OSTEOARTHRITIS

NURUL MAGFIRAH RUSLI (C11113564)

HASNI PENGGENG (C11112)
SITI HARTINA INDAH (C11113563)
Residen : Dr. NITHA
Supervisor: Dr. dr. Faridin HP, Sp.PD,KR
 CASE STUDY
A man 56 y.o consul to the rheumatology with complaints
of pain in both knees especially on his left knee. Have long
felt pain for approximately 10 years but getting worse on 1
last month. Pain feels like being stabbed. When the pain
appears ordinary patients taking herbs (as anti-pain) and
the patient feels pain was reduced. The patient feels pain
when walking and feeling preferably at rest, but the last 1
month although patients feel knee pain at rest. Stiffness on
knee, especially in the morning.
No history of diabetes melitus, hepatitis or coronary
disease. History of hypertension denied, but the past few
days tension increase. No history in family with same
complain.
From physical examination swelling, enlargement and
crepitation can be found on knee.
 Physical examination
General description :
Moderate illness/ normal nutrition / compos mentis(E4M6V5)

Vital signs :
Blood Pressure : 140/100 mmHg
Heart Rate : 80x /minute
Respiratory Rate : 18x /minute
Temperature : 36.2o C
Head :
Expression : Pain
Eye : pallor conjunctiva (-), Icteric sclera (-)
Neck : DVS R+1 cmH2O, no enlargement of lymph nodes
 CHEST EXAMINATION
Inspection : Symmetrical. Ictus cordis is not visible
Palpation : no mass/tenderness, apex palpable,
thrill not palpable
Percussion : normal heart size, liver border at ICS VI
Auscultation :
Lung : vesicular breath sound
Rhonchi -/- Wheezing -/-
Heart : S1 S2 regular, no murmur
 ABDOMINAL EXAMINATION

Inspection : follows breath movement

Auscultation : Peristaltic sound (+), normal
Palpation : No mass/tenderness, liver and
spleen are no palpable
Percussion : Tympani (+), ascites (-)
 RHEUMATOLOGY STATUS
Gait : Arthalgia
Arm : normal
Leg : Genu sinistra warm (+), efusi
(+), crepitation (+), swelling
(+), ROM limitation (+), bone
enlargement (+).
Genu dextra : pain (+), warm (-), efusi (-),
crepitation (-)
Spine : normal
 Laboratorium examination
PARAMETER RESULT NORMAL VALUE UNIT
WBC 15,3 4.0 10.0 10^3 /uL
RBC 3,86 4.0 6.0 10^6 /uL
HGB 8,2 13.0 16.0 g/dL
HCT 31 37.0 48.0 %
MCV 80 80-97.0 Gr/dL
MCH 25 26.5-33.5 pg
MCHC 31 31.5-35.0 fl
PLT 341 150 - 500 10^3 u/L
PCT 0,19 0.15 0.50 %
Neutrophil 70,5 52.0-75.0 %
Lymphocyte 20,9 20.00-40.00 %
Monocyte 5,5 2.00-8.00 10^3 /uL
Eosinophil 2,7 1.00-3.00 10^3 /uL
Basophil 0.03 0.00 01.0 10^3 /uL
 Laboratorium examination
Parameter Result Normal Value Unit
SERUM URIC ACID 11.2 2.4-5.7 Mg/dL
 RADIOLOGIC

X-Ray Genu :
Osteoarthritis genu sinistra grade II
 DIAGNOSIS
DIAGNOSTIC CLASIFICATION Man
OSTEOARTHRITIS : secondary 56 Years old
osteoarthritis due to
hyperuricemia. Based on case study,
this patient suffered
Joint pain + at least 3 of 6 criteria pain on knees
1. Crepitus Stiffness <15
second
2. Stiffness < 30 minutes
Enlargement of
3. > 50 years old knee joint
4. Enlargement of knees joint crepitus
5. Palpable pain
6. Absent of tenderness on
synovial joint
DIAGNOSIS : OSTEOARTHRITIS
 RELATED PROBLEMS

