ข้อวินิจฉัยโรคเก๊าท์ coggle

2. �Ѵ��ҧ ��âѺ�� uric acid ��Ѻ �ҢѺ�� Ӿǡ thiazide (thiazide diuretics) �ä ��ѧ (chronic renal failure) �繵�

3. �Դ�ҡ ��ҧ�� uric acid �ҡ�Թ� ��ͧ�ҡ�� ҧ ��з��¢ͧ�� ҡ��Թ� �� 㹡óբͧ �ä�� Դ ��ü�Ե��èӾǡ purine �ҡ�Թ� �� ҡ ��ͧ �ͧ�͹�� (specific enzyme) �ҧ��Դ

4. �Թ��÷��èӾǡ purine �ҡ�Թ�

�ҡ��Ǩ �� § 5 % �ͧ�Ȫ�� 40 �բ�� дѺ�ͧ�� uric acid �� ҡ�� 7 mg/dl ��о�� չ��¡�� 5 % �ͧ�Ȫ�� uric acid � ��٧��ҹ�� Դ �ҡ�� ҧ��չԤ�ͧ�ä gout �͡�ҡ�� ѧ��ա�� ҡ�� 75 % �ͧ�� ä gout �ա�âѺ�� uric acid 㹻��Ŵŧ ��˵� �ͧ��âѺ��Ŵŧ�� ѧ��繷��Һ��Ѵ 㹨ӹǹ�� ü�Ե�� Ӿǡ purine �ҡ�Թ� ��ҧ��Һ��˵� ��§�� дѺ�ͧ�� uric acid ��٧�� з�� ҧ ��з�� 繨ӹǹ�ҡ �蹡óշ�� ä�ҧ��ҧ ��˵� �ͧ��Դ�ä gout ��¡�� secondary gout ��˵ع�� ·��ѡ�Ҵ�� chemotherapy ��Ѻ �һ�ͧ�ѹ ��Դ�� uric acid ��٧��͹ ��ǹ�ҡ ��Ѻ�ҨӾǡ xanthine oxidase inhibitors

�͡�ҡ��ѧ��ṡ�ä gout �͡��˵�� 2 �ǡ

2. Secondary gout �ǡ�� ˵ط�� Һ��Ѵ ��ä gout ��Դ�� 繼ŵ��ͧ�ä �� ˵��ѡ �ͧ�ä �� ä��ʹ�� (leukemia) �� ü�Ե�� uric acid �ҡ��һ�� ä��ѧ ��ͧ�ҡ��âѺ�� uric acid Ŵŧ

��˵آͧ ��ѡ�ʺ��º��ѹ ��ä acute gout �� monosodium urate crystals �� (synovium) �� § �Ѻ�� ˵� ��Դ ��ͧ�� ѧ��Ǣ�ҧ�� ѧ��繷�� Һ��Ѵ �ä gout �ѡ�Դ�Ѻ�� metatarso-phalangeal joint �ͧ�� ç��ǧ �ͧ�š ��Ҩ��ǹ�� 㹡�÷��Դ �� ͧ��֡��÷ �͡�ҡ�� ѧ�� ä gout �ѧ�Դ�� Ѻ�� (ankle joint) ��о�� 㹢�� (knee joint) �� ⾡ (hip joint) ��ͧ�ҡ ��§�� (synovial fluid) �繵�� (solvent) ��Ѻ monosodium urate �Դ�Ѻ �ͧ��Ǿ�� monosodium rate ��ա�� ѧ�� Դ �� hyperuricemia �� urate 㹢�͡�д١ �� ੾�з�� ͡�д١�� س��Ե�� ֧ 20 ͧ�� 蹷�� urate ��ҹ�� С͹ �� microtophi �� ɢ�͡�д١ (synovial lining cells) ��㹡�д١��͹ ��˵ط��ѧ ��Һ��Ѵ �Ҩ�� trauma �� ֡��ҹ�� ش�͡�� §�� (synovial fluid) �ǡ��֡��ҹ�� դس��ѵ�� êѡ�ӡ��ѡ�ʺ (chemotactic) �� 繵�ǡ�е�� complement ��ҧ C3a �� C5a (��ҹ��ͧ ��ѡ�ʺ� sheet ��ᨡ仡�͹˹�ҹ�� Home Page "ChulaPatho" ��Ǣ�� general pathology ��ͧ inflammation) ��Դ �� ͧ��ʹ�� (neutrophils) �� Թ��š�� (macrophages) �� ͡�д١ �� (synovial membrane) ��Դ ��áԹ��֡ ��ҹ�� Դ �� ͹ؾѹ�� ѹ�� ҧ�� (toxic free radicals) �� leukotrienes (LTB4) ��ʹ�� лŴ�� lysosomal enzyme ��ǡѹ ��Թ��š�� (synoviocytes) �� Ե��ժѡ�� ͡�� IL-1, IL-6, IL-8 (interleukin = IL) �� ժѡ�� TNF-a (TNF = tumor necrosis factor) ��觨� �ѡ��Դ ��ѡ�ʺ��ҡ�� Դ ��÷��¢�͡�д١ ��ҡ�� ͡�ҡ�� ѧ�ա�á�е�� Hageman factors ��к� ��秵�Ǣͧ��ʹ ��Ҫ�� Դ�ѡ�ʺ �� ÷��¢�͡�д١ ��ҡ�� Դ acute gouty arthritis ��觨�� ѹ ��ѻ��͹� ��§ �� Դ�ä acute gout ��ͧ�ٴ�� ͧ��ŷ��ȹ� �о��ѡ�ʺ �Ӿǡ polymorphonuclear leukocyte �繨ӹǹ�ҡ �� ֡��÷ ��ö��Ǩ�� ʧ polarised light. �ѧ�� ͡�д١ �Դ��ѡ�ʺ��º��ѹ ��ҹ�� ըӹǹ ��ʹ�� ١�� 繨ӹǹ�ҡ ��㹢�͡�д١ ��ѡ�ʺ�� ա��С��˹�� ü�֡��Ҵ�� ҹ�� Ҩ�� ѹ��µ�� ա�� ˵ع�� Դ ��ѡ�ʺ��º��ѹ �ҡ�ä gout �ѡ��Դ ��ѡ�ʺ��Դ cellulitis �ͺ� ��͡�д١ ��仴��͢�͡�д١ �Դ�ѡ�ʺ �� Դ ��ѡ�ʺ��ѧ chronic arthritis ��е��Դ ��ҧ tophi �� ѡ�ʺ ��ҹ�� ͺ ��͡�д١

