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    Gout Arthritis Acute: Case Report

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    Agung Sukriadi Harli
    This case report summarizes a 56-year-old man presenting with acute gout arthritis in his big toe. He reported sudden onset pain, swelling, and redness in the toe joint for the past 3 days. Physical examination found swelling, erythema, and tenderness in the first MTP joint of the right foot. Laboratory tests showed elevated uric acid levels. Based on the criteria from the American College of Rheumatology, the patient was diagnosed with acute gout arthritis. He was prescribed colchicine and meloxicam for treatment along with dietary and lifestyle counseling.

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    Gout Arthritis Acute: Case Report

    Uploaded by

    Agung Sukriadi Harli
    62 views44 pages
    This case report summarizes a 56-year-old man presenting with acute gout arthritis in his big toe. He reported sudden onset pain, swelling, and redness in the toe joint for the past 3 days. Physical examination found swelling, erythema, and tenderness in the first MTP joint of the right foot. Laboratory tests showed elevated uric acid levels. Based on the criteria from the American College of Rheumatology, the patient was diagnosed with acute gout arthritis. He was prescribed colchicine and meloxicam for treatment along with dietary and lifestyle counseling.

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    This case report summarizes a 56-year-old man presenting with acute gout arthritis in his big toe. He reported sudden onset pain, swelling, and redness in the toe joint for the past 3 days. Physical examination found swelling, erythema, and tenderness in the first MTP joint of the right foot. Laboratory tests showed elevated uric acid levels. Based on the criteria from the American College of Rheumatology, the patient was diagnosed with acute gout arthritis. He was prescribed colchicine and meloxicam for treatment along with dietary and lifestyle counseling.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    62 views44 pages

    Gout Arthritis Acute: Case Report

    Uploaded by

    Agung Sukriadi Harli
    This case report summarizes a 56-year-old man presenting with acute gout arthritis in his big toe. He reported sudden onset pain, swelling, and redness in the toe joint for the past 3 days. Physical examination found swelling, erythema, and tenderness in the first MTP joint of the right foot. Laboratory tests showed elevated uric acid levels. Based on the criteria from the American College of Rheumatology, the patient was diagnosed with acute gout arthritis. He was prescribed colchicine and meloxicam for treatment along with dietary and lifestyle counseling.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 44

    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

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