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Anakku oh Anakku….

Erwin

405080114

LO 1:

MM. Sendi & prinsip pergerakannya

LO 2:

MM. Jenis – jenis arthritis

Arthritis

Osteoarthritis Gout Rheumatoid Arthritis – Juvenille RA

Definisi

Penyakit sistemik kronik pada sendi, biasanya poliartikular, yang ditandai dengan radang pada membran sinovial dan struktur-struktur sendi serta atrofi otot dan penipisan tulang

Etiologi

Penyebab tidak diketahui Kemungkinan: infectious agent

misalnya: Mycoplasma, EBV, CMV, parvovirus, dan rubella virus

Patofisiologi

Epidemiologi

Wanita : pria = 3 : 1 Pada wanita, insiden RA 6x lebih besar pada

usia 60 – 64 tahun daripada pada usia 18 – 29 tahun

The onset is most frequent during the fourth and fifth decades of life, with 80% of all patients developing the disease between the ages of 35 and 50

Faktor resiko

Usia Jenis kelamin genetik

Criteria RA

Morning stiffness Arthritis of 3 or more joint areas Arthritis of hand joints Symmetric arthritis Rheumatoid nodules Serum rheumatoid factor Radiographic changes

note: diagnosis RA dapat ditegakkan bila didapati 4 dari 7 kriteria di atas

Temuan Laboratorium Rheumatoid factor Antibodies to CCP (complement control protein) Anemia normositik normokrom Erythrocyte Sedimentation Rate Analisis cairan sinovial

- white blood cells count > 2000/uL with 75% PMN is highly characteristic of inflamatory arthritis- hemolytic complemen: C3 & C4- reduced viscocity- increased protein content

Temuan radiologis

Juxtaarticular osteopenia

apparent between after onset Loss of articular cartilage and bone develop

develop after months of sustained activity

Definisi

Juvenile RA is not a single entity, rather a group of conditions with differing clinical and immunogenetic features

Synovitis, manifest as swelling within a joint, or limitation in range of joint motionwith associated joint pain or tenderness and persisting for at least 6 weeks, is the essential clinical feature of all subtypes of Juvenille RA

Klasifikasi inflamatory arthritids in childhood Menurut ACR (American College of Rheumatology):

- Juvenile Rheumatoid Arthritis

- onset <16 years

- duration 6 weeks

- subtypes:

1. systemic arthritis

2. pauciarticular arthritis

3. polyarticular arthritis (excludes spondyloarthropathies and psoriatic arthritis)

Menurut ILAR (International League of Associations for Rheumatology)- Juvenile Idiopathic Arthritis- onset < 16 years- duration 6 weeks- subtypes:1. systemic arthritis2. oligoarticular arthritis

- persistent- extended

3. polyarthritis, RF-4. polyarthritis, RF+5. enthesitis related arthritis6. psoariatic arthritis7. other arthritis

Menurut EULAR (European League Against Rheumatism)

- Juvenile Chronic Arthritis

- onset < 16 years

- duration 3 months

- subtypes:

1. systemic arthritis

2. pauciarticular arthritis

3. polyarticular arthritis

(excludes RF+ disease: known as juvenile rheumatoid arthritis)

Etiologi

Genetics– MHC (Major Histocompatibility Complex)

Cytokines

Pro-inflamatory cytokines Anti-inflamatory cytokines

IF-γ IL-1 receptor antagonist

IL-1 α dan β IL-4

TNF-α IL-10

Lymphotoxin α IL-13

IL-6 Transforming growth factor β

IL-12 (induces IFN-γ) IL-6

Tanda & Gejala

Pada umumnya meliputi

- Swelling

- Heat

- Pain & loss of function Manifestasi klinik biasanya bermacam-

macam, berdasarkan usia, tahap perkembangan anak, dan subtipe – subtipe klinis dari penyakit

Pemeriksaan

Radiologis3 stages of radiographic changes:- early: periarticular osteopenia- intermediate: cortical erosions, joint space narrowing and subchondral cysts- late: destructive joint changes with ankylosis, joint contractures, metaphyseal and diaphyseal changes and growth anomalies

CT is useful for visualizing certain joints, especially the sacroilliac joints

Laboratory findingsInvestigation oligoarthritis polyarthritis Systemic disease

Hemoglobin

White cell count

Platelets

ESD

CRP

Liver enzymes

ANA

RF

Normal

Normal

Normal

Raised +

Normal

Normal

Often positive

Negative

Low (anemia of chronicdiseaseRaised +

Raised +

Raised ++

Raised +

Normal

Normal

Positive in subgroup

Low (anemia of chronicdisease)Raised +++

Raised +++

Raised +++

Raised ++

Often raised

Normal

Normal

Complications

Articular

- flexion contractures

- overgrowth of affected limbs

- discrepancy in lower limb length may result in a pelvic tilt and scoliosis in adult life

- TMJ involve polyarthritis cosmetic and functional difficulties

Extra-articular

- uveitis

- nutritional status and growth

- osteoporosis

- psychosocial

DD in inflamatory arthritis in childhood SLE Dermatomyositis Vasculitis Mix connective tissue disease

Penatalaksanaan

Drug Total daily dose Times daily

Diclofenac 1 – 3 mg/kg 2 – 3

Naproxe 10 – 20 mg/kg 2 – 3

Ibuprofen 20 – 50 mg/kg 3 – 4

Indometacin 1 – 3 mg/kg 2

Piroxicam < 15 kg 5mg

16–25 kg 10mg

26 – 45 kg 15mg

> 46n kg 20mg

Once daily