Manifestasi Klinis dan

Penatalaksanaan Osteoartritis
Yulia Dewi Pratiwi
1610211122
 Manifestasi Klinis
1) Nyeri sendi (recurring pain or tenderness in joint)
Keluhan nyeri merupakan keluhan utama yang seringkali membawa penderita ke
dokter, walaupun mungkin sebelumnya sendi sudah kaku dan berubah bentuknya.
Biasanya nyeri sendi bertambah dikarenakan gerakan dan sedikit berkurang
bila istirahat.
Nyeri pada osteoarthritis dapat menjalar kebagian lain, misal osteoarthritis pinggang
menimbulkan nyeri betis yang disebut sebagai claudicatio intermitten.
Korelasi antara nyeri dan tingkat perubahan struktur pada osteoarthritis sering
ditemukan pada panggul, lutut dan jarang pada tangan dan sendi apofise spinalis.
2) Kekakuan (stiffness)
Pada beberapa penderita, kaku sendi dapat timbul setelah duduk lama di kursi, di
mobil, bahkan setelah bangun tidur. Kebanyakan penderita mengeluh kaku setelah
berdiam pada posisi tertentu.
Kaku biasanya kurang dari 30 menit.


3) Hambatan gerakan sendi (inability to move a joint)

Kelainan ini biasanya ditemukan pada osteoarthritis sedang sampai berat.
Hambatan gerak ini disebabkan oleh nyeri, inflamasi, sendi membengkok,
perubahan bentuk. Hambatan gerak sendi biasanya dirasakan pada saat berdiri
dari kursi, bangun dari tempat berbaring, menulis atau berjalan.
Semua gangguan aktivitas tergantung pada lokasi dan beratnya kelainan sendi
yang terkena.
4) Bunyi gemeretak (krepitasi)
Sendinya terdengar berbunyi saat bergerak.
Suaranya lebih kasar dibandingkan dengan artritis reumatoid dimana
gemeretaknya lebih halus.
Gemeretak yang jelas terdengar dan kasar merupakan tanda yang signifikan.
 .

5) Pembengkakan sendi (swelling in a joint)

Sendi membengkak / membesar bisa disebabkan oleh radang sendi dan
bertambahnya cairan sendi atau keduanya.
6) Perubahan cara berjalan atau hambatan gerak
Hambatan gerak atau perubahan cara berjalan akan berkembang sesuai dengan
beratnya penyakit. Perubahan yang terjadi dapat konsentris atau seluruh arah
gerakan maupun eksentris atau salah satu gerakan saja (Sudoyono, 2009).
7) Kemerahan pada daerah sendi (obvious redness or heat in a joint)
Kemerahan pada sendi merupakan salah satu tanda peradangan sendi. Hal ini
mungkin dijumpai pada osteoarthritis karena adanya sinovitis, dan biasanya
tanda kemerahan ini tidak menonjol dan timbul belakangan (Sudoyono,
2009)
 Penatalaksanaan

Osteoarthritis is a chronic (long-term) disease. There is no cure,

but treatments are available to manage symptoms. Long-term
management of the disease will include several factors:
Managing symptoms, such as pain, stiffness and swelling
Improving joint mobility and flexibility
Maintaining a healthy weight
Getting enough of exercise
Supportive therapies to help make everyday activities
easier.
In a few cases, where other treatments haven't been helpful,
surgery to repair, strengthen or replace damaged joints may also
be considered
 Non-farmakologi

Changes Lifestyle
Exercise
Exercise is one of the most important treatments for people with osteoarthritis,
whatever your age or level of fitness. Your physical activity should include a
combination of exercises to strengthen your muscles and exercises to improve your
general fitness.
If osteoarthritis causes you pain and stiffness, you may think exercise will make your
symptoms worse.
However, regular exercise that keeps you active, builds up muscle and strengthens
the joints usually helps to improve symptoms.
Losing weight
Being overweight or obese often makes osteoarthritis worse as it can place some of
your joints under increased strain.
If you're overweight, try to lose weight by doing more physical activity and eating a
healthier diet.
 Farmakologi

