GOUT AND URIC ACID

METABOLISM
Definition of Gout
Inflammatory arthritis induced by microscopic
crystals of monosodium urate monohydrate
(MSU) and to pathognomic deposition of
aggregated MSU crystals (tophi) in various
tissues and some organs
Chronic hyperuricemia
Urolithiasis

INCIDENCE
0,5-0,7% on men > 0,1% on woman
Serum urate values increase with age


HYPERURICEMIA
MEN : > 5,1 mg/dl
Woman : > 4,0 mg/dl
Uric acid
10-59 years 2,5-9,0 mg/dl
Female 2,0-8,0 mg/dl

ETIOLOGI
PRIMER
- langsung pembentukan asam urat (alkohol,
obesitas, diet tinggi purin) atau penurunan
ekskresinya dalam tubuh (gagal ginjal,
diuretik).
SEKUNDER
- pembentukan asam urat yang berlebih atau
penurunan ekskresi asam urat yang berkurang
akibat proses penyakit lain/ pemakaian obat
tertentu
URIC ACID PRODUCTION AND
ELIMINATION
Glomerular filtration
- Complete
- by diuretics, renal diuretics
Tubular reabsorption
- Active, linked to Na reabsorption
- Inhibited by uricosuric drugs: probenecid, Sulfinpyrazone,
benzobromarone, high dose aspirin
Tubular secretion
- Active process
- Inhibited by agents that cause hyperuricemia: pirazinamid, low dose
aspirin, B-hydroxybutyrate, branched-chain ketoasidosis
Postsecretory reabsorbtion




Tubular
reabsorption
98-100

Glomerular
filtration

100



Tubular
secretion
50



Postscretory
reabsorption
40-44 6-10
x.o
x.o
BIOSYNTHETIC PATHAWAYS
De novo
Salvage
Tahap Perjalanan Klinis
Hiperurisemia asimtomatik
- terjadi peningkatan asam urat serum
- tidak ada gejala yg timbul
Artritis gout akut
- pembengkakan dan nyeri mendadak
- tanda peradangan lokal
- demam dan peningkatan leukosit
Tahap interkritis
- tidak ada gejala pada masa ini
- serangan berulang pada waktu kurang dari 1 tahun
(jk tidak diobati)
Tahap gout kronik
- peradangan kronik nyeri, sakit, kaku, penonjolan
dan pembesaran sendi
- terbentuk tofi (bursa olekranon, tendon achilles,
heliks telinga)





Tubular
reabsorption
98-100

Glomerular
filtration

100



Tubular
secretion
50



Postscretory
reabsorption
40-44 6-10
Penurunan
krn diuretik,
Gagal ginjal
Diinhibisi oleh
uricosuric drugs
(probenecid,
sulfinpyrazone,
benzobromarone,
high dose aspirin)
Inhibited by agents that cause
hyperuricemia: pirazinamid, low
dose aspirin, B-hydroxybutyrate,
branched-chain ketoasidosis
x.o
x.o
ACUTE GOUT INTERVAL GOUT LONG TERM
Therapeutic goal:
terminate acute
inflammatory attack
Therapeutic goal:
Prevent recurent attacks
Therapeutic goal:
Prevent attacks; resolve
tophi; maintain serum
urate at < 6mg/dl
NSAIDS Colchicine oral Colchicine oral
Colchicine oral Start hypouricemic agent if
indicated by frequent
attacks, severe
hyperuricemia, presence of
tophi, urolithiasis, or urate
overexcretion
Allopurinol
Colchicine IV Uricosuric agent
Steroids High fluid intake to
promote uric acid excretion
in a dilute urine. Diet-
moderate protein, low fat;
avoid excessive alcohol
High fluid intake,
particularly at night, to
promote uric acid excretion
in a dilute urine. Diet-
moderate protein, low fat;
avoid excessive alcohol
Hypouricemic agents Acetazolamide 250 mg at
bedtime (may be used to
keep urine pH > 6)
TERIMA KASIH