Presentasi Penyakit Tidak Menular Dr Jerry
53
OSTEOARTHRITIS OSTEOARTHROSIS DEGENERATIVE JOINT DISEASE
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Transcript of Presentasi Penyakit Tidak Menular Dr Jerry
OSTEOARTHRITIS
OSTEOARTHROSIS
DEGENERATIVE JOINT DISEASE
DEFINITION
Osteoarthritis OA is a degenerative disease of diarthrodial (synovial) joints, characterized by
Breakdown of articular cartilage
and proliferative changes of surrounding bones
EPIDEMIOLOGY
Osteoarthritis(OA) is the most common joint disease
OA of the knee joint is found in 70% of the population over 60 years of age
Radiological evidence of OA can be found in over 90 % of the population
LIMITED FUNCTION
OA may cause functional loss
Activites of daily living
Most important cause of disability in old age
Major indication for joint replacement surgery
CHARACTERISTICS OF OA
OA is a chronic disease of the musculoskeletal system, without systemic involvement
OA is mainly a noninflammatory disease of synovial joints
No joint ankylosis is observed in the course of the disease
CLASSIFICATION OF OA
Primary OA Secondary OA
Etiology is unknown Etiology is known
AGE
Primary OA > 40 years
Direct correlation
Aging process
RISK FACTORS FOR PRIMARY OA
Age
Sex
Obesity
Genetics
Trauma (daily)
SECONDARY OSTOARTHRITISTraumaPrevious joint disorders;Congenital hip dislocationInfection: Septic arthritis, Brucella, TbInflammatory: RA, ASMetabolic: GoutHematologic: HemophiliaEndocrine: DM
ETIOLOGY OF OA
Cartilage properties
Biomechanical problem
Morphology of Primary OA
LABORATORY FINDINGS OF OA
There are no pathognomonic laboratory findings for OA
Laboratory analysis is performed for differential diagnosis
RADIOLOGIC FINDINGS OF OA
Narrowing of joint space
(due to loss of cartilage)
Osteophytes
Subchondral (paraarticular) sclerosis
Bone cysts
RADIOLOGIC GRADE OF OA
G1 Normal
G2 Mild
G3 Moderate
G4 Severe
Kellgren Lawrence Classification
DIAGNOSIS OF OA
CLINICAL FINDINGS
Joint pain
+
RADIOLOGIC FINDINGS
Osteophytes
CLINIC OF OA SIGNS AND SYMPTOMS
Joint pain - degenerative
Stiffness following inactivity – 30 min
Limitation of ROM – later stages
Deformity – restricition of ADL
OA OF KNEE JOINT (GONARTHROSIS)
More common in obese females over 50 years of ageJoint stiffness (<30 minutes)Mechanical painPhysical examination findings: CrepitusPain on pressurePainful ROM and functional limitationLimitation of ROM in later stages of OA (first extension)Laboratory analysis within normal limits
OA OF HIP JOINT
More common in males over 40 years of age
Joint stiffness
Pain of hip, gluteal and groin areas radiating to the knee (N obturatorius)
Mechanical pain
Limited walking function
ETIOPATHOGENESIS OF OA
Age,gender
Local
Genetic OA biochemical effects
Other factors
TREATMENT OF OA
Symptomatic treatment
Structure modifying treatment
Surgical treatment
STRUCTURE MODIFYING TREATMENT
Hyaluronic acid injection (HA)
Glycose amino glycans (GAG)
PRIMARY PREVENTION OF OA ??
Regular exercises
Weight control
Prevention of trauma
AIMS OF OA TREATMENT
Pain relief
Preservation and restoration of joint function
Education
Non-Pharmacologic Treatment of OA
Patient educationWeight loss (if overweight)Aerobic exercise programsPhysical therapy Range-of-motion exercises Muscle-strengthening exercisesOccupational therapyJoint protection and energy conservation
PHARMACOLOGIC TREATMENT OF OA
Oral Systemic Medical Agents - Analgesics (acetaminophen) - NSAIDs - Opioid analgesics
Intraarticular agents: Hyaluronan Glucocorticoids (effusion)
Topical agents
HAND OA - RESTING SPLINT
SYMPTOMATIC TREATMENT OF OA
Decrease of joint loading
- Weight control
- Splinting
- Walking sticks
Exercises
- Swimming
- Walking
- Strengthening
Patient education
INDICATIONS OF SURGICAL INTERVENTION
Severe joint pain,
resistant to conservative treatment methods
Limitation of daily living activities
Deformity, angular deviations, instability
Cardiovascular Disease
Direct and indirect costs (in billions of dollars) of major cardiovascular diseases and stroke (United States: 2008)
Source: National Heart, Lung, and Blood Institute.
©2011 American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2011
Types Of Cardiovascular Disease
Atherosclerosis
Coronary heart disease (CHD)• Chest pain (angina pectoris)• Irregular heartbeat (arrhythmia)• Congestive heart failure (CHF)• Congenital and rheumatic heart disease• Stroke
Development of Atherosclerotic Plaques
NormalFatty streak
Foam cells
Lipid-rich plaque
Lipid core
Fibrous cap
Thrombus
Ross R. Nature. 1993;362:801-809.
(Adapted from Glagov et al.)(Adapted from Glagov et al.)
Coronary RemodelingCoronary Remodeling
NormalNormalvesselvessel
MinimalMinimalCADCAD
ProgressionProgression
Compensatory expansionCompensatory expansionmaintains constant lumenmaintains constant lumen
Expansion Expansion overcome:overcome:
lumen narrowslumen narrows
SevereSevereCADCAD
ModerateModerateCADCAD
Glagov et al, Glagov et al, N Engl J MedN Engl J Med, 1987., 1987.
Intraluminal thrombusGrowth of thrombus
Intraplaque thrombus Lipid pool
Blood Flow
Atherosclerotic Plaque Rupture and Thrombus Formation
Adapted from Weissberg PL. Eur Heart J Supplements 1999:1:T13–18
Mylifecheck.heart.org
Reducing Your Risk For Cardiovascular Diseases
• Risks you can control Avoid tobacco Cut back on saturated fat and cholesterol Maintain a healthy weight Modify dietary habits Exercise regularly Control diabetes Control blood pressure
Systolic – upper numberDiastolic – lower number
Manage stress
Reducing Your Risk For Cardiovascular Diseases
• Risks you cannot controlHeredityAgeGenderRace
