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LBM 3

STEP 1
1. Radiograph
Pemeriksaan menggunakan sinyal radio
2. Joint
Sendi : penghubung antar tulang

STEP 2
1. What is the definition of joint?
2. How the Anatomy, fisiology and histology of joint?
3. What is the definition of OA and RA?
4. What are the sign and symptoms of OA and RA?
5. What are the differences of OA and RA?
6. How is the etiology of the scenario?
7. what is the pathogenesis of the scenario?
8. What are the risk factor of the scenario?
9. how are the physical examination of the scenario?
10.What is the treatment from the scenario ?
11.Why the pasient feels stiffness on the knee in the morning?
12.Why is there the cracking sound when the left joint moves?
13.why the patient feel pain and warm on her knee?
14.What is gout disease?

STEP 3
1. What is the definition of joint?
Joint is the connection of bone one and the other that can possible make our
body to move
2. How the Anatomy, fisiology and histology of joint?
Anatomy
Cartilago: layer of bone in the apex

Cavity of joint: cavity between 2 bone


Capsule : cover of joint
Synovial liquid: in cavity of joint
Membrane synovial: covered cavity of joint
Membrane fibrose: outer layer of joint
Bursa : room for synovial liquid
The capability of joint:
Synarthrosis : can not be moved
Example: sutura os cranial
Ampyarthrosis: limited movement
Ex: vertebra, symphisis pubis
Diarthrosis : free movement
Ex: patella, humeri

Histology
Fibrosa joint: can not be moved, ex: sutura, syndesmosis
Cartilage joint: limited movement, top of cartilage covered by hyaline
and strength by ligament
Synovial joint: free movement
Fisiology
Cartilage: smoothen movement between bone and damping
The growth of the bone

3. What is the definition of OA and RA?


OA: osteo Arthritis (PSD: penyakit sendi degenerative) which attack
geriatric , sendi yang sering digunakan, degenerative disease, kerusakan
proteoglikan cartilage, ada osteofit, broken in synovial liquid
primer because idiopatic and genetic
sekunder because etiology of obesity, inflamasi, disfungsi endocrine
RA: autoimun disease, idiopatic , chronic
4. What are the sign and symptoms of OA and RA?

OA:

Stiffness in the morning not more than 30 menit


Predilection is asimetris
Old people more than 60 years
In knee and vertebra hips, carpal

RA:

Stiffness in the morning more than 1 hour


Predilection is simetris
Less than 45 years
The location is in interfalang proximal
Progressive

5. How is the etiology of the scenario?


primer because idiopatic and genetic
sekunder because etiology of obesity, inflamasi, disfungsi endocrine
6. what is the pathogenesis of the scenario?
degenerasi kolagen meningkat metabolism sendi meningkat produksi
hasil degenerasi meningkat berakumulasi di sendi muncul factor
inflamasi
IgF 1 turun TGF beta tidak dapat berfungsi dengan baik IL1 keluar
proteoglikan menurun inflamasi
Uma
7. What are the risk factor of the scenario?
Age : >60 year
Genetic
Obesity
Stress
Gender: in woman is more risk
Trauma
8. how are the physical examination of the scenario?
range of movement (goniometer)

3 steps: look (inflammation), feel (cracking sound), move (keaktifan


gerak)
9. What are the support examinations?
X-ray : to show the change of cartilage
Athroscopy : small camera that put in to joint
Perifer blood: leukocyte (inflammation), LED (RA increase, OA
decrease)
10.What is the treatment from the scenario?
11.Why the pasient feels stiffness on the knee in the morning?
12.Why is there the cracking sound when the left joint moves?
13.why the patient feel pain and warm on her knee?
14.What is gout disease?

STEP 7
1. What is the definition of joint?
Sendi adalah semua persambungan tulang baik yang memungkinkan tulang
tulang tersebut dapat bergerak satu sama lain , maupun tidak dapat
bergerak satu sama lain
Setiawati, Siti dkk. Ilmu Penyakit Dalam jilid III edisi VI, Jakarta: Interna
Publishing
2. How the Anatomy, fisiology and histology of joint?

Anatomy
Cartilago: layer of bone in the apex
Cavity of joint: cavity between 2 bone
Capsule : cover of joint
Synovial liquid: in cavity of joint
Membrane synovial: covered cavity of joint
Membrane fibrose: outer layer of joint
Bursa : room for synovial liquid
The capability of joint:
Synarthrosis : can not be moved
Example: sutura os cranial
Ampyarthrosis: limited movement
Ex: vertebra, symphisis pubis
Diarthrosis : free movement
Ex: patella, humeri

Histology
Fibrosa joint: can not be moved, ex: sutura, syndesmosis
Cartilage joint: limited movement, top of cartilage covered by hyaline
and strength by ligament
Synovial joint: free movement
Fisiology
Cartilage: smoothen movement between bone and damping
The growth of the bone
3. What is the definition of OA and RA?
OA: penyakit sendi degeneratif dimana keseluruhan struktur dari
sendi mengalami perubahan patologis. Ditandai dengan kerusakan
tulang rawan (kartilago) hyalin sendi, meningkatnya ketebalan serta
sklerosis dari lempeng tulang, pertumbuhan osteofit pada tepian sendi,
meregangnya kapsula sendi, timbulnya peradangan, dan melemahnya
otototot yang menghubungkan sendi.

