Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis
-
Upload
yohanes-eko-saputra -
Category
Documents
-
view
607 -
download
11
Transcript of Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis
![Page 1: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/1.jpg)
Arthritis
![Page 2: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/2.jpg)
Tujuan pembelajaran Memahami konsep arthritis,
reumathoid arthritis, gout & osteoarthritis
Melakukan asuhan keperawatan pada pasien dengan arthritis (RA, Osteoarthritis, Gout)
![Page 3: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/3.jpg)
Pendahuluan Arthritis berasal dari bahasa
yunani arthron = sendi & itis inflamasi
Beberapa tipe disebabkan karena inflamasi.
Beberapa tipe disebabkan oleh inefeksi virus, bakteri, injury, atau kristal sodium urate
![Page 4: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/4.jpg)
Revew Anfis Sendi
Merupakan persambungan antar tulang
Fungsi sendi: Menjaga tulang-tulang tetap
bersama Memudahkan mobilisasi
Klasifikasi: Fungsional Struktural
![Page 5: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/5.jpg)
![Page 6: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/6.jpg)
Klasifikasi fungsional
Synarthroses – tdk bergerak
Ex: Sendi fibrosa Amphiarthroses – Gerakan
terbatas
Ex: Sendi Cartilaginous Diarthroses – Bebas bergerak
Ex: Sendi Synovial
![Page 7: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/7.jpg)
Tulang2 yang dihubungkan oleh jar fibrous (sendi fibrous)
Contoh:
Sutura
Syndesmoses
Lebih moveble daripada sutura
Contoh: Tibia & fibula distal
![Page 8: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/8.jpg)
Tulang2 yg dihubungkan oleh cartilago (Cartilaginous Joints)Cartilaginous Joints)
Contoh:
Simfisi pubik
Sendi intervertebralis
![Page 9: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/9.jpg)
Synovial JointsSynovial Joints1. Articular cartilage (hyaline
cartilage) melindungi ujung-ujung tulang
2. Permukaan sendi dilindungi oleh fibrous articular capsule
3. Terdapat rongga sendi yg berisi cairan synovial
4. Ligament menjaga sendi pada tempatnya
5. Bursae Berbatasan dgn membran
synovial Memproduksi cairan synovial Bukan bagian aktual dari sendi
6. Ujung tendon Letak bursa berada disekitar
ujung tendon ke tulang
![Page 10: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/10.jpg)
The Synovial JointThe Synovial Joint
![Page 11: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/11.jpg)
Tipe Sendi Synovial
![Page 12: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/12.jpg)
Kondisi Inflamasi pd Sendi
Bursitis – Inflamasi bursa akibat benturan atau gesekan
Tendonitis – Inflamasi pada tendon
Arthritis – Inflamasi atau penyakit degeneratif sendi
![Page 13: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/13.jpg)
Rheumatoid Arthritis
Rheumatoid arthritis disebabkan oleh inflamasi
Merupakan penyakit outoimun – sistem imun menyerang sendi
Inflamasi utama terjadi pada membran sinovial
Inflamasi jaringan sinovial dirasakan pd rongga sendi & dapat menjalar ke kartilago dan tulang sendi
Inflamasi jaringan sinovial dpt disebabkan karena erosi tulang dan kartilago
![Page 14: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/14.jpg)
Rheumatoid Arthritis Lanjutan … Kadang2 kerusakan irreversible dpt
terjadi spt destruksi total pd sendi dgn fusi pd permukaan tulang
Inflamasi ringan dpt terjadi berbulan2 atau bertahun2 sebelum kerusakan irreversible terjadi
Gejala dimulai dgn inflamasi sendi bilateral
Sering menyebabkan deformitas Utk semua tipe arthritis early detection &
treatment akan memebrikan dampak lebih baik
![Page 15: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/15.jpg)
Rheumatoid arthritis
![Page 16: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/16.jpg)
![Page 17: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/17.jpg)
Etiology
Penyebab dari artritis rhematoid belum dapat ditentukan secara pasti, tetapi dapat dibagi dalam 3 bagian, yaitu:1.Mekanisme imunitas (antigen
antibodi) seperti interaksi IgG dari imunoglobulin dengan rhematoid faktor
2.Faktor metabolik3.Infeksi dengan kecenderungan virus
![Page 18: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/18.jpg)
Gejala & tanda lokal Sakit persendian disertai kaku terutama pada
pagi hari (morning stiffness) & gerakan terbatas tdk > 30 menit
Bengkak, hangat, merah dan lemah Poli artritis simetris sendi perifer sering pd
sendi kecil tangan, kaki, pergelangan tangan, Artritis erosif erosi pada pinggir tulang Deformitas pergeseran ulnar, deviasi jari-
jari, subluksasi sendi metakarpofalangea, deformitas boutonniere dan leher angsa.