Painkillers:
Paracetamol
If you have pain caused by osteoarthritis, your GP may suggest taking
paracetamol to begin with.
However, when taking paracetamol, always follow the dosage your GP
recommends and don't exceed the maximum dose stated on the pack.
Non-steroidal anti-inflammatory drugs (NSAIDs)
If paracetamol does not effectively control the pain of your osteoarthritis, your
GP may prescribe a stronger painkiller.
NSAIDs are painkillers that work by reducing inflammation. There are two
types of NSAID and they work in slightly different ways:
traditional NSAIDs such as ibuprofen, naproxen or diclofenac
COX-2 inhibitors often called coxibs such as celecoxib and etoricoxib
Some NSAIDs are available as creams (topical NSAIDs) that you apply directly to
the affected joints.
They can be particularly effective if you have osteoarthritis in your knees or hands.
As well as helping to ease pain, they can also help reduce any swelling in your joints.
NSAID tablets may not be suitable for people with certain conditions, such as
asthma, a peptic ulcer or angina, or if you have had a heart attack or stroke.
If your GP recommends or prescribes an NSAID to be taken by mouth, they'll
usually also prescribe a medicine called a proton pump inhibitor (PPI) to take at
the same time.
NSAIDs can break down the lining in your stomach that protects it against
stomach acid. PPIs reduce the amount of acid produced by the stomach,
reducing the risk of damage to your stomach lining.
COX-2 drugs have a lower risk of causing stomach problems, but still need to be
used with a PPI if you take them regularly.


Opioids
Opioids, such as codeine, are another type of painkiller that may ease your pain if
paracetamol does not work.
Opioids can help relieve severe pain, but can also cause side effects such as
drowsiness, nausea and constipation.
Capsaicin cream
Capsaicin cream works by blocking the nerves that send pain messages in the
treated area.
Don't use capsaicin cream on broken or inflamed skin and always wash your hands after
applying it.
Be careful not to get any capsaicin cream on delicate areas, such as your eyes, mouth,
nose and genitals.
Capsaicin is made from chillies, so if you get it on sensitive areas of your body, it's likely to
be very painful for a few hours. However, it won't cause any damage.
You may notice a burning sensation on your skin after applying capsaicin cream.
But avoid using too much cream or having a hot bath or shower before or after applying it,
because it can make the burning sensation worse.


