Lecture Farmaco 31/08

Artristis bukan Cuma disebabkan oleh inflamasi. Ada karena infeksi -> septic
arthritis (virus, fungi, bacteria), trauma, asam urat.
OSTEOARTHRITIS

Penyakit degenerative, bisa disertai inflamasi di fase akut, tapi mostly timbul
karena usia, proses kebiasaan yg merusak sendi.
Symptoms khas : nyeri dan kerusakan sendi di jaringan cartilage. Sifatnya
progresif. Which means, kalo treatment ga tepat, bakal trs progress dan
merusak seluruh articular cartilage
Ada 3 perubahan : pd articular cartilage, subchondral bone, osteophytes.
Bisa didapat dr radiologi dan aspirasi synovial fluid.
Ada cyst -> hyperactivity dr osteophytes

Risk Factor :

Definitive
1. Age
2. Gender
3. Obesity
4. Heavy trauma di lutut
5. Major knee injury
6. Gangguan sirkulasi di daerah extremity
7. Inflammatory joint disease
Problems
8. Occupational
9. Knee bending/lifting
Possible
1. Running
2. Rokok (-)
3. Osteoporosis
4. Estrogen therapy
5. Physic therapy

Site lain OA : hip, lower back, neck -> semutan smp ke tangan.
Penyebabnya : gerakan repetitive dlm jangka panjang yg beresiko/rawan untuk
sendi.
ACR Classification :

Hip
1. Hip pain and at least
2. ESR diatas 20 mm/hr
3. Osteophytes on xr femoral / acetabular
4. Joint space narrowing di XR
Knee
1. Knee pain + XR osteophytes + 1 of fllowing
2. Age diatas 50

3. EMS dibawah 30
4. Crepitus
Second line OA :
1. Kalo Paracetamol fail, ganti pake NSAID
2. Intra-articular agents
3. Opioid.
Third line OA :
1. Arthroscopy
2. Osteotomy
3. Total joint replacement
Symptoms modifying : mengurangi symptoms -> analgesic, paracetamol
Disease modifying : menghambat progressivity disease (SYSADOA)
Symptomatic (Fast Effect)

Per oral :

Analgesic

Simple Analgesic : Paracetamol (acetaminophen)

Combination Analgesic : - Paracetamol + Codeine

- Paracetamol + Ibuprofen

NSAID :Conventional

: Aspirin, Sodium Diclofenac, Ketoprofen

Cox 2 selective inhibitor : Celecoxib, Etoricoxib, Valdecoxib, Parecoxib

Rofecoxib, Lumiracoxib (Withdrawal from market)

Opioid Analgesic

Intra-articular injection

Corticosteroid : triamcinolone hexacetonide, dexamethasone,

methylprednisolone

Suntik intra articular

Mechanism of action is unknown, however:

Inhibit accumulation of inflammatory cell lines

Reduction of prostaglandin synthesis

Inhibit leukocyte secretion from synovial cells

Decrease interleukin secretion by the synovium

Increase viscosity of synovial fluid

3 bulan minimal, dibawah 3 merusak cartilage. 6 maksimal

Bisa menimbulkan atrofi

Orang RA yang RF nya + mempengaruhi quality of life & life expectancy

Tempat inflamasi pertama ada di synovial membrane, invasi ke tulang.
Systemic, bukan local di sendi.
Tanda inflamasi terlihat dominan -> KDRT
Ada psoriasis -> penebalan

RA

Treatment

1.
2.
3.
4.
5.
6.
7.

1.
2.
3.

Nonpharmacologic treatment
Education and emotional factors controlling
Physical and occupational therapies
Systemic and articular rest
Appropriate exercise
Heat and cold modulation
Assistive devices like splints, canes, raised toilet seat and/or crutches or
walker
Weight loss
Pharmacology
Nonsteroidal Anti-inflammatory agents like aspirin: usually given in a dose of
1 gram three to four times per day.
NSAID : merusak ginjal, lambung, nerve 8 -> jd pennitus
DMARD :
Corticosteroid -> systemic, IM/IV, oral. Ga boleh kelamaan

If patients develop tinnitus, a common side effect, the dose should be reduced by
0.6-0.9 grams every 3 days until the patient improves.
Enteric coated aspirin may be associated with less GI distress/ulcus.
Pancytopenia : menurunkan sel darah.