GOUT ARTHRITIS

Definisi Gout
Merupakan penyakit metabolik yng
menimbulkan deposisi kristal sodium urate
monohydrate (kondisi hiperurisemia) di
membran synovial, articular cartilage,
ligaments, dan bursae yang mengakibatkan
destruksi dari cartilage.
Mekanisme Gout
Gangguan metabolisme purin
Deposisi kristal Sodium monourate di
kartilage, synovium, periarticular, dan
jaringan subkutan.
Deposisi asam urat di artikular manapun.
 Anabnormality in handling uric acid can
cause attacks of painful arthritis (gout
attack), kidney stones, and blockage of the
kidney-filtering tubules with uric acid
crystals, leading tokidney failure

Asymptomatic hyperuricemia is considered

a precursor state to the development of
gout.
Epidemiologi Gout
- > 40 th
- males > females
- > at 1st MTP joint
- usually not seen until 6-12 years after initial attack
Etiologi Gout
Idiopathic
Gout
- M:F = 20:1
- Overproduction of uric acid
- Abnormality of renal urate excretion

Secondary Gout
- Rarely cause for radiographically apparent
disease
- Myeloproliferative disorders (e.g.
polycythemia vera, leukemia, lymphoma,
multiple myeloma)
- Blood dyscrasias
- Myxedema, hyperparathyroidism
- Chronic renal failure
Risk factor
Diabetes
Kidney disease
Obesity
Sickle cell anemiaand otheranemias
leukemiaand other blood cancers
moderate to heavyalcoholintake
Certain drugs, such as thiazide
diuretics
(hydrochlorothiazide[Dyazide]), low-
dose aspirin,niacin,cyclosporine,
tuberculosis medications
(pyrazinamide and ethambutol)
Lokasi Gout
Sendi :
Tangan dan kaki (Sendi MTP pertama
sering terkena = podagra), maupun
pergelangannya.
Carpometacarpal compartment pada knee,
shoulder, hip, sacroiliac joint

Ear pinna > bones, tendon, bursa

Gejala Klinis Gout
Bengkak
Nyeri tekan
Kemerahan
Nyeri tajam pada ibu jari kaki, jari kaki,
pergelangan tangan dan kaki.
Serangan dalam beberapa hari atau minggu
sebelum nyeri menghilang.
Gambaran Radiologi
Deposit kalsifikasi (topus)
Erosi artikuler intra/eksta (punch out lesion)
Tidak ada demineralisasi
Terkadang dengan oval cyst sub artikuler
Penyempitan artikuler
Hancurnya kartilage
Pembengkakan artikuler terkadang dengan chondro
calsinosis
Tidak ada penyempitan sampai tahap lanjut
Tidak ada atau sedikit osteophorosis
Pembengkakan jaringan lunak
Bone erosions (marginal periarticular) overhanging
margin sign
Gambaran Radiologi
Soft tissue findings
o Deposisi kalsifikasi pada topus 50% (only calcium urate crystals are opaque)
o Eccentric juxta-articular lobulated soft-tissue masses (hand, foot, ankle,
elbow, knee)
o Bilateral olecranon bursitis
o Aural calcification

Joint findings
o Preservation of joint space initially
O Absence of periarticular demineralization
o Erosion of joint margins with sclerosis
o Cartilage destruction late in course of disease
o Periarticular swelling (in acute monarticular gout)
o Chondrocalcinosis (menisci, articular cartilage of knee) resulting in
secondary osteoarthritis
 Gambaran Radiologi
Bone findings
o "Punched-out" lytic bone lesion sclerosis of
margin
o "Mouse / rat bite" from erosion of long-standing
soft-tissue tophus
o "Overhanging margin" (40%)
o Ischemic necrosis of femoral / humeral heads
o Bone infarction
Terdapat pembengkakan jaringan lunak pada olecranon
bursa (white arrow).
Terdapat erosi (blue arrows) disekitar sendi siku.
Tidak ada demineralisasi.
Figure 1 is an X-ray of a normal foot with healthy bones and joints.
Figure 2 is an X-ray of a deformed toe joint caused by chronic gout.
The great toe
Demonstrates
extensive
juxta-articular
Erosions
with soft tissue
swelling and
little
osteoporosis
Phase
Early-phase 1
-limited to the soft tissues
-asymmetric swelling around
the affected joint,
-edema of the soft tissues
around the joints,
-multiple episodes of gouty
arthritis in the same
jointa cloudy area of
increased opacity
intermediate phase 2
-the earliest bony changes appear(initially
appear in the first metatarsophalangeal joint
area), generally seen outside the joint or in
the juxta-articular area.
-often described as punched-out lesions, which
can progress to become sclerotic as they
increase in size.
-Fractures may be present in affected areas in
severe cases of intermediate-phase gout.
late-phase 3
-the hallmark findings are
numerous interosseous tophi.
-joint-space narrowing, which
can be severe and
symptomatic.
-Marked deformities and
subluxation may also be
noted in affected areas during
the late stage of disease.
-Calcific deposits in the soft
tissues also can be observed
in late-phase gout.
TERIMAKASIH
Hallmarks of gout
Well define erosion (sclerotic
margin)
Soft tissue nodules
Random distribution
No osteoporosis
Sharply marginated
erosions, some
with a sclerotic
margin, are noted
throughout the
carpus and
proximal
metacarpals. These
erosions are classic
in gout. Note the
absence of marked
demineralization.
A sharply marginated
erosion with an
overhanging edge (arrow)
and a sclerotic margin is
seen in the
metatarsophalangeal in the
great toe in this patient
with gout. This appearance
and location are classic for
gout, whereas psoriatic
arthritis and Reiter disease
usually involve the
interphalangeal joint and
do not have erosions that
are this sharply
marginated.
Advanced Gout. Marked
diffuse and focal soft tissue
swelling is present
throughout the hand and
wrist in this patient with
long-standing gout.
Destructive, large, well-
marginated erosions, some
with overhanging edges,
are noted near multiple
joints. The focal areas of
soft tissue swelling are
called tophi, some of which
are calcified. These only
calcify with coexistent
renal disease.
Chondrocalcinosis in
the Knee. Cartilage
calcification known as
chondrocalcinosis is
seen in the
fibrocartilage (white
arrow) and in the
hyaline articular
cartilage (black arrow)
in this patient with
calcium pyrophosphate
dihydrate deposition
disease.