INTERN DEPARTEMENT

Case Report :

GOUT ARTHRITIS ACUTE

By :
NAME/NIM
ADVISOR
SUPERVISOR

: MEYLISA/C11112156
/C11112
dr.
: dr. ABDUL RAHMAN, SP.Pd

MEDICAL FACULTY HASANUDDIN UNIVERSITY

INTERN DEPARTEMENT
SUB DIVISION RHEUMATOLOGY

ARTHRITIS
GOUT
Name
: Mr. T
Age
: 60 years old
Occupation
: Retirement
Religion
: Moeslim
Marital Status
: Married
Address
: Pare-Pare
Hospital
: RS Wahidin Sudirohusodo
Room
: HCU bed 4
RM
: 780074
Date of admission : 23 November 2016

ANAMNESIS
CHIEF COMPLAINT
HISTORY TAKING

Report Case Presentation

ANAMNESIS
HISTORY TAKING

Physical
Examination
General Description
Impression

: moderate illness

Nutritional status : well nourished

Consciousness : Composmentis

Physical
Vital Sign Examination
Blood Pressure
: 120/90 mmHg
Heart Rate
: 76x/minutes
Respiration Rate
: 26x/minutes
Temperature
: 36,6C
VAS
: 4/10 on Paracetamol 1 g
Weight
Height
BMI

: 50 Kg
: 160 cm
: 19,5 kg/m2

Physical
Examination
:

Thorax

Inspection
Palpation
Percution

:
:

Auscultation :

 Heart
Inspection

Physical
Examination

 Abdomen
Inspection

Physical
Examination

 Abdomen
Inspection

Physical
Examination

INTERN
DEPARTMENT

RHEUMATOLOGY
STATUS
-

G (Gait)

A (Arms)

L (Legs)

S (Spine)` :

LABORATORY FINDING
Type
WBC
LYMP
MON
RBC
HGB
PLT

Result
9,1x 103 /uL
19.8 %
10.1 X 103 /Ul
3.82
11.6
360

Normal Range
4 - 12 x 103 /uL
20.0 - 40.0%
2.00 8.00 x 103 /uL
4-6x106 L
12-16 g/dL
150-400 x 103 l

HCT
MCV
MCH
MCHC
RDW

34
89
30
34
13.8

37-48 %
80-97m3
26.5-33.5 pg
31.5-35.0 g/dL
10-15%

ESR I/II

79/85

LABORATORY FINDING
Ureum

25

Creatinin

1,2

Uric Acid

11

Glucose

92

10 50 mg/dL
P(<1.1);
L(<1,3) mg/dL
P(2.4-5.7);
L(3.4-7) mg/dL
140 mg/dL

LABORATORY FINDING
Color Yellow (pale)
Clarity/turbidity Clear or cloudy
pH 6.0
Specific gravity 1.010

Protein - trace
Glucose Negative
Bilirubin Negative
Urobilirubinogen Normal

PROBLEM LIST
Problem List

Planning and Treatment

Acute Gout Arthritis

- Based on :
a. Anamnesis
:
Pain
and
swelling in the genu sinistra
and dextra, unable to use
affected
joint
(3),
pain
maximal
less
than
30
minutes, resolution in less
than 2 weeks (2),

P:
1. Control of serum uric acid
2. Arthrocentesis
3. X-ray genu dextra et sinistra (AP/lateral)

T:
a. Pharmacologic treatment :
4. Colchicine 0,5mg/24 hour/oral
5. Paracetamol 1 g/ 8 hours/oral
6. Allopurinol 100mg/24 hour/oral
b. Physical Exam :
L
:Effusion,
rubor,
calor, 7. Corticosteroid injection intrarticular
crepitation, tenderness, and
limited ROM in genu sinistra b. Non-pharmacologic treatment :
8. Low-diet purin
and dextra (1)
9. Rest the pain joint
c. Laboratory Exam : serum uric

CRITERIA OF AMERICAN COLLEGE OF

RHEUMATOLOGY FOR GOUT ARTHRITIS

Pain and swelling in the genu sinistra

-Great difficulty with walking
-Resolution of symptoms in 14 days
-Theres history of hiperuricemia 13,7 mg/dl

(1)
(3)
(2)
(4)

TOTAL SCORE

10

DISCUSSIO
N

DEFINITION
An excess of uric acid (Monosodium urate
monohydrate crystals) in the blood and tissues of
the body which if present long enough may form
into a needle like crystals which can inflame your
joints and cause severe pain and swelling (UK
GOUT Society, 2016)

EPIDEMIOLOGY

Male : Female = 3:1

Menopause woman
Life style
Geriatri

ETIOLOGY
Too much uric acid in the blood ( hyperuricemia)
High purine diet ( too much meat and seafood) or drinking too
much alcohol.
Drugs that increase uric acid concentration (aspirin or niacin) or
drugs that reduce the amount of salt and water in the body
( diuretics)
Genetic conditions ( Kelley seegmiller syndrome or Lesch Nyhan
syndrome)

PATHOMECHANISM
PATHOMECHANISM

STAGES OF GOUT

CRITERIA
DIAGNOSTIC

CLINICAL
CLINICAL
MANIFESTATION
MANIFESTATION

DIFFERENTIAL
DIAGNOSIS

PHARMACOLOGICAL
TREATMENT

NON PHARMACOLOGICAL
TREATMENT

NON PHARMACOLOGICAL
TREATMENT

Thank you