RA: penyakit autoimun yang ditandai oleh inflamasi sistemik kronik


dan progresif, dimana sendi merupakan target utama
Setiawati, Siti dkk. Ilmu Penyakit Dalam jilid III edisi VI, Jakarta: Interna
Publishing
4. What are the sign and symptoms of OA and RA?
OA:
Stiffness in the morning not more than 30 menit
Predilection is asimetris
Old people more than 60 years
In knee and vertebra hips, carpal
RA:

Stiffness in the morning more than 1 hour


Predilection is simetris
Less than 45 years
The location is in interfalang proximal

Setiawati, Siti dkk. Ilmu Penyakit Dalam jilid III edisi VI, Jakarta: Interna
Publishing

5. How is the etiology of the scenario?


Primer : karena idiopatic, kausanya tidak diketahui dan tidak ada
hubungannya dengan penyakit sistemik maupun proses perubahan lokal
pada sendi
Sekunder : karena adanya kelainan endokrin,inflamasi,metabolik,
pertumbuhan, herediter, jejas mikro dan makro serta imobilisasi yang terlalu
lama
Setiawati, Siti dkk. Ilmu Penyakit Dalam jilid III edisi VI, Jakarta: Interna
Publishing
6. what is the pathogenesis of the scenario?

degenerasi kolagen meningkat metabolism sendi meningkat produksi


hasil degenerasi meningkat berakumulasi di sendi muncul factor
inflamasi
IgF 1 turun TGF beta tidak dapat berfungsi dengan baik IL1 keluar
proteoglikan menurun inflamasi

Setiawati, Siti dkk. Ilmu Penyakit Dalam jilid III edisi VI, Jakarta: Interna
Publishing
7. What are the risk factor of the scenario?
Age : >60 year
Gender : pada umur dibawah 45 tahun frekuensi wanita sama dengan
laki2, tetapi di atas 50 tahun, frekuensi wanita lebih banyak daripada
laki2 karena peran hormonal
Suku Bangsa : lebih sering pada orang amerika asli (indian) karena
perbedaan cara hidup dan perbedaan paad frekuensi kelainan
kongenital dan pertumbuhan
Genetic
Kegemukan dan penyakit metabolik
Cedera sendi, pekerjaan, dan olah raga
Kelainan pertumbuhan

Tingginya kepadatan tulang : tulang yang lebih padat tak membantu


mengurangi benturan beban yang diterima oleh rawan sendi, sehingga
tulang rawan sendi lebih mudah robek (orang gemuk dan pelari)
Setiawati, Siti dkk. Ilmu Penyakit Dalam jilid III edisi VI, Jakarta: Interna
Publishing
8. how are the physical examination of the scenario?
Pemeriksaan Radiologis
Untuk mengetahui adanya :
penyempitan celah sendi yang seringkali asimetris
peningkatan densitas (sklerosis) tulang subkondral
Kista tulang
Osteofit pada pinggir sendi
Perubahan struktur anatomi sendi
Pemeriksaan Fisik
Untuk mengetahui adanya :
Hambatan gerak
Pembengkakan sendi Asimetris
Tanda tanda peradangan
Perubahan bentuk pada sendi
Perubahan gaya berjalan
Pemeriksaan Laborat :
Darah Tepi ( Hb, Leukosit, LED )
Pemeriksaan Imunologi
Setiawati, Siti dkk. Ilmu Penyakit Dalam jilid III edisi VI, Jakarta: Interna
Publishing
9. What are the support examinations?
X-ray : to show the change of cartilage
Athroscopy : small camera that put in to joint
Perifer blood: leukocyte (inflammation), LED (RA increase, OA
decrease)

10.What is the treatment from the scenario?


Terapi non farmakologis :
o Edukasi atau penerangan
o Terapi fisik dan rehabilitasi
o Penurunan berat badan
Terapi farmakologis :
o Analgesik oral non opiat
o Analgesik topikal
o OAINS (obat anti inflamasi non steroid)
o Chondroprotective
o Steroid intra-artikular
Terapi Bedah
Setiawati, Siti dkk. Ilmu Penyakit Dalam jilid III edisi VI, Jakarta: Interna
Publishing

11.Why the pasient feels stiffness on the knee in the morning?


12.Why is there the cracking sound when the left joint moves?
Karena cairan sinovial lama-lama habis sehingga mengakibatkan gesekan
pada kedua permukaan tulang sendi
Setiawati, Siti dkk. Ilmu Penyakit Dalam jilid III edisi VI, Jakarta: Interna
Publishing
13.why the patient feel pain and warm on her knee?
14.What is gout disease?
Arthritis Pirai ( gout) merupakan penyakit akibat disposisi Kristal
monosodium urat pada jaringan atau akibat perubahan kadar asam urat
dalam serum meninggi ataupun menurun. Penurunan urat serum dapat
mencetuskan pelepasan Kristal monosodium urat dari deposit nya dalam tofi
( crystal shedding ) .Peradangan pada arthritis gout adalah akibat
penumpukan agen penyebab yaitu kristal monosodium urat pada sendi
.mekanisme peradangan ini belum diktehui secar pasti . hal ini diduga oleh
peranan mediator kimia dan selular.

Setiawati, Siti dkk. Ilmu Penyakit Dalam jilid III edisi VI, Jakarta: Interna
Publishing