INTERN PARTEMENT

Case Report :

GOUT ARTHRITIS ACUTE

By :
Aulia Giffarinnisa
Lina Latifah
Sri Wahyuni Harli

MEDICAL FACULTY HASANUDDIN UNIVERSITY

INTERN DEPARTEMENT
SUB DIVISION RHEUMATOLOGY
 ARTHRITIS GOUT
Name : Mr.A
Age : 56 years old
Occupation : Truck driver
Religion : Muslim
Address : Enrekang
 ANAMNESIS
CHIEF COMPLAINT
Pain and swollen on the big toe joint MTP-1 dextra
HISTORY TAKING

It felt since the last 3 days and make him difficult to walk. He felt it suddenly and
continuous. Therere pain , swelling and redness in his joint. Patient felt pain if it
touched.
Theres no injury in joint, theres fever since 3 days ago, no cough, no nausea
and vomiting.
 ANAMNESIS
HISTORY TAKING
Urination volume is normal with clear light yellow urine, no sandy, stone and
painfull feeling when urination.
Defecation frequent is normal with yellow stool and solid consistency, no
history of melena (black stool).
History of hypertension and diabetic mellitus unknown. Patient never take
medication before.
Theres family history with same complaint his father.
Theres history of drink alcohol and smoking since 30 years ago. Patient likes
to counsumed high purine diet ( meat and seafood)
 Physical
Examination
General Description
Impression : moderate illness
Nutritional status: well nourished
Consciousness : Composmentis
 Physical
Vital Sign Examination
Blood Pressure : 120/80 mmHg
Heart Rate : 80x/minutes
Respiration Rate : 20x/minutes
Temperature : 36,5C
VAS : 5/10
Weight : 60 kg
Height : 168 cm
BMI : 21,25
 Head : normocephal, straight black hair
Eyes : anemic (-) subconjunctival bleeding (-)
ear : no abnormalities, otorrhea (-)
Nose : no abnormalities, epistaxis (-)
Lips : no abnormalities, cyanosis (-)
Neck : JVP R-1 cmH20, no enlargement of thyroid gland, no deviation
of trachea
 Physical
Thorax
Inspection
Examination
: Symmetrical left and right,
Palpation : no Tumor mass , no tenderness
Percution : Sonor in both lung fields
Auscultation : The sound of breathing: Vesicular
Additional sound: Rhonki - / -, Wheezing
-/-
 Physical
Heart
Inspection
Examination
: Ictus cordis looked at ICS V linea medioclavicularis sinistra.

Palpation : Ictus cordis palpable at ICS V linea medioclavicularis sinistra.

Percution : Right heart border in ICS IV linea parasternalis dextra;

Left heart border in ICS V linea medioclavicularis sinistra

Auscultation : Heart sound I / II pure, regular. No Gallop , no murmur

 Physical
Abdomen Examination
Inspection : Convex, follow the motion of breath,

Auscultation : Peristaltic (+) normal impression.

Palpation : No ascites, Liver and spleen are not

palpable

Percution : Tympani (+) no ascites

 INTERN
DEPARTMENT
RHEUMATOLOGY
- G (Gait) : Antalgic STATUS
- A (Arms) : Normal

- L (Legs) : 1st MTP Dextra : oedema (+), eritema (+), tenderness (+), warm
(+).
- S (Spine)` : Normal
LABORATORY FINDING
Type Result Normal Range
WBC 6400 4 - 12 x 103 /uL
RBC 4.91 4-6.20x106 L
MCV 79.8 80-100m3
MCH 29.8 26-34 pg
MCHC 29.9 31-35.5 g/dL
HGB 14.7 11-17 g/dL
PLT 180 150-400 x 103 l
LYM % 15 25-50 %
MON % 9.5 2-10 %
 LABORATORY FINDING
Type Result Normal Range

SGOT 26 <35 U/L

SGPT 24 <45 U/L
GDS 143 >200 gr/dl
UREUM 27 0 -53 mg/dL
CREATININ 1,0 0,6 -1,3 mg/dL
ESR I/II 6/12
Uric Acid 12,7 2,4 5,7
 PROBLEM LIST
Gout Arthritis Acute
- Pain in the first MTP dextra
- Unilateral attack involving the first MTP joint
-Suddenly attack, since 3 days ago
-Pain and swelling in 1st MTP dextra joint
-Theres family history with same complaint
-Theres history of drink alcohol
 DIAGNOSIS
Problem Therapy Planning

Acute Gout Arthritis

Based on
S:
Man, 56 years old.
Pain and swelling and
redness on the big toe
suddenly felt since 3 days
ago.
Fever since 3 days ago.
There is a history of high
levels of
 CRITERIA OF AMERICAN COLLEGE OF
RHEUMATOLOGY FOR GOUT ARTHRITIS

Eritema in the joint

Swelling and pain in the first MTP joint
Unilateral attack in tarsal joint
Hyperuricemia
Inflammation only happen for a day
Monoarticuler arthritis attack
 TREATMENT

Non-pharmacological :
Pharmacological :
Low purin diet
Colchisine 0,5-0,6 mg / 6
Educate the patient (stop drink alcohol)
hours / oral
Rest the joint pain
NSAID ( Meloxicam 15 mg/
24 hours/oral)
DISCUSSI
ON
 DEFINITION

Gout is a type of arthritis in which small

crystals form inside and around the joints.
It causes sudden attacks of severe pain
and swelling.
 RISK FACTOR

high-purine diet,
alcohol use,
obesity,
and diuretic therapy
ETIOLOGY
PATHOMECHANISM
STAGES OF GOUT
CRITERIA
CRITERIA DIAGNOSTIC
DIAGNOSTIC
Examples of tophus. The tophus is defined as
a draining or chalk-like subcutaneous nodule
under transparent skin, often with overlying
vascularity. Typical locations are the ear (A),
the elbow (olecranon bursa) (B), and the
finger pulps (C and D). Note the overlying
vascularity in D.
DIFFERENTIAL
DIFFERENTIAL DIAGNOSIS
DIAGNOSIS
PHARMACOLOGICAL
PHARMACOLOGICAL
TREATMENT
TREATMENT
NON
NON PHARMACOLOGICAL
PHARMACOLOGICAL TREATMENT
TREATMENT
 NON
NON PHARMACOLOGICAL
PHARMACOLOGICAL TREATMENT
TREATMENT

Dietary measures
Weight reduction
Avoidance of alcohol
Avoidance of foods high in purines
High: Sardines, anchovies, herring, mussels, liver, kidney, goose, venison, meat soups, sweetbreads,
beer & wine
Moderate: Chicken, salmon, crab, veal, mutton, bacon, pork, beef, ham
 COMPLICATION
COMPLICATION

Joint deformity

Osteoarthritis

Tophi may produce draining sinuses that may become infected

Renal stones, pyelonephritis, obstructive renal disease

Thank you