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 ?

Osteoartritis :
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 Osteoartritis
I. II.
Idiopatik : Sekunder - Post trauma - Lokalisata : dysplasia sendi panggul - Lokalisata - Generalisata 3 sendi

- Generalisata : - Chondrodysplasia
- Hemokromatosis - Penyakit deposisi kalsium - Peny. Tulang dan sensi lain : RA, Pagets diseases - Penyakit lain : - Endokrin : akromegali - Neuropatik : Charcots disease

Faktor Risiko Osteoartritis

Genetik : Sex Peny. kolagen tipe II Peny. keturunan sendi & tulang RAS / etnik Usia Obesitas Kekurangan hormon sex wanita Trauma sendi Operasi Sendi Olah raga Pekerjaan

Non Genetik :

Lingkungan :

Epidemiologi Osteoartritis
Merupakan penyakit rematik yang paling banyak dijumpai
Sex dan Usia : < 40 th 40 50 th > 50 th : laki-laki > wanita : laki=laki = wanita : laki-laki < wanita

OA sendi tangan & lutut Wanita

OA sendi panggul Pria

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)

Pembesaran tulang
Lingkup gerak sendi menurun Krepitasi

Nyeri tekan
Nyeri gerak Efusi sendi Deformitas sendi : - Genu varus - Genu valgus

Dalam Batas Normal

Pemeriksaan Radiologis
Osteofit marginal
Penyempitan celah sendi yg asimetris

Sklerosis tulang subkondral

Pembentukan kista subkondral Deformitas ujung tulang

Typical radiographic by Kellgren & Lawrence 1957

Grade I : normal joint,minimal osteophyte 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 (+)

Grade II : definite osteophyte on two places

CHECKLIST FOR CLASSIFICATION OF OSTEOARTHRITIS OF THE KNEE

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 or 1, 2, 3, 5 or 1, 6

 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 THE 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 OF THE HIP CLINICAL

1. 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

CLINICAL AND RADIOGRAPHIC

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, or 1, 2, 4, or 1, 3, 4

Terapi Osteoartritis
Tujuan :
1. Mengurangi keluhan nyeri 2. Mencegah disabilitas 3. Memperlambat perub. Struktur sendi

Cara :
1. Farmakologi
2. Non Farmakologi

Terapi Non Farmakologis

1. Usahakan BB Ideal 2. Fisioterapi : - Program latihan aerobik

- Latihan fisik ROM

- Latihan pengencangan otot 3. Alat bantu sendi (Brace)

4. Terapi okupasi
5. Olah raga yg sesuai

Terapi Farmakologis
Oral : - Asetaminofen

- Salisilat
- Tramadol - OAINS Injeksi : - Glucocortiroid - hyaluronam - OPIOD Topical : - Capsaicin - Methyl salisilat

Terapi Lain
1. Tidal lavage

2. Pembedahan
3. Akupunktur ? 4. Masih dlm penelitian : - Glucosamin & chandroitin sulfat - DMOADS

- Autologous chondrocyte transplantation

- Autologus osteochondral plugh - mesenchymal stem cell