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 Consensus definition of OA
OA disease are manifested by morphologic, biochemical,
molecular, and biomechanical changes of both cells and
matrix which lead to a softening, fibrillation and
eburnation of sub-chondral bone, osteophytes, and sub-
chondral cysts.

Clinically evident characterized by joint pain, tenderness,

limitation of movement, crepitus, occasional effusion, and
variable degrees of inflammation without systemic effect.

Kuettner KE, et al. Am Acad Orthop Surg,1999

 Osteoarthritis principally affects
weight-bearing joints in the knees and
hips.
Also affects the feet, ankles, distal
interphalangeal joints, proximal
interphalangeal joints, first
carpometacarpal joints, cervical spine,
and lower spine

APS. Guideline for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis. 2nd ed. Glenview, Ill:
American Pain Society; 2002.
Distribution of OA of the hands
Swanson AB, Swanson G. Clin Rheum Dis 1985
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distribusi

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 Sendi Normal dan Perubahannya Pada OA

Tulang subkhondral
Tekstur tulang menebal dan ireguler,
subkhondral normal
tampak sklerostik dan
pembentukan kista
Rawan sendi Kapsul mengalami
normal, tebal dan fibrosis, distorsi dan
rata penebalan

Fibrilasi, kerusakan dan

berkurangnya volume
Ujung tulang rata
rawan sendi
Sinovium normal
dengan selapis sel Sinovitis kronik
tunggal

Pertumbuhan osteofit,
Kapsul sendi tebal dan penebalan jaringan
ikat lunak

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 Common symptoms and sign of OA

Symptoms Signs

Pain Crepitus
Stiffness Restricted movement
Alteration in shape Tenderness - joint line
Functional impairment - periarticular
+ anxiety, depression Bony swelling
Deformity
Muscle wasting / weakness
+ effusions, increased warmth
+ instability

OReilly S, Doherty M. in OA Oxford Press 1998

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Osteoartritis sendi lutut

Kista subkondral

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 OARSI recommendations
for the management of hip and knee OA
1. Optimal management of OA requires a combination of
non-pharmacological and pharmacological modalities.
SOR: 96% (95% CI 93-99)
2. Patients with hip and knee OA should be encouraged to
undertake, and continue to undertake, regular aerobic,
muscle strengthening and range of motion exercises.
SOR: 96% (95% CI 93-99)
3. Patients with hip and knee OA, who are overweight,
should be encouraged to lose weight and maintain their
weight at a lower level. SOR: 96% (95% CI 92-100)
 OARSI recommendations
for the management of hip and knee OA

4. Acetaminophen can be an effective initial oral analgesic

for treatment of mild to moderate pain in patients with
knee or hip OA. In the absence of an adequate
response, or in the presence of severe pain and/or
inflammation, alternative pharmacologic therapy
should be considered based on relative efficacy and
safety, as well as concomitant medications and
comorbidities. SOR: 92% (95% CI 88e99)
5. In patients with symptomatic hip or knee OA, non-
steroidal anti-inflammatory drugs (NSAIDs) should be
used at the lowest effective dose but their long-term
use should be avoided if possible. SOR: 93% (95% CI
88e99)
 OARSI recommendations
for the management of hip and knee OA

6. Intra-articular (IA) injections with corticosteroids can

be used in the treatment of hip or knee OA, and should
be considered particularly when patients havemoderate
to severe pain not responding satisfactorily to oral
analgesic/anti-inflammatory agents and in patients with
symptomatic knee OA with effusions or other physical
signs of local inflammation. SOR: 78% (95% CI 61e95)
Injections of IA hyaluronate may be useful in patients
with knee or hip OA. They are characterised by delayed
onset, but prolonged duration, of symptomatic benefit
when compared to IA injections of corticosteroids. SOR:
64% (95% CI 43e85)
 Chronic systemic autoimmune inflammatory
disease , especially affected small joint, leading to
joint destruction and disability
Joint destruction mostly in first 2 year
Early aggressive treatment with DMARDs is
needed to achieve the greatest effect on long term
outcome
Prevalence: - 1 % (USA)
- 0.2 - 0.6 % (Asia)
Female : male = 3 : 1
 Inflamed
Synovial NORMAL RA synovial
membrane membrane

Major cell types:

T lymphocytes
macrophages
Pannus
Cartilage Minor cell types:
fibroblasts
plasma cells
endothelium
dendritic cells

Synovial Major cell type:

Capsule fluid neutrophils

Cartilage thinning
Adapted from Feldmann M, et al. Ann Rev Immunol. 1996;14:397-440;
Pincus T. Drugs. 1995;50(suppl 1):1-14; Tak P, Bresnihan B. Arthritis Rheum. 2000;43:2619-2633.
 Remission
1. Pain control
2. Maintan joint fuction for essential and daily
activity
3. Optimize QOL
4. Prevent or inhibit joint destruction
 Education
Non pharmacologic : diet, exercise,
rehabilitation
Pharmacologic :
NSAIDs
DMARD :
Conventional
Biologic
Glucocorticoid
Surgery
Others
 The NSAIDs are used to modify the symptoms of RA.
The use of NSAIDs is recommended at disease onset,
when a new DMARD is introduced, and occasionally
when uncontrolled isolated symptoms persist despite
good response to a DMARD.
The need for continuous use of NSAIDs in a patient with
RA should be interpreted as inadequate control of
inflammatory activity and should, therefore, lead to
reassessment of the DMARD regimen.
 All NSAIDs should be used at the full dose for at
least 1 week before considering the treatment to
have failed. Once symptoms have been controlled,
the minimum effective dose should be used.
There is no evidence that some NSAIDs are better
than others, but vary in their potential
gastrointestinal, liver and cardio-renal toxicity;
therefore, when choosing the agent and dose,
healthcare professionals should take into account
individual patient risk factors