GOUT

An old disease in new perspective

Tri Wulandari (1910017070)

Pembimbing : dr. Gregorius Tekwan, Sp.OT, M.Si
Introduction
● Gout is a systemic disease that results from the deposition of monosodium
urate crystals (MSU) in tissues.

● Hyperuricemia is the main pathogenic defect in gout, but only 5% of people

with hyperuriceamia above 9 mg/dL develop gout.

● MSU crystals can be deposited in all tissues mainly in and around the joints
forming tophi.

● Gout is mainly diagnosed by identification of the pathognomonic MSU

crystals by joint fluid aspiration or in tophi aspirate

● Lowering SUA levels below deposition threshold either by dietary

modification and using serum uric acid lowering drugs is the main goal in
management of gout.
 Epidemiology
● 1–4% of the general population.

● Prevalence rises up to 10% in men and 6% in women

more than 80 years old

● It occurs in men 2–6 folds more than women

● Incidence increases gradually due to poor dietary

habits such as fast foods, lack of exercises, increased
incidence of obesity and metabolic syndrome
Diagnosis
 Clinical diagnosis

Intercritial period
• Absence of symtoms
• It may be interrupted suddenly by newer attacks if
proper treatment for hyperuricemia has not been
Asymtomatic introduced.
hyperuricemia
Chronic tophaceus
Acute gouty attack gout
• Redness, hotness,
tenderness, swelling and
lost of function
• Podagra
• Laboratory diagnosis

• Radiologic diagnosis
Conventional radiography (CR) MRI
Ultrasound (USG) Nuclear scintigraphy
Conventional CT (CCT) Positron emission tomography
(PET)
Dual-energy CT (DECT)
X-ray
During the early stages of gout, radiographic images are usually normal or may show
asymmetric soft tissue swelling near the affected joints

In chronic tophaceous gout, the main radiographic features are:

• Tophi which are articular or periarticular soft tissue dense
nodules.
• Joint space narrowing
• Bone erosions
• Calcified MSU deposits can penetrate in the bone; in severe
cases
USG
Conventional CT Scan

• CCT is not helpful in the diagnosis of acute gout as it can’t

detect inflammation, synovitis, tenosynovitis and osteitis

• It is able to detect erosions better than MRI or X-ray

• Tophi, soft tissue, intra-articular as well as intra-osseous ones

appear as soft tissue masses with well described attenuation

• CCT can help to monitor disease burden and response to

therapy, but has the disadvantage of radiation exposure
MRI
• MRI role is limited because of expense and limited availability.
• It is, however, useful for evaluation of gout at unusual sites
DECT
 Management of
flares
● Colchicine
● NSAID
● Steroid
● IL-1 blockers
 Management of chronic gout and
prevention of flares

● Uricemia targets
● Patient education
● Diet and life style changes
● Cessation of hyperuricemic drugs (thiazide, loop diuretic)
● Urate lowering drugs (ULDs)
 Allopurinol
 Febuxostat
 Uricosuric
 Management of comorbidities

Cardiovascular and
renal disease
Hypertension treatment (losartan, CCB)

Dislipidemia (statin or fenofibrate)

 Thank you 

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