SERUMEN

dr. Angga Pramuja, Sp.THT-KL

SERU
3
 What’s Osteoarthritis

OA merupakan jenis arthritis yang umum dan paling sering terjadi

1

Prevalensi tinggi & causa kecatatan paling banyak pada orang tua
2
(usia lanjut)
Menyerang sendi bagian servikal, lumbosacral, pinggul, lutut,
3
phalangeal metatarsal, interphalangeal distal dan proximal.

4 Dapat merubah struktur sendi secara makro dan mikro

Obesitas merupakan risk factor tertinggi selain disebabkan oleh

5
komplikasi penyakit lain
SYNOVIAL JOINTS
ANATOMY

Osteorthritis | Humaryanto 5
THE KNEE JOINT

Osteorthritis | Humaryanto 6
THE KNEE JOINT

Osteorthritis | Humaryanto 7
DEFINISI
Merupakan gangguan
pada sendi yang
ditandai dengan
perubahan patologis
pada struktur sendi
berupa degenerasi
cartilago hialin.

Osteoarthritis | Humaryanto 8
 ETIOLOGI
Kim Bennell, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Australia

BIOMEKANIK &
OBESITY & METABOLIC BIOKIMIA
SYNDROME
COMMONLY
UNKNOWN
KOMPLIKASI PATOLOGIS
USIA LAIN

Osteoarthritis | Humaryanto 9
PREVALENCE AND INCIDENCE
Curr Opin Rheumatol. 2015 May ; 27(3): 276–283. doi:10.1097/BOR.0000000000000161.

-----------------------
-----
Multiple joint 72%
Females, particularly
those 55 and older, tend to
Foot 61%
have more severe
Knee 25,4% osteoarthritis in the knee
but not in other sites.
Hip 19,6%

Osteoarthritis | Humaryanto 10
 EPIDEMIOLOGY 11

Tahun 2030, Tahun 2050,

20% Amerika
80% usia 65th;
(70
Estimasi global >130
Juta) usia >65
dengan estimasi
tahun
juta terkena OA
berisiko terkena
30 juta orang
OA
Amerika
mengalami OA

Osteoarthritis | Humaryanto
 RISK FACTOR
Curr Opin Rheumatol. 2015 May ; 27(3): 276–283. doi:10.1097/BOR.0000000000000161.

JOINT-LEVEL RISK PERSON-LEVEL RISK

FACTOR FACTOR
• Demographic characteristics • Bone/joint shape
and family history • Injury
• Obesity and metabolic • Muscle strenght & mass
syndrome
• Joint loads & algiment
• Nutritional and vitamin
factors • Occupation & physical act

• Bone density and bone mass • Leg lenght inequalty

• Smoking • Other joint-level risk factors

Osteoarthritis | Humaryanto 12
AETIOPATHOGENESIS OF
OSTEOARTHRITIS

Osteoarthritis | Humaryanto 13
PATOGENESIS

Osteoarthritis | Humaryanto 14
STAGE OF
OSTEOARTHRITIS

Osteoarthritis | Humaryanto 15
 CLINICAL SIGN

STIFNESS
• Morning (<1 hour)

JOINTS INCLUDE • End of Day

BONY
ENLARGEMENT PAIN
• Crepitus
• Decreased • Sharp Ache
ROM • Burning
• Worse with Activity

Osteoarthritis | Humaryanto 16
SIGN AND SYMPTOMS OF
OA
Physical examination is important in
making the diagnosis. Pain on range of
motion and limitation of range of motion
are common to all forms of osteoarthritis,
but each joint has unique physical
examination findings (Table 1). Figure 1
in next slide shows a hand with typical
changes of osteoarthritis.

Osteoarthritis | Humaryanto 17
HAND
AFFECTED BY
OSTEOARTHRITI
SFigure. 1

1.Herberden nodes
2.Bouchard nodes
 IMAGING FINDING

Diagnosis OA seringkali bisa didasarkan pada pemeriksaan fisik,

namun bisa dilakukan pemeriksaan radiologis berupa foto X-Ray
untuk memastikan diagnosis.
Osteoarthritis | Humaryanto 19
 RADIOGRAPH OF THE
KNEE

A. Anteroposterior views
B. Lateral views showing
1. Joint space narrowing
2. Osteophyte formation.
Osteoarthritis: Diagnosis and Treatment KEITH SINUSAS,
MD, Middlesex Hospital, Middletown, Connecticut

20
Osteoarthritis | Humaryanto
 ASSOCIATIONS OF LEG LENGTH
INEQUALITY
Leg Ann Internlength
Med. 2010 March 2; 152(5): 287–295. doi:10.1059/0003-4819-152-5-201003020-00006.

inequality ≥1 cm
was associated
with prevalent
radiographic 53%
and symptomatic
30%

Radiographic leg length inequality was associated with prevalent, incident

symptomatic and progressive knee osteoarthritis. These results point to leg
length inequality as a potentially modifiable risk factor for knee osteoarthritis.