Rematoid nodul sering pd siku (bursa olekranon) atau sepanjang permukaan ekstensor lengan bawah, bentuknya oval atau bulat dan padat dan jari-jari
psoriasis of the skin & nail bed, dry eye syndrome, & scleritis.
Kronik Ciri khas rematoid artritis
![Page 19: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/19.jpg)
![Page 20: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/20.jpg)
![Page 21: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/21.jpg)
![Page 22: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/22.jpg)
Tanda & Gejala Sistemik
Lemah, Demam Tachikardi, Berat badan turun, Anemia, Anoreksia
![Page 23: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/23.jpg)
Test Diagnosis
Tdk ada test spsifik pd rheumatoid arthritis.
Test darah: Faktor rheumathoid (terjadi 50-90% penderita), LED, leukosit, test fungsi ginjal (BUN & creat), Hb & Ht
Test cairan sinovial: fisis, inflamasi, infeksi
X-rays, MRI, Bone Scan utk melihat perubahan pd struktur tulang dan kartilago
![Page 24: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/24.jpg)
Stadium Stadium sinovitis
Perubahan dini pada jaringan sinovial yang ditandai adanya hiperemi, edema karena kongesti, nyeri pada saat istirahat maupun saat bergerak, bengkak, dan kekakuan.
Stadium destruksi kerusakan pada jaringan sinovial terjadi juga
pada jaringan sekitarnya yang ditandai adanya kontraksi tendon. terjadi pula perubahan bentuk pada tangan yaitu bentuk jari swan-neck.
Stadium deformitas Deformitas dan ganggguan fungsi secara
menetap. Perubahan pada sendi diawali adanya
sinovitis, berlanjut pada pembentukan pannus, ankilosis fibrosa, dan terakhir ankilosis tulang
![Page 25: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/25.jpg)
Conventional Methods of Treatment Nonsteroidal Anti Inflammatory Drugs
(NSAIDs) – Aspirin, Ibuprofen, COX-2 inhibitor.
Corticosteroids – Cortisone Disease Modifying Antirheumatic Drugs
(DMARDs) – Methotrexate, Injectable Gold, Hydroxychloroquine.
Biologic Response Modifiers – Enbrel, Remicade, Humira.
![Page 26: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/26.jpg)
Alternative Methods of Treatment Diet Kontrol BB Exercise Acupuncture Herbal Medicines Massage Stress Reduction Techniques –
prayer, relaksasi, meditation, hypnosis, yoga, tai-chi.
![Page 27: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/27.jpg)
Pembedahan
Sinovektomi, untuk mencegah artritis pada sendi tertentu, untuk mempertahankan fungsi sendi dan untuk mencegah timbulnya kembali inflamasi.
Arthrotomi, yaitu dengan membuka persendian.
Arthrodesis, sering dilaksanakan pada lutut, tumit dan pergelangan tangan.
Arthroplasty, pembedahan dengan cara membuat kembali dataran pada persendian.
![Page 28: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/28.jpg)
Gout Gout merupakan permasalahan kompleks akibat
deposit garam & kristal asam uratthe di dalam & sekitar sendi serta jaringan lunaknya atau kristalisasi asam urat pd traktus urinarius
Asam urat adalah hasil akhir normal dari degradasi purin (metabolisme) Rute perjalanan melalui ekskresi di ginjal Manusia menghasilkan enzim uricase utk
mengahancurkan asam urat ke dalam berbagi bentuk
Kelainan metabolik pada gout yaitu hyperuricemia
![Page 29: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/29.jpg)
Gout
Gout merupakan bentuk arthritis akut yang disebabkan oleh kristal urate crystals pd rongga sendi
Serangan dipicu oleh stress, alcohol/drugs, adanya penyakit lain.
