pemicu 1- muskulo

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Pemicu 1 SMS Anakku oh Anakku…. Erwin 405080114

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Transcript of pemicu 1- muskulo

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Pemicu 1 SMS

Anakku oh Anakku….

Erwin

405080114

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LO 1:

MM. Sendi & prinsip pergerakannya

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LO 2:

MM. Jenis – jenis arthritis

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Arthritis

Osteoarthritis Gout Rheumatoid Arthritis – Juvenille RA

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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

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Etiologi

Penyebab tidak diketahui Kemungkinan: infectious agent

misalnya: Mycoplasma, EBV, CMV, parvovirus, dan rubella virus

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Patofisiologi

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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

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Faktor resiko

Usia Jenis kelamin genetik

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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

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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

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Temuan radiologis

Juxtaarticular osteopenia

apparent between after onset Loss of articular cartilage and bone develop

develop after months of sustained activity

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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

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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)

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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

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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)

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Etiologi

Genetics– MHC (Major Histocompatibility Complex)

Cytokines

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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

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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

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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

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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

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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

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Extra-articular

- uveitis

- nutritional status and growth

- osteoporosis

- psychosocial

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DD in inflamatory arthritis in childhood SLE Dermatomyositis Vasculitis Mix connective tissue disease

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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