisartan -40mg) from 4days.
N/O diabetes milletus, thyroid , asthma, CAD, CVA , TB , any surgeries.

 PERSONAL HISTORY:-  
Appetite - normal, mixed diet ( allergic to meat - itching on face ) , sleep - sufficient, bowel movements - regular,bladder movements - poor stream of urine since 5yrs , occasional alcohol drinker , chews tobacco  for 10 days and stops for other 3-4 months as he spits blood.
 
GENERAL EXAMINATION :- 
No pallor , No icterus, No clubbing , No cyanosis , Bilateral pedal edema is seen 
BP :- 120/80mm of Hg
PULSE RATE :- 64bpm 
RESPIRATORY RATE :- 16rpm

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