Osteoarthritis | Humaryanto
RADIOGRAPH OF A HAND
AFFECTED BY
OSTEOARTHRITIS
SHOWING

1. Joint space narrowing

2. Osteophytes
3. Joint destruction.
4. Also changes at
carpometacarpal joint.
Osteoarthritis: Diagnosis and Treatment KEITH SINUSAS,
MD, Middlesex Hospital, Middletown, Connecticut

22
Osteoarthritis | Humaryanto
 RIGHT WORSE THAN
LEFT LOSS OF JOINT
SPACE WITH
SUBCHONDRAL
SCLEROSIS AND
GEODES.
https://radiopaedia.org/cases/hip-osteoarthritis

23
Osteoarthritis | Humaryanto
RADIOGRAPH OF THE
HIPS SHOWING

1.Joint space narrowing

2.Osteophyte formation.
Osteoarthritis: Diagnosis and Treatment KEITH SINUSAS,
MD, Middlesex Hospital, Middletown, Connecticut

24
Osteoarthritis | Humaryanto
 MRI : NORMAL KNEE
JOINT

MRI helps the physician to a

more detailed assessment of the
problem by checking the status
of articular cartilage, meniscus
and ligaments, which will
determine the topography of
arthritis and the type of
treatment to be followed.
25
Osteoarthritis | Humaryanto
 MRI KNEE JOINT.
SEVERE DEGENERATIVE
OSTEOARTHRITIS.
http://www.goudelis.gr/sites/default/files/IMG_3328_1.JPG

26
Osteoarthritis | Humaryanto
THERAPY
OSTEOARTHRITIS

27
 TREATMENT
Pengobatan
Tujuan terapidapat
Osteoarthritis
dilakukan dengan
adalah terapi
untuk farmakologis
mengurangi
rasa atau
dan nyeri PROTECTION
1 terapi
dan meminimalisasi
nonfarmakologis.
hilangnya fungsi fisik.

2 REST

3 ICE

4 COMPRESSION

5 ELEVATION

Osteoarthritis | Humaryanto
 TREATMENT
Osteoarthritis: Diagnosis and Treatment KEITH SINUSAS, MD, Middlesex Hospital, Middletown, Connecticut

PHARMACOLOGIC

NONPHARMACOLOGIC

Osteoarthtritis | Humaryanto 29
 ACETAMINOFE OPIOID
N & NSAID

CORTICOSTEROID HYALURONIC
ACID

PHARMACOLOGIC TREATMENT

Osteoarthritis | Humaryanto 30
ACETAMINOFEN
& NSAID
When acetaminophen
Patients fails to control
should be instructed to takesymptoms,
650-1,000
or
mgifofsymptoms are moderate
acetaminophen up to fourtotimes
severe,
per NSAID
day to
therapy is recommended.
relieve osteoarthritis symptoms. The FDA
Patients taking NSAIDs should be cautioned
recommends
about adverse noeffects,
more which
than 4,000 mg of
may include
acetaminophen bleeding,
gastroIntestinal per day torenal
avoiddysfunction,
liver toxicity.and
blood pressure elevation
Osteoarthritis | Humaryanto 31
OPIOID
Opioids areshould be prescribed
often used to treat painfirst
and at
are low
an
dosages
option forand carefully monitored
osteoarthritis to evaluate
pain. Because for
of the
potential dependence. Opioids also may cause
potential for abuse, opioids should be an option
chronic constipation and can place older
only if the patient
patients at risk of falls. has not responded to
acetaminophen or NSAID therapy, or cannot
tolerate them because of adverse effects.
Osteoarthritis | Humaryanto 32
CORTICOSTEROI
D
The use of intraarticular corticosteroids
primarily provides short-term relief lasting four
to eight weeks. It has proven effectiveness in
osteoarthritis of the knee, but may not be as
effective for osteoarthritis of the shoulder or
hand.
Osteoarthritis | Humaryanto 33
HYLURONIC ACID
a Cochrane review
Intra-articular of 76 clinical
hyaluronic trials concluded
acid injections, also
that viscosupplementation
known was effective
as viscosupplementation, for
are widely
treating knee osteoarthritis.
used by orthopedic surgeons to treat
osteoarthritis of the knee.

