OA merupakan penyakit reumatik yang

paling banyak dijumpai

Menjadi problem kesehatan masyarakat yg

besar karena : nyeri, disabilitas,

kehilangan jam kerja

Patogenesisnya masih banyak teori

Terapi ?

OsteoartritisOsteoartritis :Adalah penyakit degenerasi sendi akibat

proses mekanik dan biologik sehinga

terjadi ketidakseimbangan antara proses

degradasi dan sintesis rawan sendi,

kondrosit, matriks ekstra seluler dan

tulang subkondral

Klasifikasi OsteoartritisKlasifikasi Osteoartritis

I. Idiopatik : - Lokalisata

- Generalisata 3 sendi

II. Sekunder

- Post trauma

- Lokalisata : dysplasia sendi panggul

- Generalisata : - Chondrodysplasia

- Hemokromatosis

- Penyakit deposisi kalsium

- Peny. Tulang dan sensi lain : RA, Paget’s diseases

- Penyakit lain :

- Endokrin : akromegali

- Neuropatik : Charcot’s disease

Faktor Risiko OsteoartritisFaktor Risiko Osteoartritis

Genetik : - Sex

- Peny. kolagen tipe II

- Peny. keturunan sendi & tulang

- RAS / etnik Non Genetik : - Usia

- Obesitas

- Kekurangan hormon sex wanita

- Trauma sendi

- Operasi Sendi

- Olah raga Lingkungan : - Pekerjaan

Epidemiologi OsteoartritisEpidemiologi Osteoartritis

Merupakan penyakit rematik yang paling banyak dijumpai

Sex dan Usia : < 40 th : laki-laki > wanita

40 – 50 th : laki=laki = wanita

> 50 th : laki-laki < wanita

OA sendi tangan & lutut Wanita

OA sendi panggul Pria

Gejala Klinik (Symptoms)Gejala Klinik (Symptoms)

Nyeri sendi, diperberat bila aktifitas dan menyangga

tubuh, berkurang bila istirahat

Kaku pagi hari kurang dari 30 menit

Gel phenomen : setelah istirahat

Sendi tidak stabil

Fungsi sendi berkurang

Tanda Klinik (Signs)Tanda Klinik (Signs)

Pembesaran tulang

Lingkup gerak sendi menurun

Krepitasi

Nyeri tekan

Nyeri gerak

Efusi sendi

Deformitas sendi : - Genu varus

- Genu valgus

Dalam Batas Normal

Pemeriksaan RadiologisPemeriksaan Radiologis

Osteofit marginal

Penyempitan celah sendi yg asimetris

Sklerosis tulang subkondral

Pembentukan kista subkondral

Deformitas ujung tulang

Typical radiographic by Typical radiographic by Kellgren & Lawrence 1957Kellgren & Lawrence 1957

Grade I : normal joint,minimal osteophyte

Grade II : definite osteophyte on two places

with subchondral sclerosis,normal

joint space,subchondral cyst ?

Grade III : moderate osteophyte, deformity of

bone margin, narrowing of joint space

Grade IV : major osteophyte, narrowing of joint

space (-), Cyst (+), Sclerosis (+)

Clinical : Knee pain for most days of prior month Crepitus on active joint motion Morning stiffness of the knee 30 minutes Age 38 years Crepitus, bony enlargement of knee (-) No crepitus; bony enlargement (+)

Osteoarthritis Present* 1, 2, 3,4 or1, 2, 3, 5 or1, 6

CHECKLIST FOR CLASSIFICATION OFCHECKLIST FOR CLASSIFICATION OF

OSTEOARTHRITIS OF THE KNEEOSTEOARTHRITIS OF THE KNEE

CLINICAL AND RADIOGRAPHIC

Knee pain for most days of prior month

Radiographic osteophytes at the joint margins

Synovial fluid of the osteoarthritis (at least;

clear, viscous, WBC<2,000 cells/ml)

Synovial fluid not available; age 40 years

Morning stiffness of the knee 30 minutes

Crepitus on active joint motion

Osteoarthritis Present* 1, 2 or

1, 3, 5, 6 or

1, 4, 5, 6

CLASSIFICATION OF OSTEOARTHRITIS OF CLASSIFICATION OF OSTEOARTHRITIS OF THE HANDTHE HAND

Hand pain, aching, or stiffness for most days of prior month Hard tissue enlargement of 2 of 10 selected hand joints MCP swelling in 2 joints Hard tissue enlargement of > 1 DIP Deformity 1 of 10 selected hand joints

Osteoarthritis Present* 1, 2, 3, 4 or 1, 2, 3, 5

Note : Second and third DIP may be counted in both item no.2 item no. 4. Ten selected hand joint include second and third DIP, second and third PIP, and first CMC of both hands.

