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CURRICULUM VITAE

NAMA : dr. Rudy Hidayat, SpPD-KR, FINASIM


TTL : Malang, 3 Mei 1975
PEKERJAAN : Staf Divisi Reumatologi
Departemen Ilmu Penyakit Dalam FKUI/
RSUPN Ciptomangunkusumo Jakarta
PENDIDIKAN :
Pendidikan Dokter Umum 1992-1999 FKUB
Pendidikan Spesialis Penyakit Dalam 2004-2008 FKUI
Pendidikan Subspesialis Reumatologi 2009-2012 FKUI
ORGANISASI :
Ikatan Dokter Indonesia (IDI)
Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia (PAPDI)
Perhimpunan Reumatologi Indonesia (IRA)
Perhimpunan Osteoporosis Indonesia (PEROSI)
Perhimpunan SLE Indonesia (PESLI)
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Asia Pacific League of Associations for Rheumatology (APLAR)
MUSCULOSKELETAL PAIN :
How to manage it
Is it important ??
Riskesdas 2013
Rheumatic/joint disease prevalence :
Health workers diagnosis : 11,9 %
Symptom-based diagnosis : 24,7 %

Page 3 Balitbangkes Kementrian Kesehatan 2013


PAIN PAIN KILLER
PAIN NSAIDs
Its important about pain !!!

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ILUSTRASI KASUS

Seorang laki-laki datang ke poliklinik


dengan keluhan nyeri pinggang :
Umur 30 tahun, keluhan sejak dua minggu yang lalu
Umur 30 tahun, keluhan sejak tiga bulan yang lalu hilang
timbul, menjalar ke sepanjang tungkai kanan
Umur 30 tahun, keluhan sejak tiga bulan yang lalu
terutama pagi hari, dan membaik dengan aktifitas
Umur 55 tahun, keluhan sejak tiga bulan yang lalu hilang
timbul, terutama saat beraktifitas
Umur 75 tahun, keluhan sejak tiga bulan yang lalu hilang
timbul, terutama saat beraktifitas, riwayat jatuh sebelumnya
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+
What is Pain?
Definition of pain based on IASP
(International Association For The Study Pain)

Pain has been defined as


unpleasant sensory and
emotional experience associated
with actual or potential tissue damage.

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Dureja GP, Journal of Pain Research 2017;10:709-36
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Nociceptive vs Neuropathic Pain
Nociceptive Mixed Type Neuropathic
Pain Caused by a Pain
combination of both
Caused by activity in Initiated or caused by
primary injury and
neural pathways in primary lesion or
secondary effects
response to potentially dysfunction in the
tissue-damaging stimuli nervous system

CRPS*
Postherpetic
Postoperative Trigeminal
neuralgia
pain Arthritis neuralgia

Sickle cell Neuropathic


Mechanical crisis low back pain Central post-
low back pain
stroke pain
Distal
Sports/exercise polyneuropathy
injuries (eg, diabetic, HIV)
*Complex regional pain syndrome
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National Initiative on Pain Control, 2005
PAIN: assessment

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Robert Bruce Salter
3rd Ed. William & Wilkin
General Principles in
musculoskeletal treatment
1. First do no harm (premum non
concern)
2. Base treatment on accurate diagnosis
and prognosis
3. Select treatment with specific aims
4. Cooperate with the laws of nature
Robert Bruce Salter
3rd Ed. William & Wilkin
General Principles in
musculoskeletal treatment
1. First do no harm (premum non
concern)
2. Base treatment on accurate diagnosis
and prognosis
3. Select treatment with specific aims
4. Cooperate with the laws of nature
5. Be realistic and practical in your
treatment
6. Treat the patient as
individually
Pain Management
Goals of Pain Management
o Relieve suffering
o Subjective patient comfort (pain free)
o Inhibiting stress response (stress free)
o Increase functional capacity
o Improve quality of life
o Decrease Morbidity and Mortality

