Subbagian Reumatologi
Bagian Ilmu Penyakit Dalam
FK Unand/RSUP dr. M. Djamil Padang
Definisi
Penyakit Autoimun
Articular/hyaline cartilage
-acts as a shock absorber
- allows for friction-free movement
- not innervated!
Synovial membrane/synovium
-secretes synovial fluid
-nourishes cartilage
-cushions the bones (Day et al., 2010; Cartilage Health, 2008)
Synovitis causes the
Erosions and Juxta
articular osteopenia
Pamela E. Prete MD
What is the evidence for genetic
factors in Rheumatoid arthritis?
1970s association with
HLA DR4
In all populations, RA
susceptibility is in the
shared epitope
Pamela E. Prete MD
Rheumatoid arthritis Systemic
autoimmune / auto inflammatory
disease--
How does RA affect all
these organ systems ?
By causing
1. Synovitis
2. Serositis
3. Nodules
4. Vasculitis
5. Autoantibodies
Pamela E. Prete MD
A chronic autoimmune disease characterized by the inflammation of the synovial joints
(The Arthritis Society, 2012; Gulanick & Myers, 2011; Firth, 2011)
Symptoms
Morning stiffness lasting
more than half an hour
Simultaneous symmetrical
joint swelling
Not relieved by rest
Fever
Weight loss
Fatigue
Anemia
Lymph node enlargement
Nodules
Raynauds phenomenon
(The Arthritis Society, 2012; Firth, 2011; Oliver, 2010; Day et al., 2010)
Diagnosis
Skor > 6
Sendi yang terkena : bukti sinovitis secara
pencitraan
Tidak masuk kategori : DIP, CMC I, MTP I
LES
Artritis reaktif
Diagnosis
No single test is specific to Rheumatoid Arthritis
CBC
Radiographs of involved joints
CT/MRI scans
Direct arthroscopy
Synovial/Fluid aspirate
Synovial membrane biopsy
Arthrocentesis
Benefits
Minimally invasive
Less tissue damage
Fewer complications
Reduced pain
Quicker recovery time
Outpatient basis
(American Academy of Orthopaedic Surgeons, 2012; Day et al., 2010)
Synovial/Fluid aspirate
Synovial membrane biopsy
Arthrocentesis
Athrocentesis: synovial fluid is aspirated and analysed for inflammatory components
X-rays are an important diagnostic test for monitoring the disease progression
Edukasi
Latihan/Program rehabilitasi
Pengobatan : DMARD, agen biologik, Steroid,
OAINS
Pembedahan
Edukasi :
1. Penjelasan penyakit
AR, perjalanannya, prognosis, pengobatan
Walking
4 times a week for
Light jogging
30 minutes Water aerobics
Cycling
Yoga
Tai chi
stretching
Terapi Psikologis
(Walker, 2012; Gulanick & Myers, 2011; The Arthritis Society, 2011; Firth, 2011)
Medications
DAS 28
Nilai nyeri dan pembengkakan 28 sendi
LED , CRP , VAS
Kriteria remisi ACR 1987
Peran Dokter Umum
Pamela E. Prete MD
PIP Swelling
Ulnar Deviation, MCP Swelling,
Left Wrist Swelling
Rheumatoid nodules?
Occur over extensor
tendons
Elbow most common
Firm nodule -0.3-1cm
Occur with disease
activity
Can occur anywhere
Have a characteristic
pathology
Pamela E. Prete MD
Pamela E. Prete MD
Nodules
TERIMA KASIH