��Ҹ��Ҿ��Ӥѭ�ͧ�ä gout�մѧ��

acute arthritis. ��Ҹ��Ҿ ��ʹ�� 繨ӹǹ�ҡ �� (synovium) �� 㹹��§�� (synovial fluid) ��֡ ��÷� �⵾��ʫ�� ͧ��ʹ�� Ѻ�� ֡��ҹ�� ѹ�繡�� ֡��ҹ�� ٻ��ҧ �� ͡�ҡ�� ѧ�� ͺ�� ʹ�� ʹ��ʹ ��Ѻ �� lymphocytes, plasma cells �� macrophages
Chronic tophaceous arthritis �Դ�ҡ ��õ��С͹ �ͧ��֡��÷ �� Դ ��ѡ�ʺ��º��ѹ �� ֡��÷ ��ҹ��ШѺ�ѹ �� Ǣ�͡�д١ �� (synovium) �Դ ��ӹǹ (hyperplasia) �ҡ�� Ǿѹ�� ͡�ҡ�� ˹��ѡ�ʺ ��ҡ�� Դ�� ¡�� pannus �� з�� д١��͹ ��ҧ�� ع�ç ��Դ �� 㹷��ش��
Tophi�Դ�ҡ��֡ ��÷ ��ҹ�� ѹ�ҡ ��ѡ�ʺ ��Դ�Թ��š�� (macrophages) �� lymphocytes �� multinucleated foreign body giant cells �ҡѴ�Թ ��з�� ֡��ҹ�� Դ ��ѡ�ʺ �� ֡��÷ �� tophi �Ҩ�Դ�� 鹼�Ǣ�� ;�� ͺ�� ֧ ��繷�� § �蹾�� olecranon, patellar bursae Archilles tendons �� Դ �� д١��͹�ͧ��١ ��˹ѧ�� ¹�� Ҿ� �͡�� ˹ѧ �Ҩ��Դ �Ţ�Ҵ�˭� ��˹ѧ��
Gouty nephropathy��Ҩ�� ֡��÷ 㹺��ǳ interstitium ��medulla ��Ҩ �Դ�� tophi �� ͡�ҡ�� ֡��÷ �Ҩ�� renal tubule �� ·�� hyperuricemia �ع�ç �Ҩ��Դ �� (renal stone) ��Ҩ�� Դ��á��͹ �� Դ ��ѡ�ʺ ��Դ pyelonephritis ��

�ѡɳзҧ��չԤ

- �ѡ�� ҧ 40 �֧ 60 �� ջ��ѵ� ��ͺ��ä

- �� ѡ�Դ ��ѡ�ʺ��º��ѹ �Ѻ��͡�д١ 㴢�͡�д١˹�� ¢�� ǡѹ �ջ��ҳ 10 % ��辺 ��ҡ�� ˹�觢��