OSTEOARTHRITIS

DEFINISI (WHO)

DEFINISI cont …

GEJALA KLINIS

PATOFISIOLOGI

FUNGSI

PATOFISIOLOGI cont…

Soeparman (1995)

KLASIFIKASIGrade Classification Description

0 Normal No features of OA

1 Doubtfull Minute osteophyteDoubtful significance

2 Mild Definite osteophyte. Normal joint space

3 Moderate Moderate joint space reduction

4 Severe Joint space greatly reduced Subchondral sclerosis

The epidemiology of chronic rheumatism, Kellgren ,vol. 2. Atlas of standard radiographs. Oxford: Blackwell Scientific; 1963.

PENATALAKSANAANTidak ada pengobatan spesifik untuk

osteoarthritis (hanya simptomatis + pertahankan pergerakan sendi)

dapat melakukan kegiatan sehari-hari

Pengobatan secara konservatif sebelum pengobatan bedah (operasi pergantian sendi)

Lama-kelamaan nyeri bertambah hebat obat-obatan & terapi pembedahan diperlukan

PENATALAKSANAAN MILD OSTEOARTHRITIS

• Rasa nyeri menganggu• Tetapi pasien masih dapat melakukan aktifitas sehari-harinya

PENATALAKSANAAN MODERATE OSTEOARTHRITIS

• Nyeri berlangsung terus-menerus i/ untuk pemberian obat-obatan

• Bila masih memungkinkan (+) aktifitas fisik• Istirahat• Pengurangan BB

PENATALAKSANAAN SEVERE OSTEOARTHRITIS

• Nyeri masih terasa• Mengganggu aktifitas• Sudah diberikan obat-obatan pengurang rasa sakit

PENATALAKSANAAN PEMBEDAHAN

Pada pasien penderita osteoarthritis berat yang tidak membaik dengan obat-obatan mengganggu aktifitas sehari-hari

PENATALAKSANAAN ALTERNATIF• Masih sedikit uji klinis yang dilakukan sulit

mengetahui manfaatnya• Efek samping belum diketahui

PROGNOSIS

• Depends on the joints involved + the severity of the condition.

• The prognosis is good for patients with osteoarthritis who have undergone joint replacement, with success rates for hip and knee arthroplasty being generally more than 90%. However, a joint prosthesis may need revision 10-15 years after its installation, depending on the patient's activity level.

EFEK SAMPING ANALGESIK ORAL• Acethaminophen 325-650 mg PO/PR q4hr

PRN, or 500 mg PO q8hr PRN (max 4 g/day)

EFEK SAMPING NSAIDs

Cardiovascular Risk• May increase risk of serious cardiovascular

thrombotic events, myocardial infarction (MI), & stroke, which can be fatal

Gastrointestinal Risk• Increase risk of serious GI adverse events including

bleeding, ulceration, & perforation of the stomach or intestines, which can be fatal

• Abdominal distention & flatulence• Abdominal pain or cramps• Constipation• Diarrhea• Dyspepsia• Nausea• Peptic ulcer/GI bleeding• Edema• Fluid retention• Pruritus• Rash• Tinnitus• Dizziness• Headache

Diclofenac : Cataflam: 50 mg PO TID/QID OR Voltaren: 75

mg PO BID; Extended Release: 100 mg PO qDay,

may increase to 100 mg PO BID

• Headache (10-16%)• Hypertension (13%)• Fever (9%)• Dyspepsia (8.8%)• Upper respiratory tract infection (8.1%)• Arthralgia (7%)• Cough (7%)• Vomiting (6%)• Diarrhea (5.6%)• Gastroesophageal reflux (5%)• Sinusitis (5%)• Abdominal pain (4.1%)• Nausea (3.5%)• Back pain (2.8%)• Insomnia (2.3%)• Pharyngitis (2.3%)• Flatulence (2.2%)• Rash (2.2%)• Dizziness (2%)• Peripheral edema (2%)

Celecoxib : 200 mg PO qDay of divided

BID

EFEK SAMPING ANALGESIK OPIOID• Dizziness (26-33%)• Vertigo (26-33%)• Constipation (24-46%)• Nausea (24-40%)• Headache (18-32%)• Somnolence (16-25%)• Vomiting (9-17%)• Pruritus (8-11%)• Agitation (7-14%)• Anxiety (7-14%)• Emotional lability (7-14%)• Euphoria (7-14%)• Hallucinations (7-14%)• Nervousness (7-14%)• Spasticity (7-14%)• Asthenia (6-12%); Dyspepsia (5-13%)

