Artritis Gout FK Unbrah
description
Transcript of Artritis Gout FK Unbrah
Artritis Gout
Metabolisme Purin
Biological functions of nucleotides
1. Building blocks of nucleic acids (DNA and RNA).2. Involved in energy storage, muscle contraction,
active transport, maintenance of ion gradients.3. Activated intermediates in biosynthesis
(e.g. UDP-glucose, S-adenosylmethionine).4. Components of coenzymes (NAD+, NADP+, FAD,
FMN, and CoA)5. Metabolic regulators:a. Second messengers (cAMP, cGMP)b. Phosphate donors in signal transduction (ATP)
c. Regulation of some enzymes via adenylation and uridylylation
-OO
H(OH)
HH
HHO
OP
O
O-
Purine orPyrimidineBase
Phosphate
Pentose sugar
Nucleoside
Nucleotide
1'
2'3'
4'
5'
Nucleotides
b-glycosidic bond
RNA- ribose (R)DNA – deoxyribose (dR)
Hiperuricemia
• Etiologi : - overproduction- underexcretion
Terdiri atas :1. Hiperuricemia primer
akibat kelainan molekular, eenzim atau defek genetik2. Hiperuricemia sekunder
akibat penyakit atau obat2 an tertentu3. Hiperuricemia idiopatik
penyebab tidak diketahui
Hiperurisemia Asimtomatik
• Tidak dapat digunakan utk memastikan diagnosis gout
• Hanya sebagian penderita hiperurisemia yg berlanjut menjadi gout artritis akut
• Sebagian besar hiperurisemia asimtomatik tidak memerlukan pengobatan
Patofisiologi gout artritis
• Uric acid: overproduction vs. underexcretion
• Mechanisms of urate “production”– cellular nucleoproteins/nucleotides (~ 66%)– diet (~33%)
• Mechanisms of urate excretion– kidney (~66%)– gut (~33%)
Manifestasi klinis
1. Artritis gout akut2. Stadium interkritikal3. Stadium Artritis Gout Menahun (kronis)
Acute Gouty Arthritis:Clinical Features
• Acute onset (hours) of severe arthritis• Usually monarticular
– almost any joint can be affected– 1st MTP joint (podagra) most common (50%)– Other joints (in decreasing frequency): midfoot, ankle,
heel, knee, wrist, fingers, elbow
• Associated findings: fever, WBC, ESR• Typically resolves over days or weeks,
regardless of treatment
Acute Gouty Arthritis
podagra
• Faktor pencetus serangan gout akut1. Fluktuasi kadar asam urat darah
- obat2 penurun kadar asam urat- pemakaian diuretik ( HCT )- pemakaian aspilet
2. pembedahan3. konsumsi alkohol
Gejala klinis Gout akut
• Nyeri sendi hebat dan tiba2• Biasanya monoartrikular• Merah dan bengkak pada sendi• Gejala sistemik seperti demam, menggigil• Terutama mengenai sendi MTP I
Stadium interkritikal
• Kelanjutan dari stadium akut• Secara klinik tidak terdapat tanda2 radang
akut• Pada aspirasi sendi ditemukan kristal urat• Dapat berlangsung beberapa bulan sampai
tahunan
Stadium artritis gout kronis
• Terbentuk tofi pada sendi (poliartrikular)• Sering sdh disertai komplikasi seperti gaagal
ginjal atau batu saluran kemih
Evolution of GOUT
Pengobatan pada gout akut
• Non-steroidal antiinflammatory drugs• Colchicine• Steroids
– intra-articular– oral
• Joint aspiration• Analgesics• Observation (no therapy)
Pengobatan pada gout atritis kronik bertofus
• Control and prevent acute gouty arthritis– Non-steroidal antiinflammatory drugs– Colchicine– Steroids– Analgesics
• Reduce serum uric acid levels (< 4.0 mg/dL)– decrease uric acid production (inhibit xanthine
oxidase)– increase uric acid excretion (uricosuric drugs)