Skenario

Mr Rudi, 54-year-old complaint a sudden onset of pain in his right knee that awakened his from sleep. He
does not report any trauma and was essentially asymptomatic when he went to bed. His history is remarkable
for two episodes of similar, severe pain 9 months and 2 years ago, especially when he consumed a lot of sea
food such as shrimps and lobsters. He is pain-free between episodes.

Physical Examination :
Body Weight: 70kg, Height: 163cm, BP: 120/80mmHg, HR: 84bpm, RR: 20rpm, T:36,7oC. Right Knee:
warm, tender to touch, erythematous and limited active and passive range of motion cause of pain.

Laboratory finding :
urea 34mg/dl, Creatinin 1,0mg/dl, blood uric acid 11,1mg/dl and urine uric acid is 240mg/24 hours.

Klarifikasi Istilah

- Sudden onset of pain : Nyeri akut yang datang secara tiba-tiba.

- Tender to touch: Keadaan sangat sensitive terhadap sentuhan atau tekanan.
- Active range of motion: Kisaran dapat diekstensikan dan difleksikannya suatu sendi yang
digerakkan secara volunter oleh pasien dan diukur dengan derajat lingkaran.

- Passive range of motion: Kisaran dapat diekstensikan dan difleksikannya suatu sendi pada pasien
yang digerakkan oleh pemeriksa dan diukur dengan derajat lingkaran.

- Uric acid: Hasil akhir dari katabolisme purin, meningkat pada gout dan nefrolitiasis. Bentuk
kristalnya(kristal urat) tidak dapat larut dalam air dan bisa membentuk batu atau kalkuli.

Identifikasi Masalah

Mr Rudi, 54-year-old complaint a sudden onset of pain in his right knee that awakened his from
sleep. (***)

He does not report any trauma and was essentially asymptomatic when he went to bed. His history
is remarkable for two episodes of similar, severe pain 9 months and 2 years ago, especially when he
consumed a lot of sea food such as shrimps and lobsters. He is pain-free between episodes. (**)

Physical Examination :
Body Weight: 70kg, Height: 163cm, BP: 120/80mmHg, HR: 84bpm, RR: 20rpm, T:36,7oC. Right
Knee: warm, tender to touch, erythematous and limited active and passive range of motion cause of
pain. (*)

Laboratory finding :
urea 34mg/dl, Creatinin 1,0mg/dl, blood uric acid 11,1mg/dl and urine uric acid is 240mg/24 hours.
(*)

Analysis Masalah
Mr Rudi, 54-year-old complaint a sudden onset of pain in his right knee that awakened him from
sleep. (***)
a. Bagaimana anatomi dari sendi lutut?
b. Bagaimana hubungan umur dan jenis kelamin dengan keluhan Mr Rudi?
c. Apa makna klinis dari nyeri secara tiba-tiba sehingga terbangun dari tidur?
d. Bagaimana mekanisme nyeri terkait kasus?

He does not report any trauma and was essentially asymptomatic when he went to bed. His history
is remarkable for two episodes of similar, severe pain 9 months and 2 years ago, especially when he
consumed a lot of sea food such as shrimps and lobsters. He is pain-free between episodes. (**)
a. Apa makna klinis dari tidak ada riwayat trauma dan asimptomatik ketika tidur?
b. Apa makna klinis dari riwayat nyeri hebat yang sama pada 9 bulan dan 2 tahun yang lalu
khususnya setelah mengkonsumsi banyak udang dan lobster?
c. Apa makna klinis dari periode bebas nyeri diantara dua episode?
d. Apa kandungan yang terdapat pada udang dan lobster yang menyebabkan gejala diatas?

Physical Examination :
Body Weight: 70kg, Height: 163cm, BP: 120/80mmHg, HR: 84bpm, RR: 20rpm, T:36,7oC. Right
Knee: warm, tender to touch, erythematous and limited active and passive range of motion cause of
pain. (*)
a. Bagaimana interpretasi hasil pemeriksaan fisik?
b. Bagaimana mekanisme abnormalitas hasil pemeriksaan fisik?

Laboratory finding :
urea 34mg/dl, Creatinin 1,0mg/dl, blood uric acid 11,1mg/dl and urine uric acid is 240mg/24 hours.
(*)
a. Bagaimana interpretasi hasil pemeriksaan laboratorium?
b. Bagaimana mekanisme abnormalitas hasil pemeriksaan laboratorium?
c. Bagaimana metabolisme purin?

Hipotesis: Mr Rudi, 54 Tahun, diduga menderita Gout arthritis.

Template
1. Definisi
2. DD
3. WD
4. How to diagnose
5. Etiologi
6. Epidemiologi
7. Faktor resiko
8. Patofisiologi dan Patogenesis
9. Manifestasi Klinis (predileksi)
10. Pemeriksaan Penunjang (gold standar untuk gout)
11. Tatalaksana dan Edukasi (tatalaksana awal + diet rendah purin)
12. Komplikasi
13. Prognosis
14. SKDI
LI
- Metabolisme Asam Urat
- Pseudogout

Refrensi
- IRA
- Pedoman GOUT, EULAR 2016
- OARSI
- ACR