Tanpa treatment gout dpt menyebebkan kerusakan permanen pd sendi & kadang-kadang pd ginjal
![Page 30: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/30.jpg)
Penyebab
Kegagalan/ketidakmampuan ginjal untuk mengekskresikan asam urat (90%)
Produksi asam urat berlebih (10%) : diet, penyakit
Faktor resiko
![Page 31: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/31.jpg)
Faktor Predisposisi Genetik Kanker & kelainan pembuluh darah Kecanduan alkohol Obesitas Hypothyroidism Intake purin dalam diet tinggi Keracunan (moonshine whisky) Radiasi (pengobatan) Umur Durasi hyperuricemia Starvasi Renal failure Obat-obat: (thiazides, cyclosporine, pyrazinamide,
ethamburol, nicotinic acid, warfarin, low dose salicylates)
![Page 32: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/32.jpg)
![Page 33: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/33.jpg)
![Page 34: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/34.jpg)
![Page 35: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/35.jpg)
![Page 36: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/36.jpg)
![Page 37: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/37.jpg)
![Page 38: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/38.jpg)
Purine nucleotides hypoxanthine
xanthine
Uric acid
Xanthine oxidase
Alimentary excretion
Urinary excretion
Tissue deposition in excess
Urate crystal microtophi
Phagocytosis with acute inflammation and arthritis
![Page 39: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/39.jpg)
Tanda & Gejala ACUTE: Dalam 12-24 jam
• Muncul sering pd malam hari
• Kulit: kemerahan, tegang dan mengkilap
• Sendi: nyeri, bengkak, hangat kekakuan
• Demam
• Menggigil
• Perasaan sakit: lesu, malaise
• Denyut jantung meningkat
• Sering kencing ( nocturnal )
CHRONIC: Kerusakan sendi progresif– Sering terjadi
– Deformitas
– Ketidakmampuan sendi (fungsi)
![Page 40: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/40.jpg)
![Page 41: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/41.jpg)
![Page 42: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/42.jpg)
Diagnosis Pengkajian riwayat dan pemeriksaan
fisik Hasil arthrocentesis (pengambil sampel
cairan sinovial sendi):Kristal urat (MSU) dgn neutrophils & macrophages.
Asam urat nonspesifik: 30% pd tingkat normal
Urine: <800 mg underexcertor(<600 purine-free
diet) Gout sulit didiagnosis:
Kadang tidak ada hiperurisemia pd saat serangan.
Tanda & gejala mirip dengan penyakit arthritis lainnya
![Page 43: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/43.jpg)
Diagnosis X-ray
AcuteJaringan lunak membengkak
Chronic Tampak chronic tophaceous gouty
arthritis, erosi tulang yang luas sampai ke metakarpal
Sclerosis & joint-space menyempit
![Page 44: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/44.jpg)
Laboratorium Uric Acid
Batas nilai pada pasien hyperuricemic umumnya tdk akan berkembang menjadi gout
Normal selama serangan akut Darah
Leukositosis ringan pd serangan akut, tetapi dapat jua menjadi lebih dari 25,000/mm
LED Peningkatan ringan 2-3x normal
Asam urat urin 24 jam Hanya diperiksa ada pasien dengan terapi
atau jika atau bila sebab hiperuresemia memerlukan penyelidikan
Trial pd colchicine Respon positif pd tipe artritis lain termasuk
pseudogout.
![Page 45: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/45.jpg)
![Page 46: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/46.jpg)
Purine nucleotides
hypoxanthine
xanthine
Uric acid
Xanthine oxidase
Alimentary excretion
Urinary excretion
Tissue deposition in excess
Urate crystal microtophi
Phagocytosis with acute inflammation and arthritis
uricosurics
colchicine NSAID
Allopurinol
Oxypurinol
![Page 47: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/47.jpg)
Manajemen Gout
Asymptomatic hyperuricemia Acute gouty arthritis Chronic or tophaceous gout
![Page 48: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/48.jpg)
Asymptomatic hyperuricemia Treatment of asymptomatic
hyperuricemia usually in not necessary
![Page 49: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/49.jpg)
Preventif
Hindari BB berlebihan Kurangi resiko hipertensi Hindari terapi diuretik Hindari alkohol
![Page 50: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/50.jpg)
Manajemen Gout Akut
NSAID Colchicine Steroids
![Page 51: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/51.jpg)
Manajemen Gout Akut NSAID
Indomethacin (50mg qid-50mg tid-25mg tid)
Sulindac (risk of renal side effect) 200mg q6h
Ibuprofen 800mg q6h
Kontraindikasi Renal insufficiency, peptic ulcer,
liver disease, chronic heart failure