* Minimum criteria classification

CMC = carpometacarpal joint; DIP = distal interphalangeal joint; MCP = metacarpaphalangeal joint; PIP = proximal interphalangeal joint. (From Altman, R.D.)

CLASSIFICATION OF OSTEOARTHRITIS CLASSIFICATION OF OSTEOARTHRITIS OF THE HIPOF THE HIP

CLINICAL1. Hip pain for the most day of the prior month

2. Hip internal rotation 15

3. Hip internal rotation 15

4. ESR 45 mm/h

5. ESR not available. Hip flexion 115

6. Morning stiffness of the hip of 60 minutes

7. Age 50 years

Osteoarthritis present* 1, 2, 4, or

1, 2, 5, or

1, 3, 6, 7

1. Hip pain for most day of the prior month

2. ESR 20 mm/h

3. Radiographic femoral and / or acetubular

osteophytes

4. Radiographic hip joint space narrowing

Osteoarthritis present* 1, 2, 3, or1, 2, 4, or1, 3, 4

CLINICAL AND RADIOGRAPHICCLINICAL AND RADIOGRAPHIC

Terapi OsteoartritisTerapi Osteoartritis

TujuanTujuan :

1. Mengurangi keluhan nyeri

2. Mencegah disabilitas

3. Memperlambat perub. Struktur sendi

CaraCara :

1. Farmakologi

2. Non Farmakologi

TujuanTujuan :

1. Mengurangi keluhan nyeri

2. Mencegah disabilitas

3. Memperlambat perub. Struktur sendi

CaraCara :

1. Farmakologi

2. Non Farmakologi

Terapi Non FarmakologisTerapi Non Farmakologis

1.1. Usahakan BB IdealUsahakan BB Ideal

2.2. Fisioterapi :Fisioterapi :

- Program latihan aerobik- Program latihan aerobik

- Latihan fisik ROM- Latihan fisik ROM

- Latihan pengencangan otot- Latihan pengencangan otot

3.3. Alat bantu sendi (Brace)Alat bantu sendi (Brace)

4.4. Terapi okupasiTerapi okupasi

5.5. Olah raga yg sesuaiOlah raga yg sesuai

1.1. Usahakan BB IdealUsahakan BB Ideal

2.2. Fisioterapi :Fisioterapi :

- Program latihan aerobik- Program latihan aerobik

- Latihan fisik ROM- Latihan fisik ROM

- Latihan pengencangan otot- Latihan pengencangan otot

3.3. Alat bantu sendi (Brace)Alat bantu sendi (Brace)

4.4. Terapi okupasiTerapi okupasi

5.5. Olah raga yg sesuaiOlah raga yg sesuai

Terapi FarmakologisTerapi Farmakologis

Injeksi :Injeksi : - Glucocortiroid- Glucocortiroid

- hyaluronam- hyaluronam

- OPIOD- OPIOD

Topical :Topical : - Capsaicin- Capsaicin

- Methyl salisilat- Methyl salisilat

Oral :Oral : - Asetaminofen- Asetaminofen

- Salisilat- Salisilat

- Tramadol- Tramadol

- OAINS- OAINS

Terapi LainTerapi Lain

1.1. Tidal lavageTidal lavage

2.2. PembedahanPembedahan

3.3. Akupunktur ?Akupunktur ?

4.4. Masih dlm penelitian :Masih dlm penelitian :

- Glucosamin & chandroitin sulfat- Glucosamin & chandroitin sulfat

- DMOADS- DMOADS

- Autologous chondrocyte transplantation- Autologous chondrocyte transplantation

- Autologus osteochondral plugh- Autologus osteochondral plugh

- mesenchymal stem cell- mesenchymal stem cell

1.1. Tidal lavageTidal lavage

2.2. PembedahanPembedahan

3.3. Akupunktur ?Akupunktur ?

4.4. Masih dlm penelitian :Masih dlm penelitian :

- Glucosamin & chandroitin sulfat- Glucosamin & chandroitin sulfat

- DMOADS- DMOADS

- Autologous chondrocyte transplantation- Autologous chondrocyte transplantation

- Autologus osteochondral plugh- Autologus osteochondral plugh

- mesenchymal stem cell- mesenchymal stem cell