CURRICULUM VITAE

DR. Dr. NYOMAN KERTIA SPPD-KR

LAHIR DI: BALI 16 SEPTEMBER 1960

RIWAYAT PENDIDIKAN
1987 DOKTER UMUM UNIV. UDAYANA
1998 INTERNIST UNIV. GADJAH MADA
1999-2001 PENDIDIKAN RHEUMATO - IMMUNOLOGY &
PHYTOPHARMACY ROYAL PERTH HOSPITAL
UNIVERSITY OF WESTERN AUSTRALIA
2000 KURSUS AKUPUNTUR DI BEIJING - CINA
2002 KONSULTAN REUMATOLOGI
2009 LULUS DOKTOR DI UNIVERSITAS GADJAH MADA

RIWAYAT PEKERJAAN
19998-2000 : PENELITI OBAT TRADISIONAL BADAN LITBANGKES DEPKES RI
2001-2004 : KEPALA BIDANG RISET KLINIK
PUSAT STUDI OBAT TRADISIONAL UNIV. GADJAH MADA
2003 SEKARANG : KEPALA. SUB.BAG. REUMATOLOGI
BAG IPD, FK-UGM / RS. DR. SARDJITO YOGYAKARTA
2004-2006 : PENELITI ETNOMEDICINE DAN OBAT ASLI INDONESIA
BADAN PENGAWAS OBAT DAN MAKANAN RI
2004- SEKARANG: STAF PENGAJAR FITOFARMAKA
FAKULTAS KEDOKTERAN UNIVERSITAS GADJAH MADA
2008-SEKARANG: KETUA TIM KEDOKTERAN HERBAL RSUP DR SARDJITO
2008-SEKARANG: KEPALA SENTRA PENGEMBANGAN DAN PENERAPAN
PENGOBATAN TRADISIONAL PROPINSI DAERAH ISTIMEWA
YOGYAKARTA
2010SEKARANG: KETUA KOMISI II DEWAN RISET DAERAH DIY
2010SEKARANG: ANGGOTA KOMISI NASIONAL SAINTIFIKASI JAMU

ORGANISASI
IDI, PAPDI, IRA, APLAR
IPS (Indonesian Pain Society)
IASP(International Association for the Study of Pain)
Gout arthritis
Cardinal signs of
inflammation

Vascular reaction,
immunologic (cellular)
 SPECTRUM OF GOUT
JOINT
Asymptomatic Hyperuricemia
Acute Gout Arthritis
Intermittent phase
Chronic tophaceus gout tophy
URINARY TRACT
Uric Crystal Deposition in the kidney parenchymal
Uric nephropaty
Urolitiasis

ACRFP
ACRFP
THERE ARE RELATIONSHIP
BETWEEN GOUT AND:
Alcoholism
Dislipidemia
Hypertension
Urolithiasis
Kidney diseases
Myeloproliferative Disorder
Family story

ACRFP
 ACUTE GOUT ARTHRITIS
- hyperuricemia
- the most common: first mtp
- affected the mtps
- red colour of the joint
- mostly just one joint
- most severe in the first day
- monosodium urate crystal
- recurrent
- tophy
- assymetric
- sub.cortical cyst
- no microorganism in the synovial fluid
the patient has acute gout if at least six of these criteria are
satisfied.
DIFFERENTIAL DIAGNOSIS

Pseudogout
Septic Arthritis
Reactive arthritis
Trauma
Autoimune arthritis

ACRFP
PSEUDO GOUT
MOSTLY AFFECTED LARGE JOINTS EG. KNEE
THE CRYSTAL IS PYROPHOSPHAT DEHYDRATE
COMMONLY FOUND IN ELDERLY
THE CLINICAL SIGNs AND SIMPTOMs SOME TIME
CONFUSING TO GOUT ARTHRITIS
SEPTIC ARTHRITIS
 REACTIVE ARTHRITIS
(E.G. REITERS DISEASE)
 MANAGEMENT OF GOUT ARTHRITIS

