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GOUT

GOUT. Ketut Widyani Astuti. Gout. DEFINISI : Artritis perifer akibat dari deposit kristal sodium urat pada minimal salah satu sendi Ditandai dengan inflamasi , kemerahan , nyeri yang tiba-tiba Hiperurisemia : pria : > 7 mg/ dL wanita : > 6 mg/ dL. Gout.

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GOUT

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  1. GOUT KetutWidyaniAstuti

  2. Gout DEFINISI : Artritisperiferakibatdari deposit kristal sodium uratpada minimal salahsatusendi Ditandaidenganinflamasi, kemerahan, nyeri yang tiba-tiba Hiperurisemia : pria : > 7 mg/dL wanita : > 6 mg/dL

  3. Gout Affects less than 0.5% of the population Due to familial disposition, incidence may be as high as 80% in families affected by disorder. Stoffey et al, Emed 2002

  4. Gout • Empattahapperkembangan Gout: • asymptomatic hyperuricemia • acute gouty arthritis • interval or intercriticalgout • chronic or tophaceousgout

  5. Pathophysiology • Uratejenuhdi plasma padakonsentrasi7 mg/dL • Kristal uratterdepositpadajaringan yang rendahvaskularisasideposits in less vascular tissue • Kartilago • Tendon/ligamen • Adakecenderunganterdepositpadapersendian

  6. Pathophysiology GOUT PRIMER Tidakdiketahui/ kelainangenetik Produksiasamuratberlebihkarena : 1. PeningkatanaktivitasenzimPhosphoribosilPirophosphat (PRPP) sintetase 2. KekuranganHipoksantinGuaninPhosphoribosilTransferase (HGPRTase) 3. Kekurangan Glukosa-6-Phosphat 4. Kekurangan Fruktosa-1-fosfat aldolase

  7. METABOLISME PURIN

  8. Pathophysiology GOUT SEKUNDER 1. Peningkatanproduksiasamurat - makananpurintinggi - penguraianasamnukleat (leukimia, kanker, kematiansel) - pemecahan ATP (epilepsi, latihanfisik berlebih, merokok, konsumsialkohol)

  9. Pathophysiology GOUT SEKUNDER 2. Penurunanekskresiasamurat - alkohol - obat : aspirin, diuretik - penyakit : diabetes, ketoasidosis

  10. GOUT berdasarkanjenisserangan • Acute attack: • Over hours frequently nocturnal • Excruciating pain • Swelling, redness and tenderness • Podagra • May effect knees, wrist, elbow, and rarely SI and hips. • Chronic: • Destructive tophacous • Much greater chance if untreated

  11. Manifestasiklinik gout Gout ArtritisAkut Nefrolitiasisasamurat : pengandapanasamuratpadanefronkarenakelarutanpada pH asamberkurang Nefropati gout : terdepositkristalasamuratpadaginjal Pseudogout : kristalkalsiumpirofosfatdihidrat Tophaceous gout : agregatkristal monosodium urat

  12. Diagnosis • Pemeriksaanfisik • Konfirmasiarthrocentesis • Kristal urat : kristalberbentukjarummengapungbebasataudidalamneutrophils & macrophages. • Kadar asamurat non spesifik. • 30% menunjukkanlevel normal • Pengumpulanurin Kadar asamurat normal dalam 24 jam : 250 – 750 mg

  13. Microscopic Diagnosis

  14. X-ray • Acute • Soft tissue swelling • Chronic • chronic tophaceous gouty arthritis, extensive bony erosions are noted throughout the carpal bones • Sclerosis and joint-space narrowing are seen in the first metatarsophalangeal joint, as well as in the fourth interphalangeal joint .

  15. PENANGANAN NON FARMAKOLOGI Hindarimakananpurintinggi : jeroan, ham, kacang, makananlaut Karbohidrat : kurangikarbohidratsederhanasptgula, permen Sesuaikankebutuhankalori Rendah protein Rendahlemak Banyakminum

  16. PENANGANAN FARMAKOLOGI SASARAN TERAPI : Meringankanbengkakdan rasa sakit pd gout akut (AINS, kortikosteroid, kolkisin) Menurunkankonsentrasiasamurat plasma (allopurinol, probenesid, sulfinpirazon) Mencegahkekambuhan (allopurinol, kolkisinprobenesid, sulfinpirazon) Mencegahdanmengurangipembentukantophi (probenesid, sulfinpirazon) Mengatasibatuginjalkarenaasamurat (allopurinol)

  17. ALGORITMA PENANGANAN GOUT AKUT

  18. FARMAKOTERAPI GOUT AKUT

  19. Farmakoterapi Gout Interkritikal - Kronis

  20. Prognosis Generally good More severe course when Sx present < 30 y/o Up to 50% progress to chronic disease if untreated. Surgical intervention may be required for tophi.

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