CASE REPORT

GOUT ARTHRITIS

ANILDHAH WAHAB
ST ADINDA SRIKANDI
 PATIENT’S IDENTITY
Name : Mr. R
Age : 41 years old
Adress : dg rammang street, Makassar
Religion : Islam
MR :750954
 HISTORY TAKING
Chief Complaint : Pain on both of knees
Present History :
 Male, 45 years old

 Patient admitted in Wahidin Sudirohusodo hospital with chief

complain pain on both knees since 3 days ago. The pain started in
the early morning and accompanied with stiffness in the joint. The
painis especially felt during activities. There are also swelling on both
knees. Patient can’t walk. There is also pain on PIP joint on both
hands. Patient also complain about the chest pain and patient found
out that he has Congestive Heart Failure on January 2010. Patient
had history of angioplasty coroner.
 There is history of the patient admitted in Hasanudin University
hospital in 2014 with the diagnosis is Gout Arthritis. The patient was
given Allopurinol and Recolfar but patient didn’t take it regularly.
 HISTORY TAKING
 There is history of high purin consumption, such as coto and konro.
 History of high uric acid level is 11.7 mg/dl
 Patient had history of melena, urination normal, there is no stone
found in the urine.
 Patient was also has a history of jamu capsule consumption until
2014.
 There is history of hipertension and was given captopril
 There is no history of DM.
 The patient was given some drugs, which were paracetamol
500mg/24h/oral, Allopurinol 100mg/48h/oral, Recolfar
0,5mg/48h/oral, Colcisin 500mg/24h/oral
 PHYSICAL EXAMINATION
General Description
General condition : Moderate illness
Nutrition : Normoweight
- Height : 165 cm
- Weight : 60 kg
- BMI: 20.9 kg/m2

Vital Signs
- Awarness : Conscious (GCS 15)
- Blood pressure : 100/60
- Heart rate : 80 x/minutes, regular
- Respiratory rate : 20 x/minutes
- Temperature : 36,5 °C
- VAS (numerical) : 4/10
 PHYSICAL EXAMINATION
 Head : Normocephal, hair not easy to remove
 Face : Normal (simetric)
 Eyes : Pupils isochor, conjunctiva anemic (+), sclera not
icterus
 Ear : No abnormalities, otorrhea (-)
 Nose : No abnormalities, secret (-)
 Oral cavity : No abnormalities
 Throat : No abnormalities, pharyngeal hyperemia (-), T1-T1
 Neck : JVP R+0 cm H2O, no lymphadenopathy, no deviation
of the trachea.
 PHYSICAL EXAMINATION
 Lung
 Inspection : Symmetrical left and right

 Palpation : Focal fremitus normal

 Percussion : Sonor

 Auscultation : Vesicular breathing sounds, wheezing (-), ronchi (-)

 Heart
 Inspection : Ictus cordis not seen
 Palpation : Ictus cordis palpable at ICS V linea midclavicularis
 Percussion : Dull, left heart border linea midclavicularis

 Auscultation : Heart sound I / II regular, no murmur

 Abdomen
 Inspection : Normal
 Auscultation : Bowel peristalsis (+) normal
 Palpation : Liver and spleen not palpable
 Percussion : Tympani
 RHEUMATOLOGICAL STATUS
 Gait : Antalgic gait
 Arm : Tophus on PIP II/III billateral
 Leg :
Genu dextra : Kalor (+), Rubor (+), Dolor
(+), Limited ROM (+), Efusi (-), Tophus (-)
Genu sinistra : Kalor (+), Rubor (+),
Dolor (+), Limited ROM (+), Efusi (-),
Tophus (+)
 Spine: Normal
 LABORATORY FINDING
Laboratorium Result

Parameter Results Normal value

WBC 7,5100µL 4000-10000/µL

RBC 3.75 x 106 µL 4.0 – 6.0 x 106 /µL

HGB 9.6 g/dL 12.0 – 16.0 g/dL

HCT 32.1 % 37.0 – 48.0 %

PLT 605000µL 150000 – 400000 /µL

Neutrofil 61,5 % 52.0 – 75.0 %

Lymphosit 25,2 % 20.0 – 40.0 %

Monosit 5.1 % 2.00 – 8.00 %

 LABORATORY FINDING
Parameter Results Normal value
Ureum 50 10-50 mg/dl

Creatinin 2.26 L <1.3, P <1.1 mg/dl

Uric Acid 11.7mg/dl L 3.4-7.0, P 2.45-5.7 mg/dl

 PROBLEM LIST
Assessment Planning Diagnostic Planning Therapy

1. Chronic Gout Arthritis with tophus Urine uric acid 24 • Low purin diet
acute exarcebation hours • Celecoxib
200mg/12h/oral
• Recolfar 0,5 mg/48
h/oral
• Colcisin
500mg/24h/oral
 PROBLEM LIST
Assessment Planning Planning Therapy
Diagnostic

2. Congestive heart failure • Forusemide 40

mg/24h/oral
• Captopril 0,25 mg/8
jam/oral
• Atorvastatin 45
mg/24 jam/oral
• Zson 5
mg/sublingual
• Clopidogrel/ 75 mg/
oral
 PROBLEM LIST
Assessment Planning Diagnostic Planning Therapy

3. Gastropati NSAID USG abdomen • Lansoprazole

30mg/124h/oral
DISCUSSION
 WHAT IS GOUT ARTHRITIS?
- Gout is a type of inflammatory arthritis that is
triggered by the crystallization of uric acid
within the joints and is often associated with
hyperuricemia
- Prevalence is greater in men (5.9%; 6.1
million) than women (2.0%; 2.2 million)
- Occurring mainly in 40 to 60 year old men
 RISK FACTOR
 Alcohol consumption
 Obesity
 Hypertension
 Use of diuretic drugs
 Gender
 Age
 Diet. The risk of gout is increased by the frequent consumption of foods high
in purines, including meats, seafood, certain vegetables and beans, and
foods containing fructose.
 Race. African American men are nearly twice as likely to report having had
gout as Caucasian men
 Renal Impairment
 Genetic Mutations
 URID ACID METABOLISM

Dennis A, et al. Pathogenesis of Gout. Annals of Internal Medicine. 2005; 143(7): 505
 PATHOPHYSIOLOGY OF GOUT

G Ragab et al. Gout: An Old Disease in New Perpective. Journal of Advanced Research 8. 2017; 495-511
STAGES OF GOUT

 Asymptomatic hyperuricemia
 Acute Gouty Arthritis

 Intercritical Gout

 Chronic Articular and Tophaceous Gout

Stage Clinical Features

Asymptomatic Elevated serum urate with

Hyperuricemia no clinical manifestations of
gout

Acute Gout Acute inflammation in the

joint caused by urate
crystallization
Intercritical Gout Asymptomatic intervals
between acute attacks
Chronic Tophaceous Gout Development of tophi in and
around the joints and soft
tissues
DIAGNOSIS
DEFINITIVE DX. – INTRACELLULAR
MONOSODIUM URATE CRYSTALS IN
SYNOVIAL FLUID.
MANAGEMENT THERAPY

MANAGEMENT
THERAPY

NON
PHARMACOLOGICAL
PHARMACOLOGICAL
NON PHARMACOLOGICAL

- Reduce body weight until ideal

- Lower purin diet
- Rest the joint
- Avoid drugs that causes increase urid acid level

Panduan Praktis Klinis Reumatologi

DIET
THANK YOU