Arthritis Gout

Introduction
Our kidneys work to eliminate the body
of excess fluids
Rids water, salts, urea, and uric acid
Uric acid is a waste of protein
metabolism

 Gout can also occur as a result of

overproduction of uric acid
Gout is an attack of uric acid deposits in
joints
Usually found in joints of feet and legs

What is Gout Arthritis

Purines are not
properly processed
in our body
Excreted through
kidneys and urine
Hyperuricemiabuild-up of uric
acid in body and
joint fluid

The Four Stages of Gout

Asymptomatic
Acute
Intercritical
Chronic

ASYMPTOMATIC
A- meaning without
indicates that there
are no symptoms
associated
Patient will be
unaware of what is
happening
Gout can only be
determined with the
help of a physician

ACUTE

Sever and sudden onset

Involve one or a few joints
Frequently starts nocturnally
Joint is warm, red, and tender

INTERCRITICAL
More concentration of uric acid
crystals
Typically no need for drug
intervention at the time.

CHRONIC
Continuous or persistent over a long
period of time
Treatment required
Not easily or quickly resolved

SYMPTOMS
Joint pain
Affects one or more joints : hip, knee, ankle, foot,
shoulder, elbow,wrist, hand, or other joints
Great toe, ankle and knee are most common

Swelling of Joint
Stiffness
Warm and red
Possible fever

Skin lump which may drain chalky material

Diagnosis Gout
Adanya 6 dari 12 tanda klinis :
1. >1 serangan artritis akut
2. Inflamasi maksimal yang berkembang dalam 1 hari
3. Serangan mono arthritis
4. Sendi yang terkena warna merah
5. Nyeri atau bengkat sendi pada sendi pertama
metatarsofalangeal : ibu jari
6. Inflamasi unilateral pada sendi pertama metatarsofalangeal
7. Serangan pada sendi tarsal unilateral
8. Tophii
9. Hiperuresemia
10.Pembengkakan sendi asimetris tampak pada rontgen
11.Kista subkortikal tanpa erosi pada rontgen
12.Kultur bakteri cairan sendi negatif

Diagnosing Gout
X-rays
Arthrocentesis- extraction of joint
fluid
Examination of joint
Patient medical history

TREATMENT
Colchicine- reduces pain, swelling, and
inflammation; pain subsides within 12 hrs
and relief occurs after 48 hrs. 0.5-0.6
mg/hari, dose maximal 6 mg
OAINS, Indometasin 150-200 mg/hari
untuk 2-3 hari, kemudian dilanjutkan 75100 mg/hari sampai nyeri berkurang
Allopurinol- decreases the production of
uric acid. Dose maximal 300 mg/hari

 Probenecid and sulfinpurazone- prevent

absorption of uric acid in the tubules of
kidney
Reduce alcohol intake
Increase water intake
Watch diet for food rich in purines

Prognosis
Quo ad vitam dubia ad bonam
Quo ad functionam dubia ad bonam
Dengan terapi yang adekuat