Tramadol : Initial: 100 mg PO qDay, titrate up by 100

mg/day q5Days; not to exceed 300 mg/day Conversion from

immediate-release to extended-release: Round total

daily dose down to nearest 100 mg

Tramadol : Initial: 100 mg PO qDay, titrate up by 100

mg/day q5Days; not to exceed 300 mg/day Conversion from

immediate-release to extended-release: Round total

daily dose down to nearest 100 mg

Sweating (6-9%)Diarrhea (5-10%)Dry mouth (5-10%)Hypertonia (1-5%)Malaise (1-5%)Menopausal symptoms (1-5%)Rash (1-5%)Urinary retention (1-5%)Urinary frequency (1-5%)Vasodilation (1-5%)Visual disturbance (1-5%)

EFEK SAMPING CORTICOSTEROID

• Methylprednisolone : 2-60 mg/day divided QD/QID PO

• Betamethasone : Intrabursal, intra-articular, intradermal: 0.25-2 mL (6 mg/mL)

• Triamcinolone : 60 mg IM q6Weeks, may give additional 20-100 mg IM PRN Intra-articular/intrasynovial/soft-tissue injection: Large joints: 15-40 mg; Small joints/tendon sheath inflammation: 2.5-10 mg

EFEK SAMPING SODIUM HYALURONATE AGENTS

Sodium Hyaluronate• Indicated for treatment of pain in osteoarthritis

of the knee• Euflexxa: Inject 20 mg (2 mL) qWeek x 3 weeks• Hyalgan: Inject 20 mg (2 mL) qWeek x3-5 weeks• Nuflexxa: Inject 20 mg (2 mL) qWeek x 3-5 weeks• Supartz: Inject 25 mg (2.5 mL) qWeek x5 weeks

• Intraocular administration – Increased IOP – Keratitis – Cystoid macular edema – Conjunctival hemorrhage

• Intra-articular injection – Arthralgia– Headache– Injection site pain– Anaphylactoid reaction

CAUTIONS !!!o Transient increased

inflammation in injected knee may occur

o Avoid strenuous activity or prolonged (>1 hr) weight-bearing activities (eg, running, tennis) within 48 hr following injection

o Pain relief may not be evident until after 3rd injection

o Remove joint effusion, if present, before injection

Ny. S/ 53 th Ibu Rumah Tangga

Keluhan utama:

Nyeri lutut sebelah Kiri

RIWAYAT PENYAKIT SEKARANG

Nyeri lutut sebelah Kiri terus menerus dan bertambah bila Berjalan, nyeri dirasakan 2 bulan. Morning stiffness (-), baal (-), kesemutan (-)Riwayat trauma (-)Pernah Berobat Ke Puskesmas diberi obat warna putihRiwayat menstruasi : sdh menopauseKeluhan tambahan : (-)

RPD

HT, DM, Peny Jantung disangkal Asam urat tidak pernah periksa Maag (-)

RPK Tidak ada yang sakit seperti ini

RIW PEKERJAAN, SOSIOEKONOMI, KEBIASAAN

Sehari – hari ibu mengerjakan pekerjaan rumah tangga (beres-beres rumah, pergi ke pasar).

Sudah 40 tahun menikah dikaruniai 7 orang anak .

Tinggal di rumah sendiri , t.d 1 lantai. Ada tangga untuk menjemur pakaian di atas. WC : kloset jongkok

Mobilisasi: mandiri Sosioekonomi : cukup

PEMERIKSAAN UMUM

Kesadaran : CM, KU: sakit ringan T : 120/80 mmHg N : 80 x/mnt Suhu : afebris RR : 18 x/mnt Gizi : Baik BB : TB : 151 cm

PEMERIKSAAN TITIK KHUSUS

1. Pemeriksaan titik nyeri spontan2. Pemeriksaan nyeri pasif :

Daerah ekstremitas inferior-Heiting- Dupi

- Yan lin quan- Taichong

DIAGNOSA KERJA

OA Genu Sinistra

RENCANA TERAPI Alat yang digunakan : jarum akupunktur 1

dan 1,5 cun, kapas alkohol Pemilihan titik akupunktur:

Heiting,Dupi, Yenlinquan,Taichong (LR 3), Zulinqi (GB 41), Zusanli (ST 36), Hegu (Li4),

Teknik perangsangan: sedang, dilakukan selama 30 menit dan dirangsang sampai deqi @ 5’

Sesi dan seri terapi: 1 sesi 10 – 12 x dengan interval 2 x / minggu

Anjuran : Turunkan BB Makan teratur dengan menu seimbang Kurangi Aktivitas berat

PROGNOSIS

Quo ad vitam : ad bonam Quo ad functionam : ad bonam Quo ad sanactionam : dubia ad bonam

Evaluasi hasil Ro

EVALUASI DAN TINDAK LANJUT