GOUT

THEO AUDI YANTO

OBJECTIVE
Gain an overview of classification and
features of Gout Arthritis

Discuss some of the key mechanism(s) of

joint damage in GA and the radiographic
and pathological changes of the joint in RA

Understand some of the extra-articular

features of inflammatory arthritis

Gain insight Pathomechanisms in GA

URATE, HYPERURICEMIA &

GOUT
Urate:

end product of
purine metabolism

Hyperuricemia:

serum
urate > urate solubility (>
6.8 mg/dl)

Gout:

deposition of
monosodium urate crystals
in tissues

CRITERIA
6 OUT OF

12
More than one attack of acute arthritis
Maximal inflammation developed within 1 day
Attack of monarticular arthritis
Joint redness observed
First metatarsophalangeal joint painful or swollen
Unilateral attack involving first metatarsophalangeal joint
Unilateral attack involving tarsal joint
Suspected tophus
Hyperuricemia
Asymmetric swelling within a joint (radiograph)
Subcortical cysts without erosions (radiograph)
Negative culture of joint fluid for microorganisms
during attack of joint inflammation

CLASIFICATION
ASYMTOMATIC HYPERUICEMIA
ACUTE INTERMITENT GOUT
INTERCRITICAL GOUT
CHRONIC TOPHACEOUS GOUT

ASYMPTOMATIC
HYPERURICEMIA
Very common biochemical
abnormality

ELEVATED URIC ACID

Defined as 2 SD above mean
value

Majority of people with hyperuricemia

never develop symptoms of uric acid
excess

TIPS: LOOK FOR THE KIDNEY

ACUTE
intermintent
GOUTY
(FLARES)
Abrupt onset of severe joint

inflammation, often nocturnal;

Warmth, swelling, erythema,

& pain;
Possibly fever
Untreated?

Resolves in 3-10 days

90%

1st attacks are monoarticular

50%

are podagra

SITES OF ACUTE
FLARES
90%

of gout
patients eventually
have podagra : 1st
MTP joint

Sites
Can

occur in other joints, bursa &

tendons

INTERCRITICAL
GOUT
Asymptomatic
If untreated, may advance
Intervals may shorten
Crystals in asx joints
Body urate stores increase

CHRONIC
TOPHACEOUS
GOUT
Chronic

Arthritis

X-ray

Changes

Tophi

Develop

Acute

Flares continue

ADVANCED GOUT
Chronic

Arthritis

Polyarticular

acute
flares with upper
extremities more
involved

TOPHI
Solid

urate
deposits in tissues

QUESTION ?
??

Risk Factor
Age 40-50
Male
Genetic predisposisition
Medical Condition : Hypertension, Diabetes, obesity,
hematologic disease, renal failure, psoriasis

Alcohol consumption
High purine diet
Medication: HCTZ, Aspirin

The Gout
Cascade

Urate

Overproductio
Underexcretio
n
n
Hyperurcemi
a
Silent
Associated
Renal
Tissue
CV events
Manifestatio
Gout
Depositio
and
n
n
mortality

Uric acid transport and disease

Alexander So, Bernard Thorens
Published in Volume 120, Issue 6
J Clin Invest. 2010; 120(6):17911799

RADIOLOGIC
SIGNS

X-RAYS

William John Martin and Jacquie L Harper

Immunology and Cell Biology 88, 15-19

Immunity, Volume 34, Issue 4, 455-458, 22 April

2011

Alexander So, Bernard Thorens

Published in Volume 120, Issue 6
J Clin Invest. 2010; 120(6):17911799

ABCG2, also known as BCRP, is a high-capacity urate exporter

Kimiyoshi Ichida, et al.

Nature Communications 3, Article number: 764

Beyond Gout

Daniel I. Feig, M.D., Ph.D., Duk-Hee Kang, M.D., and Richard J. Johnson, M.D.
N Engl J Med 2008; 359:1811-1821

Terima Kasih