![Page 52: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/52.jpg)
Manajemen Gout AkutColchicine
Efektif pd 24 jam serangan
Mechanism of colchicine Inhibit phagocytosis (microtubular
system) Affect chemotaxis Affect motility and adhesion of
neutrophil Reduce release PGE2 and LTB4
![Page 53: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/53.jpg)
Manajemen Gout Akut
Colchicine Efek samping
GI disturbance, blood dyscrasias, myoneuropathy
Kontraindikasi Renal dysfunction, liver disease,
sepsis, bone marrow dysfunction
![Page 54: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/54.jpg)
Manajemen Gout Akut
Kortikosteroid Bila NSAID & colchicine
dikontraindikasikan Prednison 20-50mg oral 3-20 hr ACTH 40IU IM 1 dose ACTH 40-80IU IM,IV /8 jam
sc /12 jam
Steroid Intra-artikuler
![Page 55: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/55.jpg)
Terapi Profilaksis Indications
Serangan berulang Tophi Gangguan pd ginjal Urolithiasis asam urat Gangguan metabolik Derajat hyperuricemia (11.8 mg/dl)
![Page 56: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/56.jpg)
Terapi Profilaksis
Colchicine NSAID Urate-lowering therapy
Allopurinol Uricosuric agents
Induce a flare up
Concurrent colchicine prophylaxis
![Page 57: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/57.jpg)
Terapi Profilaksis
Pembatasan diet yg mengandung purin dapat menurunkan plasma urate lebih dari 1.0 gm/dl
Flares terjadi selama penurunan serum urate
![Page 58: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/58.jpg)
Terapi Profilaksis Allopurinol
Xanthine oxidase inhibitorIndications Renal insufficiency Nephrolithiasis Tophi Tumor lysis syndrome Primary metabolic defects
Allopurinol 300mg-900mg Side effect (<2%)
Potentiating imuran marrow suppressive effect
Hypersensitivity syndrome Hepatitis Interstitial nephritis
![Page 59: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/59.jpg)
Terapi Profilaksis Uricosuric agents
Probenecid Sulphinpyrazone Benzbromarone
Mechanism Inhibit renal tubular reabsorption
Uricosuric agents Side effects
Uric acid crystalluria GI disturbance Allergy Hepatic impairment
Contraindications Renal insufficiency nephrolithiasis
![Page 60: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/60.jpg)
OsteoarthritisNama lainnya: Degenerative joint disease Arthrosis Osteoarthrosis Hypertrophic arthritis
![Page 61: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/61.jpg)
Osteoarthritis Diketahui sebagai penyakit
dgeneratif sendi Merupakan jenis arthritis
yang paling sering etrjai Karakteristik lokal adanya
kerusakan rawan sendi Umumnya terjadi pd orang
tua, tapi dpt juga terjadi pd orang muda sebagai akibat mekanisme genetik atau trauma pada sendi
![Page 62: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/62.jpg)
Predisposisi
Usia (penuaan) Genetik Hormon Mekanik
![Page 63: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/63.jpg)
Mekanisme kerusakan Katabolisme pd kartilago menghasilkan zat-
zat perusak ke dalam cairan sinovial yang memicu terjadinya respon inflamasi oleh synoviocytes
Zat-zat perusak tsb meliputi: chondrointon sulfate, keratan sulfate, PG fragments, type II collagen peptides and chondrocyte membranes
Akativasi makrofag sinovial dengan menarik PMN pd sinovitis
Juga dihasilkan cytokines, proteinases and oxygen free radicals (superoxide and nitric oxide) ke dalam rongga & cairan sinovial
Mediator2 tsb bekerja pd chondrocytes &synoviocytes dengan sintesis PGs, collagen & hyaluronan
![Page 64: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/64.jpg)
![Page 65: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/65.jpg)
s
![Page 66: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/66.jpg)
Etiologi OA Primer, sering disebabkan karena idiopatik, sering
disebabkan krn kelainan gen (familial/heriditer) OA sekunder disebabkan oleh::
Obesitas Penggunaan sendi yang berulang/sering Trauma Infeksi Deposit kristal Akromegali Previous rheumatoid arthritis Metabolik (ex: alkaptonuria, hemochromatosis,
Wilson disease) Hemoglobinopathies (ex: sickle cell disease,
thalassemia) Neuropathic Charcot joint (Ex: syringomyelia,
tabes dorsalis, diabetes) Kelainan orthopedik (Ex: congenital hip dislocation,
slipped femoral capital epiphysis) Kerusakan tuilang (eg, Paget disease, avascular
necrosis)
![Page 67: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/67.jpg)
Riwayat kesehatan Pasien dengan OA sering
mengeluhkan nyeri sendi pd aktivitas.
Nyeri terjadi saat istirahat, kadang2 setelah istirahat.
Morning stiffness kurang dari 30 mnt.
Disertai pembengkakan yang intermiten yang dapat melemahkan sendi terutama lutut.
