Dr. Edi Hidayat, Osteoatritis
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Transcript of Dr. Edi Hidayat, Osteoatritis
OSTEOATRITIS
DIVISI REUMATOLOGI FK UNSRI/RSMH
OLEH : EDI HIDAYAT
Definition
Osteoarthritis (OA): is a degenerative joint disease characterized by the breakdown of the joint's cartilage. It called degenerative joint disease.
Cartilage destruction may be a result of a variety of etiologies
Prevalence and epidemiology
Over 20 million affected in U.S. About 60-90% of people over age 65 Under 45 yrs it is equally common in men and women Over 55 yrs its more common in women Indonesia: 15,5%Men and 12,7% Female ( 40-
60thn), 1-2 milliondeformed
Risk factors
Genetics• Abnormal components of the
joint as an organ• Abnormal range of motion• Congenital anomalies
Trauma Overuse syndromes Post-infectious Obesity
Osteoarthritis
Normal Joint Joint with Osteoarthritis
Pathogenesis osteoarthritis
Conceptual Model of OA
Biochemical changes/ cells and tissue
Structural changes
Pain and other signs and symptoms
Functional limitation
Reduced quality of life
Surgical replacement
8
Classification of OA
Primary (idiopathic) unidentified causes
Secondary precipitating factors
Joints affected by OA
o Knees (41%)o Hands (30%)o Hips (19%)o Spine (cervical and lumbar
regions)o Toes (first metatarso-
phalangeal joint)
OsteoarthritisCommon sites
usually one joint or same joint bilaterallyGender has some influence; knees and hands are more commonly affected in women, whereas hips are more commonly affected in men.
Clinical signs of OA
• Crepitus• Restricted joint
movement• Joint instability• Bony swelling• Soft tissue swelling• Joint deformity
• Joint tenderness• Increased joint warmth • Muscle atrophy or
weakness• Limp while walking
DIAGNOSIS
OA Genu
Nyeri lutut Salah satu kriteria berikut :
1.Usia > 30 thn2.Kaku sendi < 30 menit3.Krepitasi + Osteofit
OA Sendi tangan
Nyeri tangan atau kaku 3 dari 4 kriteria berikut:
1. P>> jar.keras dari 2 atau lebih 10 sendi
tangan tertentu (DIP II dan III, ka/ki)2. P>> jar.keras dari 2 atau lebih sendi
DIP3. Bengkak <3 sendi MCP4. Deformitas 1 dari 10 sendi tangan
OA sendi pinggul
Nyeri pinggul 2 dari 3 kriteria berikut :
1.LED < 20 mm/jam2.Radiologis : Osteofit pada femur dan asetabulum3.Radiologis : Penyempitan celah sendi
Diagnosis of OA ( Radiologi)
• Adanya osteophyt• Penyempitan celah sendi • Sclerotic change in subchondral bone• The Kellgren-Lawrence radigraphic grading scale
grade Beratnya OA Temuan radiologis
O Tidak ada Tidak ada gambaran OA
1 diragukan Osteofit kecil, signifikansi diragukan
2 minimal osteofit definitif, ruang sendi tidk terganggu
3 sedang Pengurangan moderate dari ruang sendi
4 berat Ruang sendi amat terganggu dgn adanya sklerosis tulang subchondral
Diagnosis of Knee OA (Radiologi)
OA Hip:
OA Fingers:
Typical OA Hand: Know It When You See It
Hard boney enlargements
Heberden’s nodes at the DIP joints
Bouchard’s nodes at the PIP joints
Often have “squared” first CMC joint due to osteophytes at that joint
Pengelolaan Non Farmakologi Farmakologi Bedah
Non Farmakologi
Edukasi Terapi fisik dan rehabilitasi Penurunan berat badan
Farmakologi
o Acetaminophen• Indication: mild-moderate pain• 1000 mg Q6h PRN• Better than placebo but less efficacious than NSAIDs • Caution in advanced hepatic disease
• NSAIDs• Indication: moderate-severe pain, failed acetaminophen• GI/renal/hepatic toxicity, fluid retention• If risk of GIB, use anti-ulcer agents concurrently• Agents have highly variable efficacy and toxicity
• Opioid Analgesics• Indication:
• Moderate-severe pain• Acute exacerbations• NSAIDs/Cox-2 inhibitors failed or contraindicated
• Avoid long-term use• Caution in elderly
• Confusion, sedation, constipation
Chondroprotective agent
Tetrasiklin Menghambat enzim MMP, masih dipakai pada hewan
Asam hialuronatMemperbaiki viskositas cairan sinovial,pembentukan matrix tulang rawan, mengurangi inflamasidiberikan Intra artikuler
Kondroitin sulfatProteksi terhadap kerusakan tulang rawan sendi(1500 mg/1200 mg daily )
Vitamin CMenghambat aktivitas enzim lisosim Steroid Intra artikuler
Terapi pembedahan osteoarthritis
Pada pasien penderita osteoarthritis berat yang tidak membaik dengan obat-obatan mengganggu aktifitas sehari-hari
Terapi pembedahan dapat berupa :
Penggantian sendi (arthroplasy) Debridement Osteotomy Osteotomy Arthrodesis Arthrodesis
Osteoarthritis intra-operasi
Knee replacement Hip replacement
Shoulder replacement
Terima Kasih