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Objective
Definition
Epidemiology
Pathogenesis
Clinical manifestation
Complications
Treatment
What is that?
Definition
Indonesia bervariasi:
Urinary stone
Nephropaty gout
Predisposing Factors
Heredity Psoriasis
Drug usage Poisoning
Renal failure Obesity
Hematologic Disease Hypertension
Trauma Organ transplantation
Alcohol use Surgery
Pathogenesis of Gouty
Inflammation
IL-12
TNF IL-1
Hiperurisemia asimptomatik
Hiperurisemia tanpa adanya G/ klinik
Fase ini berakhir dg adanya serangan akut u/
pertama kali
Radiologis
tdk spesifik
Edukasi
Program diet
Istirahat sendi
Fisioterapi
Penanganan medis
Kerusakan sendi dan kerusakan ginjal
Penanganan medis
Akut →
- Kolkisin: 0,5 mg/jam
sp nyeri dan inflamasi hilang.
Dihentikan bl toksisitas
- NSAID
- Kortikosteroid→ bila ada kontraindikasi
kolkisin dan NSAID.
Prednison : 40mg/hr atau ekivalennya
3-4 hr lalu diturunkan perlahan 1-2 mg
Fase lanjutan : profilaksis dg memodifikasi diet
dan gaya hidup, menghindari alkohol
Orate-lowering therapy
Allopuriol Rash, GI symptoms, headache,
urticaria, and intestinal nephritis;
rare potentially fatal hypersensitivity
syndrome, reduces orate levels in
over producers and underexcretors.
Probenecid Rash, headache, and GI symptoms; Renal dysfunction (CrCI 250mg BID for 1 to 2
rare nephritic syndrome, hepatic <50mL/min) or renal weeks↑ ny500mg
necrosis, aplastic anemia and calculi increments every 1 to 2
hemolytic anemia. Reduced orate weeks until satisfactory
levels in underexcretors.Potential for control is achieved or
numerous drug interactions because maximal dose 3 g.
of interference with excretion of
many medications.
Sulfinpyrazone Rash, headache, and GI symptoms, Renal dysfunction (CrCI 50mg BID;↑ to 300 to 400
bone narrow suppression, minor <50mL/min) or renal mg/d in 2 to 3 divided doses
hypersensitive. Possesses inherent calculi maximum dose 800 mg/d.
antiplatelet activity.
Acute treatment
Corticosteriods
– Patients who cannot tolerate NSAIDs, or failed
NSAID/colchicine therapy
– Daily doses of prednisone 40-60mg a day for 3-5
days then taper 1-2 weeks
– Improvement seen in 12-24hr
ACTH
– Peripheral anti-inflammatory effects and induction
of adrenal glucocorticoid release
– 40-80IU IM followed by second dose if necessary
Acute treatment cont’d
Immobilization of Joint
Ice Packs
Abstinence of Alcohol
– Consumption can increase serum urate levels by
increasing uric acid production. When used in
excess it can be converted to lactic acid which
inhibits uric acid excretion in the kidney
Non- Pharmacologic
Treatments
Dietary modification
– Low carbohydrates
– Increase in protein and unsaturated fats
– Decrease in dietary purine-meat and seafood.
Dairy and vegetables do not seem to affect uric
acid
Bing cherries and Vitamin C
Prophylaxis
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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