pemicu 1- muskulo
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Pemicu 1 SMS
Anakku oh Anakku….
Erwin
405080114
LO 1:
MM. Sendi & prinsip pergerakannya
LO 2:
MM. Jenis – jenis arthritis
Arthritis
Osteoarthritis Gout Rheumatoid Arthritis – Juvenille RA
Definisi
Penyakit sistemik kronik pada sendi, biasanya poliartikular, yang ditandai dengan radang pada membran sinovial dan struktur-struktur sendi serta atrofi otot dan penipisan tulang
Etiologi
Penyebab tidak diketahui Kemungkinan: infectious agent
misalnya: Mycoplasma, EBV, CMV, parvovirus, dan rubella virus
Patofisiologi
Epidemiologi
Wanita : pria = 3 : 1 Pada wanita, insiden RA 6x lebih besar pada
usia 60 – 64 tahun daripada pada usia 18 – 29 tahun
The onset is most frequent during the fourth and fifth decades of life, with 80% of all patients developing the disease between the ages of 35 and 50
Faktor resiko
Usia Jenis kelamin genetik
Criteria RA
Morning stiffness Arthritis of 3 or more joint areas Arthritis of hand joints Symmetric arthritis Rheumatoid nodules Serum rheumatoid factor Radiographic changes
note: diagnosis RA dapat ditegakkan bila didapati 4 dari 7 kriteria di atas
Temuan Laboratorium Rheumatoid factor Antibodies to CCP (complement control protein) Anemia normositik normokrom Erythrocyte Sedimentation Rate Analisis cairan sinovial
- white blood cells count > 2000/uL with 75% PMN is highly characteristic of inflamatory arthritis- hemolytic complemen: C3 & C4- reduced viscocity- increased protein content
Temuan radiologis
Juxtaarticular osteopenia
apparent between after onset Loss of articular cartilage and bone develop
develop after months of sustained activity
Definisi
Juvenile RA is not a single entity, rather a group of conditions with differing clinical and immunogenetic features
Synovitis, manifest as swelling within a joint, or limitation in range of joint motionwith associated joint pain or tenderness and persisting for at least 6 weeks, is the essential clinical feature of all subtypes of Juvenille RA
Klasifikasi inflamatory arthritids in childhood Menurut ACR (American College of Rheumatology):
- Juvenile Rheumatoid Arthritis
- onset <16 years
- duration 6 weeks
- subtypes:
1. systemic arthritis
2. pauciarticular arthritis
3. polyarticular arthritis (excludes spondyloarthropathies and psoriatic arthritis)
Menurut ILAR (International League of Associations for Rheumatology)- Juvenile Idiopathic Arthritis- onset < 16 years- duration 6 weeks- subtypes:1. systemic arthritis2. oligoarticular arthritis
- persistent- extended
3. polyarthritis, RF-4. polyarthritis, RF+5. enthesitis related arthritis6. psoariatic arthritis7. other arthritis
Menurut EULAR (European League Against Rheumatism)
- Juvenile Chronic Arthritis
- onset < 16 years
- duration 3 months
- subtypes:
1. systemic arthritis
2. pauciarticular arthritis
3. polyarticular arthritis
(excludes RF+ disease: known as juvenile rheumatoid arthritis)
Etiologi
Genetics– MHC (Major Histocompatibility Complex)
Cytokines
Pro-inflamatory cytokines Anti-inflamatory cytokines
IF-γ IL-1 receptor antagonist
IL-1 α dan β IL-4
TNF-α IL-10
Lymphotoxin α IL-13
IL-6 Transforming growth factor β
IL-12 (induces IFN-γ) IL-6
Tanda & Gejala
Pada umumnya meliputi
- Swelling
- Heat
- Pain & loss of function Manifestasi klinik biasanya bermacam-
macam, berdasarkan usia, tahap perkembangan anak, dan subtipe – subtipe klinis dari penyakit
Pemeriksaan
Radiologis3 stages of radiographic changes:- early: periarticular osteopenia- intermediate: cortical erosions, joint space narrowing and subchondral cysts- late: destructive joint changes with ankylosis, joint contractures, metaphyseal and diaphyseal changes and growth anomalies
CT is useful for visualizing certain joints, especially the sacroilliac joints
Laboratory findingsInvestigation oligoarthritis polyarthritis Systemic disease
Hemoglobin
White cell count
Platelets
ESD
CRP
Liver enzymes
ANA
RF
Normal
Normal
Normal
Raised +
Normal
Normal
Often positive
Negative
Low (anemia of chronicdiseaseRaised +
Raised +
Raised ++
Raised +
Normal
Normal
Positive in subgroup
Low (anemia of chronicdisease)Raised +++
Raised +++
Raised +++
Raised ++
Often raised
Normal
Normal
Complications
Articular
- flexion contractures
- overgrowth of affected limbs
- discrepancy in lower limb length may result in a pelvic tilt and scoliosis in adult life
- TMJ involve polyarthritis cosmetic and functional difficulties
Extra-articular
- uveitis
- nutritional status and growth
- osteoporosis
- psychosocial
DD in inflamatory arthritis in childhood SLE Dermatomyositis Vasculitis Mix connective tissue disease
Penatalaksanaan
Drug Total daily dose Times daily
Diclofenac 1 – 3 mg/kg 2 – 3
Naproxe 10 – 20 mg/kg 2 – 3
Ibuprofen 20 – 50 mg/kg 3 – 4
Indometacin 1 – 3 mg/kg 2
Piroxicam < 15 kg 5mg
16–25 kg 10mg
26 – 45 kg 15mg
> 46n kg 20mg
Once daily