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Gout and Hyperuricemia

Medical Author: William C. Shiel Jr., MD, FACP, FACR What is gout and hyperuricemia? Gout adalah keadaan yang diakibatkan dari penimbunan kristal asam urat dalam jaringan tubuh. Gout digambarkan dengan kelebihan asam urat dalam tubuh dan serangan ulang dari inflamasi sendi (arthritis). Gout kronis dapat memicu penimbunan of hard lumps of asam urat di dalam dan sekitar sendi, penurunan fungsi ginjal dan batu ginjal. Gout memiliki perbedaan yang unik untuk menjadi salah satu dari penyakit yang paling sering terjadi dalam sejarah kedokteran. Berkaitan dengan ketidaknormalan kemampuan tubuh untuk memproses asam urat yang diturunkan. Asam urat adalah hasil akhir dari pemecahan purin, yang merupakan bagian dari banyak makanan yang kita makan. Ketidaknormalan dalam pengendalian asam urat dapat menyebabkan serangan nyeri sendi (serangan gout),batu ginjal, dan blockage of the kidney filtering tubules dengan kristal asam urat, mengarah pada gagal ginjal. Dengan kata lain, beberapa pasien mungkin hanya mengalami peningkatan kadar asam urat dalam darah (hyperuriksemia) tanpa mengalami nyeri atau masalah ginjal. Istilah gout biasanya mengarah pada serangan nyeri sendi. Gout arthritis biasanya merupakan serangan nyeri yang hebat dengan kemunculan inflamasi sendi secara cepat. Inflamasi sendi disebabkan oleh penimbunan kristal asam urat dalam cairan sendi (cairan synovial) dan joint lining (synovial lining). Inflamasi sendi yang berulang-ulang mengakibatkan munculnya sel-sel darah putih untuk memakan kristal asam urat dan melepaskan zat-zat kimia yang berhubungan dengan inflamasi, menyebabkan nyeri, panas, dan kemerahan pada jaringan sendi. Who is affected by gout? Kira-kira 1 juta orang di Amerika terserang gout. Insidensi gout sembilan kali lebih banyak terjadi pada pria daripada wanita. Kebanyakan menyerang pria setelah masa pubertas, dengan frekuensi kemunculan meningkat pada usia 75 tahun. Pada wanita, serangan gout biasanya muncul setelah menopause. Selama proses peningkatan kadar asam urat dalam darah (hyperuriksemia) yang mungkin meningkatkan resiko terkena gout, hubungan antara hiperuriksemia dan gout belum jelas. Banyak pasien dengan hyperuriksemia tidak berkembang menjadi gout, di sisi lain beberapa pasien dengan serangn gout yang berulang-ulang memiliki kadar asam urat dalam darah yang normal atau rendah. Sebagian dari populasi pria di Amerika, kira-kira 10 persen mengalami hyperuriksemia. Hanya sebagian kecil dari mereka yang mengalami hyperuriksemia yang pasti akan berkembang menjadi gout. What are the risk factors for gouty arthritis? In addition to an inherited abnormality in handling uric acid, other risk factors for developing gout include obesity, excessive weight gain, especially in youth, moderate to heavy alcohol intake, high blood pressure, and abnormal kidney function. Certain drugs, such as thiazide diuretics, low-dose aspirin, niacin, cyclosporine, tuberculosis medications (pyrazinamide and ethambutol), and others can also cause elevated uric acid levels in the blood and lead to gout. Furthermore, certain diseases lead to excessive production of uric acid in the body. Examples of these diseases include leukemias, lymphomas, and hemoglobin disorders. Interestingly, a recent study demonstrated an increased prevalence of abnormally low thyroid hormone levels (hypothyroidism) in patients with gout.

In patients at risk of developing gout, certain conditions can precipitate acute attacks of gout. These conditions include dehydration, injury to the joint, fever, excessive dining, heavy alcohol intake, and recent surgery. Gout attacks triggered by recent surgery are probably related to changes in the body fluid balance as patients temporarily discontinue normal oral fluid intake in preparation for and after the surgery. What are symptoms of gout? The small joint at the base of the big toe is the most common site of an acute gout attack. Other joints that can be affected include the ankles, knees, wrists, fingers, and elbows. Acute gout attacks are characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness. Tenderness can be intense so that even a blanket touching the skin over the affected joint can be unbearable. Patients can develop fever with the acute gout attacks. These painful attacks usually subside in hours to days, with or without medication. In rare instances, an attack can last for weeks. Most patients with gout will experience repeated attacks of arthritis over the years. Uric acid crystals can deposit in tiny fluid-filled sacs (bursae) around the joints. These urate crystals can incite inflammation in the bursae leading to pain and swelling around the joints, a condition called bursitis. In rare instances, gout leads to a more chronic type of joint inflammation which mimics rheumatoid arthritis. In chronic (tophaceous) gout, nodular masses of uric acid crystals (tophi) deposit in different soft tissue areas of the body. Even though they are most commonly found as hard nodules around the fingers, at the tips of the elbows, and around the big toe, tophi nodules can appear anywhere in the body. They have been reported in unexpected areas such as in the ears, vocal cords, or (rarely) around the spinal cord!