Normocytic
normochromic Anemia
Intercritical phase ec. Suspect chronic
GOUT disease
no pain on MTP 1 right Based on physical
now, there was history of examination patient of
pain on MTP 1, level of case study, has pallor
serum uric acid 11,2. conjungtiva.
Laboratory examination :
Plan: allopurinol HGB = 9,6 g/dL
100mg/24 hours/oral
Plan:
peripheral blood smear
Treat the underlying
disease
 Therapy
Farmacology : Non Farmacology :
Paracetamol 1 Patient education.
gram/8hours/oral Exercises - increase tendons
capacity and muscle to
Injection intraarticular genu absorb stress during joint
dextra (triamcinolone motion.
acetonide 40mg) Lifestyle modifications.
Synovial fluid aspiration (genu Weight managements:
dextra) especially patient with
obesity
- Low Purin diet
Planning :
Genu dextra X-Ray
Synovial fluid analysis
LED
 DIFFERENTIAL DIAGNOSIS

Osteoathritis Rheumatoid Arthritis Gout Arthritis

Etiology Degenerative disorder arising Autoimmune reaction Caused by
from biochemical breakdown of of unknown cause, monosodium urate
articular (hyaline) cartilage in leading to synovial monohydrate crystals
synovial joint hypertrophy and
chronic joint
inflammation
Age > 60 y/o 35 - 45 y/o > 35 y/o
Gender Female = Male Female > Male Female > Male
Joints Large joints (ankles, knees, Small joints (PIP, MCP, Often on MTP,
abnormality elbows, wrists), asymmetries MTP), symmetrical asymmetries
and bilateral
Systemic No Yes Yes
symptoms
 DIFFERENTIAL DIAGNOSIS

Osteoathritis Rheumatoid Arthritis Gout Arthritis

Signs and < 30 minutes morning > 1 hour Podagra

symptoms stiffness morning (gouty
Crepitus stiffness inflammation
Enlargement of knees Overly of the great
joint swollen, toe)
Palpable pain warm joints Single (most
Difficulty performing Constitutiona common) or
daily activities l symptoms multiple
Difficulty joints
performing Signs of
daily inflammation
activities
DISCUSSION
 Definition
is a progressive disorder of the joints caused by
gradual loss of cartilage and resulting in the devel
opment of bony spurs and cysts at the margins
of the joints. The name osteoarthritis comes from
three Greek words meaning bone, joint, and infla
mmation.
 Risk Factor
Family history
Age ( > 50 years)
Gender (> women)
Previous injury
Obesity
Certain occupations
Other types of arthritis (Gout)
Pathophysiology
Kellgren-Lawrence Classification
 DIAGNOSTIC CRITERIA
Osteoarthritis Classification Diagnosis; Knee
Osteoarthritis ICD 10 code: M17
Based on clinical criteria
Joint pain + at least 3 of 6 criteria
1. Crepitus
2. Stiffness < 30 minutes
3. > 50 years old
4. Enlargement of knees joint
5. Palpable pain
6. Absent of tenderness on synovial joint
Based on clinical criteria and radiology
Pain on knee joint and osteophytes at least 1 of 3 criteria
Stiffness< 30 minutes
Age> 50 minutes
Crepitating on active motion

Based on clinical criteria and laboratory investigation.

Pain on knee joint & at least 5 from 9 criteria below:
Age > 50 y/o
Stiffness< 30 minutes
Crepitating on active motion
Tenderness around joint
Bone enlargement
No warmness on affected synovial joint
LED< 40 mm/hour
Synovial fluid analysis
 MANAGEMENT THERAPY
Rehabilitation and supportive measures.
Patient education.
Exercises - increase tendons capacity and muscle to absorb stress
during joint motion.
Lifestyle modifications.
Weight managements: especially patient with obesity
Drug therapy/pharmacology
Acetaminophen 1 g P.O/ 8 hours
may relieve pain.
NSAIDs (not given to this patient)
to treat inflammation.
Tramadol
Synthetic hyaluronans - 1 injection over 6 months
Melena : Proton pump inhibitor (PPI)
THANK YOU.