Ways to advocate for Pain Management


o Dont use placebos
o Comprehensive Treatment
o Promote pain education with all disciplines

Note: pain free is not the synonym of stress free


Choice of BENEFIT RISK

NSAID
therapy?? FD/FK (COX
selectivity, etc),
comorbidity

EFFICACY SAFETY

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COX 1 / COX 2 SELECTIVITY OF NSAID

non
COX-2 Pref.
selective COX-2 selective

Pref. COX-1
COX-1 selective

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INJURIOUS
STIMULI
Corticosteroid
Choice of BENEFIT RISK

NSAID
therapy??

Indication,
evidence

EFFICACY SAFETY
RCT of acetaminofen, nsNSAIDs (diclofenac, naproxen,
ibuprofen), and COX-2 selective NSAIDs (lumiracoxib, celecoxib,
etoricoxib) effects in OA treatment etoricoxib 30 mg is likely to
result the greatest improvement in pain and physical function.
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Stam W.B, et al. The Open Rheumatology Journal 2012;6:6-20
Objective. To assess the efficacy, safety, and tolerability of etoricoxib, a cyclooxygenase 2 (COX-2) selective inhibitor, administered
continuously over 52 weeks for the treatment of ankylosing spondylitis (AS).
Methods. This 2-part, multicenter, double-blind, parallel-group, 52-week study evaluated 2 doses of etoricoxib (90 and 120 mg)
compared with naproxen at 1,000 mg. A 6-week, active-comparator and placebo controlled period (part I) was followed by a 46-
In summary, over the 6-week placebo-controlled period, the
week active-comparatorcontrolled period (part II). The primary outcome measures (on 100-mm visual analog scales) were patients
assessment of spine pain, patients global assessment of disease activity, and the Bath Ankylosing Spondylitis Functional Index.
efficacy of the etoricoxib 90 mg and 120 mg dose groups was
Results. Of the 387 patients randomized to receive treatment, 301 (77.8%) completed part I and 284 (75.9%) completed part II.
Compared with placebo over 6 weeks, those receiving 90 mg etoricoxib, 120 mg etoricoxib, and naproxen demonstrated significantly
superior to that of placebo, and over the 1-year active
(P < 0.001) greater improvement in all primary end points; treatment effects (expressed as the difference in least squares mean
change versus placebo) were 2129 mm for spine pain, 1825 mm for disease activity, and 1115 mm for function. Compared with
comparatorcontrolled period, the efficacy of the etoricoxib 90 mg
patients receiving naproxen, significantly greater improvement in all primary end points was demonstrated in the combined group
receiving either 90 mg etoricoxib or 120 mg etoricoxib over 6 weeks, in each individual etoricoxib treatment group over 6 weeks, and
and 120 mg dose groups was superior to that of naproxen.
in the combined etoricoxib group over 1 year (all P < 0.05); results for secondary and exploratory end points were generally
consistent with those from the primary analysis. Among all groups, there were no significant differences in the incidence of overall
Etoricoxib is efficacious and generally safe and well tolerated for
clinical, drug-related, or serious adverse experiences (AEs) and discontinuations due to AEs. Safety observations during part II were
generally consistent with those in part I.
Page 22 the treatment of AS.
BIOEKUIVALEN vs ORIGINATOR

Mean plasma concentration-time profiles of etoricoxib in human subjects (n = 27)


after a single dose oral administration etoricoxib tablets (copy product- Test drug)
and the reference (Reference drug = Originator) : COMPARABLE / SIMILAR

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Putri, RSI et al. 2016. Summary Report of Bioequivalence Study. Data on file
KESIMPULAN

Musculoskeletal pain is still a huge problem in daily


practice
Comprehensive management must be done to get
best result
accessment, diagnostic, treatment
Treatment choice must selected individually,
discuss with your patients
Etoricoxib is one of choices in many
musculoskeletal problem consider efficacy and
safety !
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