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