gouty artritis
DESCRIPTION
aTRANSCRIPT
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KETUT WIDYANI ASTUTI
GOUT
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Gout
DEFINISI :Artritis perifer akibat dari deposit kristal
sodium urat pada minimal salah satu sendiDitandai dengan inflamasi, kemerahan, nyeri
yang tiba-tibaHiperurisemia :
pria : > 7 mg/dLwanita : > 6 mg/dL
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Gout
Affects less than 0.5% of the populationDue to familial disposition, incidence may
be as high as 80% in families affected by disorder.
Stoffey et al, Emed 2002
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Gout
Empat tahap perkembangan Gout:
asymptomatic hyperuricemia acute gouty arthritis interval or intercritical gout chronic or tophaceous gout
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Pathophysiology
Urate jenuh di plasma pada konsentrasi 7 mg/dL
Kristal urat terdeposit pada jaringan yang rendah vaskularisasi
Kartilago Tendon/ligamen
Ada kecenderungan terdeposit pada persendian
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Pathophysiology
GOUT PRIMERTidak diketahui/ kelainan genetikProduksi asam urat berlebih karena :1. Peningkatan aktivitas enzim Phosphoribosil Pirophosphat (PRPP) sintetase 2. Kekurangan Hipoksantin Guanin Phosphoribosil Transferase (HGPRTase)3. Kekurangan Glukosa-6-Phosphat4. Kekurangan Fruktosa-1-fosfat aldolase
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METABOLISME PURIN
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Pathophysiology
GOUT SEKUNDER1. Peningkatan produksi asam urat
- makanan purin tinggi- penguraian asam nukleat (leukimia,
kanker, kematian sel)- pemecahan ATP (epilepsi, latihan fisik berlebih, merokok, konsumsi alkohol)
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Pathophysiology
GOUT SEKUNDER2. Penurunan ekskresi asam urat
- alkohol- obat : aspirin, diuretik- penyakit : diabetes, ketoasidosis
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GOUT berdasarkan jenis serangan
Acute attack: Over hours frequently nocturnal Excruciating pain Swelling, redness and tenderness Podagra May effect knees, wrist, elbow, and rarely hips.
Chronic: Destructive tophacous Much greater chance if untreated
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Manifestasi klinik gout
Gout Artritis AkutNefrolitiasis asam urat : pengandapan asam
urat pada nefron karena kelarutan pada pH asam berkurang
Nefropati gout : terdeposit kristal asam urat pada ginjal
Pseudogout : kristal kalsium pirofosfat dihidrat
Tophaceous gout : agregat kristal monosodium urat
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DiagnosisPemeriksaan fisikKonfirmasi arthrocentesis
Kristal urat : kristal berbentuk jarum mengapung bebas atau di dalam neutrophils & macrophages.
Kadar asam urat non spesifik. 30% menunjukkan level normal
Pengumpulan urin Kadar asam urat normal dalam 24 jam : 250 – 750
mg
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Microscopic Diagnosis
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X-rayAcute
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 .
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PENANGANAN NON FARMAKOLOGI
Hindari makanan purin tinggi : jeroan, ham, kacang, makanan laut
Karbohidrat : kurangi karbohidrat sederhana spt gula, permen
Sesuaikan kebutuhan kaloriRendah proteinRendah lemakBanyak minum
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PENANGANAN FARMAKOLOGI
SASARAN TERAPI :1. Meringankan bengkak dan rasa sakit pd gout
akut (AINS, kortikosteroid, kolkisin)2. Menurunkan konsentrasi asam urat plasma
(allopurinol, probenesid, sulfinpirazon)3. Mencegah kekambuhan (allopurinol, kolkisin
probenesid, sulfinpirazon)4. Mencegah dan mengurangi pembentukan
tophi (probenesid, sulfinpirazon)5. Mengatasi batu ginjal karena asam urat
(allopurinol)
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ALGORITMA PENANGANAN GOUT AKUT
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FARMAKOTERAPI GOUT AKUT
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Farmakoterapi Gout Interkritikal - Kronis
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Prognosis
Generally goodMore severe course when present < 30 years
oldUp to 50% progress to chronic disease if
untreated.Surgical intervention may be required for
tophi.