NSAID, colchicine, corticosteroid, arthrocyntesis

Intra articular costicosteroid
Change the lifestyle
Concomitant diseases treatment
Avoid the triggering factors
Maintain the normal uric acid level in the blood
Prophylactic treatment to prevent the acute phase

ACRFP
AUTOIMUNE ARTHRITIS
RHEUMATOID ARTHRITIS
SYSTEMIC LUPUS ERYTHEMATOSUS
SERONEGATIVE SPONDYLOARTHROPATY
RHEUMATOID ARTHRITIS
Chronic erosive synovitis
Poly-arthritis, potentially disabling
More frequent in female
Extra articular manifestation --
considered to be a systemic
autoimmune disease

ACRFP
SOME DISEASE-MODIFYING
ANTI-RHEUMATIC DRUGs (DMARDs)

DMARDs SHOULD BE MONITORED

Methotrexate
Haematologic, liver, lung
Hydroxychloroquine
Ofthalmologic
Sulphasalazine
Haematologic, GI
Leflunomide
Azathioprine Haematologic, liver
Cyclosporine Haematologic, liver
Gold Kidney, Blood pressure
Haematologic, kidney
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
 MALAR RASH
1.
2. DISCOID RASH
3. PHOTOSENSITIVITY
4. ORAL ULCER
5. ARTHRITIS
6. SEROSITIS
7. RENAL DISORDER
8. NEUROLOGIC DISORDER
9. HEMATOLOGIC DISORDER
10. IMMUNOLOGIC DISORDER
11. ANTINUCLEAR ANTIBODY

A person must have SLE if any four or more of the 11 criteria are present
 ANALGESIA
ANTI-INFLAMMATORY
*CORTICOSTEROID
*NON STEROIDAL ANTI-INFLAMMATORY DRUGS
IMMUNOSUPPRESANT
OCCUPATIONAL THERAPY
PHYSIOTHERAPHY
PSYCHOTERAPHY
 Rasio Selektivitas Cox2/Cox1
Drug Rasio Cox2/Cox1
Piroxicam 250
Acetylsalicylic acid 175

Selektif Cox 2 Selektif Cox 1

Indomethacin 60
Ibuprofen 15
Paracetamol 7.4
Sodium salicylate 2.8
Carprofen 1
Meloxicam 0.8
Diclofenac 0.7
Naproxen 0.6
Nimesulide 0.1
IC50 Value (mol/L) of NSAIDs on COX-2 or COX-1 activity in intact cells
Adapted from Vane, J.R.
 Hambatan pada COX

COX-1 COX-2 Highly

Selective Selective/Specific

- Efek samping G.I.besar + Efek samping G.I.lebih

+ Efek Cardioprotektif: minimal
Contoh: efek Aspirin - Resiko Cardio/Cerebro
pd Thromboxan (TXA2) vascular meningkat
+ Efek anti inflamasi dan Preferentially - Lebih bersifat analgesik
analgesik sama kuat COX-2 Selective
+ Efek samping G.I.Minimal
+ Resiko Cardio/Cerebro
vascular minimal
+ Efek anti inflamasi dan
analgesik sama kuat
DIKLOFENAK
 Weighing the Benefits and the Risks: COX
inhibitors
platelet
aggregation
COX-1
inhibitor
fewer heart attack Bleeding

platelet
bleeding
aggregation

Bleeding
more heart attack
COX-2
inhibitor
platelet
aggregation

Imagine the pain
LINE SCALES FOR THE SUBJECTIVE OR OBJECTIVE
ASSESSMENT OF PAIN

Hamill-Ruth RJ, Marohn L : Crit Care Clin, vol 15, No.1 : 1999 35-57
Wong/Baker Faces Pain Scale
Which Face Shows How Much Hurt You Have Now?

0 1 2 3 4 5
No Hurt Hurts Hurts Hurts Hurts Hurts
Little Bit Little More Even More Whole Lot Worst

Wong DL, Baker CM. Pain in Children. Pediatr Nurs 1988; 14: 9-17
THANK YOU