Osteoarthritis | Humaryanto 34
GLUCOSAMINE &
CHONDROITIN
SUPPLEMENT FOR
OA
The literature
Which consisted
The results of small for
were favorable clinical
the
trials until of
combination the glucosamine
release of andthe
Glucosamine/Chondroitin
chondroitin, which appeared Arthritis
to be
Interventionfor
effective Trialmoderate
(GAIT), which
to included
severe
more than 1,500
osteoarthritis patients.
of the knee. The trial had
five arms comparing
Chondroitin alone didglucosamine alone,
not show benefit
chondroitin
for alone,
osteoarthritis a knee
of the combination
or hip in of
a
glucosamine and chondroitin, celecoxib,
meta-analysis.
and placebo.

35
Osteoarthritis | Humaryanto
RECOMMENDED
STEPPED-CARE
APPROACH FOR THE
TREATMENT OF OA.

Osteoarthritis: Diagnosis and Treatment KEITH

SINUSAS, MD, Middlesex Hospital, Middletown,
Connecticut

Osteoarthritis | Humaryanto 36
 SURGICAL INTERVETION

Surgery should be reserved for patients whose symptoms have not

responded to other treatments.
Osteoarthritis | Humaryanto 37
 TOTAL KNEE ARTHROPLASTY
DiCesare PE, Abramson S, Samuels J. Pathogenesis of osteoarthritis. In: Firestein GS, Kelley WN, eds. Kelley’s Textbook of Rheumatology. 8th ed.
Philadelphia, Pa.:Saunders Elsevier; 2009.

The most effective surgical intervention is total joint replacement, with excellent
patient outcomes following total joint replacement of the hip, knee, and shoulder.

Osteoarthritis | Humaryanto 38
 EDUCATION & REHABILITATION

Patient education is a core component of hip osteoarthritis treatment as it is an

indispensable element in promoting adequate self-management.
Osteoarthritis | Humaryanto 39
 3 EXERCISE OPTIONS FOR
PATIENTS WITH
OSTEOARTHTRITIS

ELLIPTICAL
SWIMMING CYCLING
TRAINING
Aerobic exercise/non impact exercise is important for weight loss, but can be
challenging in persons with osteoarthritis of weight-bearing joints. Swimming,
elliptical training, cycling, and upper body exercise may help in such cases.
Osteoarthtritis | Humaryanto 40
PHYSIOTERAPY

Osteoarthritis | Humaryanto 41
 REFERENCES
• Kelli D. Allen, Yvonne M. 2015. Epidemiology of Osteoarthritis : State of the Evidence, University of North
Carolina, Caphel Hill, USA.

• LS, Daniel, Deborah Hellinger. 2001. Radiographic Assessment of Osteoarthritis. American Family Physician.
64(2):279–286

• Lawrence RC, Felson DT, Helmick CG, et al. 2008. Estimates of the prevalence of arthritis and other
rheumatic conditions in the United States. Part II. Arthritis Rheum. 58(1):26–35.

• Dillon CF, Rasch EK, et al. 2006. Prevalence of knee osteoarthritis in the United States: arthritis data from the
Third National Health and Nutrition Examination Survey 1991–1994. J Rheumatol. 33(11):2271–2279.

• Jordan JM, Helmick CG, Renner JB, et al. 2007. Prevalence of knee symptoms and radiographic and
symptomatic knee osteoarthritis in African Americans and Caucasians: The Johnston County Osteoarthritis
Project. J Rheumatol. 34(1):172–180.

• Dillon CF, Hirsch R, et al. 2007. Symptomatic hand osteoarthritis in the United States: prevalence and
functional impairment estimates from the third U.S. National Health and Nutrition Examination Survey, 1991–
1994. Am J Phys Med Rehabil. 86(1):12–21.

• Sacks JJ, Helmick CG, Langmaid G. 2004. Deaths from arthritis and other rheumatic conditions, United States,
1979–1998. J Rheumatol. 31:1823–1828.

• Sinusaa K, 2012. Osteoarthritis : Diagnosis and Treatment, Middlesex Hospital, Academy of Family Physicians.

• Iannone F, Lapadula G. 2003. The pathophysiology of osteoarthritis. Aging Clin Exp Res. 15(5):364–372.

• Jacobson, JA, et al. 2008. Radiographic Evaluation of Arthritis : Degenerative Joint Disease and Variation.
Radiology. 248(3):737–747.

• Bannell K. 2013. Physiotrapy management of hip osteoarthritis : Departement of Physioterapy, The University of
Meilbourne, Australia

Your Date Here 42

 THANK YOU !
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