Corticosteroid injections
You may be able to have a type of treatment where medicine is injected into the joints
affected by osteoarthritis. This is known as intra-articular injection.
If you need intra-articular injections, it's likely that you'll have injections of corticosteroid, a
medicine that reduces swelling and pain.
If you get a prolonged response to the injection, it may be repeated. Ideally, you should
have no more than three corticosteroid injections a year, with at least a three-month gap
between injections.
Viscosupplementation
Viscosupplementation may be available as a treatment option for people who have tried all
other non-surgical treatments without success.
It involves receiving up to five injections of hyaluronic acid directly into the affected joints
over several weeks. Hyaluronic acid is found in the synovial fluid in joints and acts as
both a lubricant and shock absorber.
If the injections are successful, the procedure may be repeated around every six months.
In addition to lifestyle changes and medication, you may also benefit from a number of supportive
treatments that can help reduce your pain and make everyday tasks easier
Transcutaneous electrical nerve stimulation (TENS)
Transcutaneous electrical nerve stimulation (TENS) uses a machine that sends electrical impulses
through sticky patches, called electrodes, attached to the skin. This may help ease the pain
caused by your osteoarthritis by numbing the nerve endings in your spinal cord which control pain.
Treatment with TENS is usually arranged by a physiotherapist, who can advise on the strength of
the pulses and how long your treatment should last.
Hot or cold packs
Applying hot or cold packs (sometimes called thermotherapy or cryotherapy) to the joints can
relieve the pain and symptoms of osteoarthritis in some people.
A hot-water bottle filled with either hot or cold water and applied to the affected area can be very
effective in reducing pain.
Manual therapy
Not using your joints can cause your muscles to waste and may increase stiffness caused by
osteoarthritis. Manual therapy is a treatment provided by a physiotherapist. It uses stretching
techniques to keep your joints supple and flexible.
Assistive devices
If your osteoarthritis causes mobility problems or difficulty performing everyday tasks, several
devices could help. Your GP may refer you to a physiotherapist or an occupational therapist for
specialist help and advice.
If you have osteoarthritis in your lower limbs, such as your hips, knees or feet, your
physiotherapist or occupational therapist may suggest special footwear or insoles for your shoes.
Footwear with shock-absorbing soles can help relieve some of the pressure on the joints
of your legs as you walk. Special insoles may help spread your weight more evenly. Leg braces
and supports also work in the same way.
If you have osteoarthritis in your hip or knee that affects your mobility, you may need to use a
walking aid, such as a stick or cane. Hold it on the opposite side of your body to your affected leg
so that it takes some of your weight.
A splint (a piece of rigid material used to provide support to a joint or bone) can also be useful if
you need to rest a painful joint. Your physiotherapist can provide you with a splint and give you
advice on how to use it correctly.
If your hands are affected by osteoarthritis, you may also need assistance with hand-operated
tasks, such as turning on a tap. Special devices, such as tap turners, can make performing these
tasks far more manageable. Your occupational therapist can give you help and advice about
using assistive devices in your home or workplace.
 Surgery
Arthroplasty
Joint replacement therapy, also known as an arthroplasty, is most commonly carried out to replace hip and knee
joints.
During an arthroplasty, your surgeon will remove your affected joint and replace it with an artificial joint
(prosthesis) made of special plastics and metal. An artificial joint can last for up to 20 years, although it may
eventually need to be replaced.
There's also a newer type of joint replacement surgery called resurfacing. This uses only metal components and
may be more suitable for younger patients. Your surgeon will discuss with you the type of surgery that would be
best.
Arthrodesis
If joint replacement isn't suitable for you, your surgeon may suggest an operation known as an arthrodesis,
which fuses your joint in a permanent position.
This means your joint will be stronger and much less painful, although you will no longer be able to move it.
Osteotomy
If you have osteoarthritis in your knees but you're not suitable for knee replacement surgery, you may be
able to have an operation called an osteotomy. This involves your surgeon adding or removing a small
section of bone either above or below your knee joint.
This helps realign your knee so your weight is no longer focused on the damaged part of your knee. An
osteotomy can relieve your symptoms of osteoarthritis, although you may still need knee replacement
surgery eventually.
 Alternative Therapies

Nutritional supplements
A number of nutritional supplements have also been used to treat osteoarthritis in the past,
including chondroitin and glucosamine.
Glucosamine hydrochloride hasn't been shown to have any beneficial effects, but there's
evidence that glucosamine sulphate and chondroitin sulphate may help symptoms to a
small degree and don't cause many side effects.
However, these supplements can be expensive and NICE recommends that they shouldn't
routinely be offered on the NHS.
Rubefacients
Rubefacients are available as gels and creams that produce a warm, reddening effect on
your skin when you rub them in.
Several rubefacients have been used to treat joint pain caused by osteoarthritis.
However, research has shown that rubefacients have little effect in improving the symptoms
of osteoarthritis and NICE therefore doesn't recommend their use.
 Referensi

http://www.nhs.uk/Conditions/Osteoarthritis/Pages/
treatment.aspx
http://www.webmd.com/osteoarthritis/guide/osteoarthritis-
treatment-care
http://www.arthritis.org/about-arthritis/types/osteoarthritis/
treatment.php
http://digilib.unila.ac.id/7309/15/BAB%20II.pdf