Degeneratif Muskuloskeletal
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Penyakit Degeneratif Muskuloskeletal
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Degeneratif SendiKelainan daripada sendi (satul/lebih) yang dimulainya dengan kerusakan tulang rawan sendi, diikuti dengan progresivitas kerusakan, penebalan & remodelling tulang subchondral, dan disertai dengan peradangan sekunder membran sinovial.
Degeneratif Jaringan lunakNekrosis lokal dp. tendon/kapsel sendi → peradangan
Definisi
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Macam :• Primer / idiopatik (aging, genetik)• Sekunder (trauma, deformitas, gout, dll.)Patologi :• Perubahan sifat biokimiawi & fisik tlg. Rawan• Sinovtis• Penebalan kapsel• Osteofit, sklerosis, pembentukan kista subchondral.
Penyakit degeneratif sendi (Osteoarthritis)
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KLINIS RADIOLOGIK SCINTIGRAFI MRI TES LABORATORIUM ANALISA CAIRAN SENDI ARTHROSKOPI ‘MARKER’BIOKOMIAWI (COMP,CS,KS,coll chain etc.)
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Gejala• Nyeri → resting pain• Kaku sendiTanda• Pembengkakan• Atrofi otot• Krepitus• ROM ↓• Lain2 : Bouchard nodes, kelainan X-ray
Gambaran klinis OA
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SIGNSSIGNS
CrepitusRestricted movementTendernessBony swellingDeformityMuscle wasting/weaknessEffusion, increased warmthInstability
SYMPTOMSSYMPTOMS
Pain
Stiffness
Alteration in shape
Functional impairment
anxiety,depression
CLINICAL FEATURES
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• INDEKS LEQUESNE
• INDEKS WOMAC (WEST ONTARIO & MAC MASTER)
DERAJAT KLINIS
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TUJUANTUJUAN• Diagnosis• Penentuan derajat perubahan struktural
• Identifikasi chondrocalcinosis
4 GAMBARAN UTAMA RADIOLOGIK4 GAMBARAN UTAMA RADIOLOGIK• Penyempitan celah sendi• Sklerosis subchondral• Pembentukan kista subchondral• Osteofit
RADIOLOGIK
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KELLGREN & LAWRENCE (1957)
KALLMAN (1989)
CROFT (1990)
AMERICAN COLLEGE OF RHEUMATOLOGY (1991)
DERAJAT RADIOLOGIK
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NON SPESIFIKDIAGNOSA BANDING PENYAKIT LAIN a.l.• c reactive protein• asam urat• rematoid faktor• dll.
TES LABORATORIUM
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DIAGNOSTIK
DERAJAT KERUSAKAN KARTILAGO
RESPON SMOAD/DMOAD
TERAPI DEBRIDEMEN & LAVAGE
ARTHROSKOPI
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TIDAK SPESIFIKTIDAK SPESIFIK
IDENTIFIKASI IDENTIFIKASI KRISTAL CPPD IDENTIFIKASI KRISTAL URAT SEPSIS
ANALISA CAIRAN SENDI
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Non FarmakologikNon FarmakologikPenyuluhan Pendidikan Kontrol Berat BadanFisioterapi & Terapi Kerja
FarmakologikFarmakologikSistemikLokal
PembedahanPembedahan
PENATALAKSANAAN OA MASA PENATALAKSANAAN OA MASA KINIKINI
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Bedah
Injek
si In
tra ar
tikule
r ‘La
vage
’ sen
di
NSAID
Analgesik (Acetaminophen)
Pendidikan PenderitaTerapi Fisik & Terapi Kerja
Kontrol BB, Olah raga, Penggunaan Ortotik
Analgesik Topikal
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Non NSAID
•Analgesik - Asetaminofen
- Tramadol
•Narkotik
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NSAID•Non selektif
•cox-1 & cox-2 inhibitor•Selektif
•COX-2 inhibitor•Gangguan sintesis matriks
•Kelompok I >>>•Kelompok II >>•Kelompok III >
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HYALURONIC ACIDETIDRONATECALCITONINDOXYCYLINEAVOCADO/SOYBEAN UNSAPONIFIABLESSEVERAL NSAIDDIACEREIN
GAG-peptideGAGPSPENTOSANCHONDROITIN SULFATECHONDROITIN SULFATEGLUCOSAMINE SULFATEGLUCOSAMINE SULFATELOCAL CORTICOSTEROID
SMOAD (STRUCTURAL MODIFYING OSTEOARTHRITIS DRUG)/ DMOAD
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•LOKAL•Topikal - NSAID
- Capsaicin
•Intra artikuler- Kortikosteroid- Hyaluronic acid (HA)- Glycosaminoglycan
polysulfate (GAGPS)- Orgotenin, yttrium-90,
silicon, somastotin & tenoksikam
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PEMBEDAHAN
•PENCEGAHAN PROGRESIVITAS OA
•DEFINITIP PENGGANTIAN LAPISAN TULANG RAWAN
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OPERASI PENCEGAHAN
•Lavage & Debridement•Drilling•Allo/Autografting Osteo chondral•Periosteal & Perichondral Resurfacing•Transplantasi sel•Osteotomi
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OPERASI DEFINITIP
•Resection & Interpositional arthroplasty
•Artificial joint arthroplasty- Hemi/Partial- Total
•Arthrodesis
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PENGOBATAN OA MASA DEPAN
Biologic agentBiologic agent- Growth factor- Growth factor- Anti cytokine- Anti cytokine
Gene therapyGene therapy Cytokine inhibitorsCytokine inhibitors
- IL-1 inhibitors- IL-1 inhibitors- TNF-- TNF- inhibitors inhibitors
Nitric oxide synthase inhibitorsNitric oxide synthase inhibitors Metallo protease inhibitorsMetallo protease inhibitors
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Manifestasi• Back pain, ishialgia, paraparese.• Degeneratif diskus, sendi facet, spinal stenosis, segmental instabilitas,
HNPTerapi• Konservatif
• Medikamentosa, Fisioterapi, Spinal support dll• Operatip
• Dekompresi (laminektomi), stabilisasi
Degeneratif Tlg. Belakang (spondylosis deformans)
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Myofascial pain syndrome (Fibrositis)Kapsel• Subacromial bursitis• Bicipital tendinitis• Adhesive capsulitis (Frozen Shoulder) dll.Tendon• De Quervain’s disease• Ganglion• Trigger finger (snapping finger)• Tennis elbow (lateral epicondylitis)
Degeneratif Jaringan Lunak
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Konservatif• Medikamentosa• FisioterapiOperatif• Tendon release• Eksisi• Repair dll.
Terapi non artikular degeneratif
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OA MULTIFAKTORIAL DIAGNOSA TIDAK SULITDERAJAT PERUBAHAN STRUKTUR TIDAK SESUAI DENGAN GAMBARAN KLINISPROGRESIVITAS ?STRES BIOMEKANIK PERANAN PENTINGSMOAD CEGAH PROGRESIVITAS MENINGKATKAN DAYA PERBAIKANPENCEGAHAN HINDARI FAKTOR RESIKO
RINGKASAN