![Page 68: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/68.jpg)
Pemeriksaan Fisik Pemeriksaan dini pada proses awal penyakit:
Sendi tampak normal Berjalan mungkin nyeri terutama pd sendi
lutut Pada proses penyakit lebih lanjut, hasil
pemeriksaan fisik meliputi: Visible osteophytes Palpasi teraba hangat pd sendi Pd palpasi osteophytes sering tidak terasa Efusi sendi sering terjadi terutama pada sendi
perifer Keterbatasan ROM, karena retriksi tulang
dan/atau kontraktur jaringan lunak. Kripitasi pd saat ROM tidak lazim terjadi.
![Page 69: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/69.jpg)
Osteoarthritis: Symptoms & Causes Symptoms
Bengkak, kekakuan dan nyeri
Sendi gemetar setelah aktivitas fisik
Kaku dan nyeri pd leher atau pinggang yang dpt menyebabkan pembengkakan pd kaki atau tangan
Causes Trauma pd sendi
spt pengulangan gerakan sendi dlam waktu yang lama
Cidera akut sendi menyebabkan OA beberapa tahun kemudian.
Umur Kalianan
metabolik dpt menyebabkan kerusakan kartilago.
![Page 70: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/70.jpg)
Lab Studies Tidak ada pemeriksaan lab khusus pada
pasien osteoarthritis (OA) Pemeriksaan dilakukan utyk melihat:
monoclonal antibodies, synovial fluid markers dan urinary pyridinium cross-links (Ex: Sisa kerusakan kartilago).
LED tidak selalu meningkat, tetapi dapat meningkat pd kasus erosive inflammatory arthritis.
.
![Page 71: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/71.jpg)
Imaging Studies MRI pd OA sendi lutut menunjukan:
efusi sendi yang berat berhubungan dengan nyeri dan kekakuan. erdapat osteophyte pd kompartemen patellofemoral berhubungan dgn nyeri. Hasil lain menunjukan adanya abnormalitas kartilago focal maupun diffuse, subchondral cysts, bone marrow edema, subluxation pd meniscus, meniscal tears, and Baker cysts (Kornaat, 2004; Kornaat, 2006).
Bone scan, membantu utk early diagnosis OA pd tangan. Bone dpt membantu membedakan nyeri krn OA dgn nyeri karena akibat lain.
X-Ray sering tampak normal pd deteksi awal
![Page 72: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/72.jpg)
Test Lain
Pemeriksaan cairan sendi dgn aspirasi sendi.
Pemeriksaan histologi: biopsi kartilago umumnya normal
![Page 73: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/73.jpg)
Lokasi sendi pd OA: Pinggang (lower backs), lutut, panggul, leher, ibu jari, and ujung jari-jari.
![Page 74: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/74.jpg)
Diagnosis
Tidak bisa dengan hanya satu jenis pemeriksaan pd osteoarthritis.
Memeriksa riwayat kesehatan, keluhan gejala, pemeriksaan fisik, cek refleks dan cek kemamouan utuk berjalan
X-ray: kerusakan pd kartilago Pemeriksan cairan sendi
![Page 75: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/75.jpg)
Treatment Kontrol BB Exercise Obat:
- Simple analgesics (Acetaminophen (Tylenol, Panadol, Feverall, Aspirin Free Anacin) - Topical analgesics (Capsaicin (Dolorac, Capsin, Zostrix)- Nonsteroidal anti-inflammatory drugs
(buprofen (Motrin, Advil, Nuprin, Rufen)
- Cyclooxygenase-2 inhibitors (Celecoxib (Celebrex) - Opioid analgesics (Oxycodone (OxyContin, Roxicodone)
![Page 76: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/76.jpg)
Surgical Intervention Tindakan pembedahan pd OA lutut:
Arthroscopic lavage - Using a saline lavage to wash out the joint
Joint realignment (realignment osteotomy) Joint fusion (arthrodesis) - Surgically fusing
the joint to eliminate motion Joint replacement (arthroplasty)
Tindakan pembedahan pd OA panggul: Joint realignment (realignment osteotomy) Joint fusion (arthrodesis) - Surgically fusing
the joint to eliminate motion Joint replacement (arthroplasty)
![Page 77: Arthritis, Rheumatoid Arthritis, Gout, Osteoarthritis](https://reader031.fdocument.pub/reader031/viewer/2022012309/557210ed497959fc0b8df087/html5/thumbnails/77.jpg)
Rehabilitation Program:
Physical Therapy Occupational Therapy . Recreational Therapy