3.

Mrs. Ani 43-year old woman present with a history of insidious onset of joint
pain since three month ago. Affected are all small joints of the hands, wrist,
knees and forefeet.
a.Bagaimana anatomi sendi yang terlibat pada kasus?39
SENDI TANGAN
SENDI PERGELANGAN TANGAN
SENDI LUTUT
SENDI KAKI DEPAN

3.2

A steroid dose-pack and 400 mg dose of ibuprofen three times a dayrelieved

all symptoms for one more month, but was followed by slow return of joint
pain, now with clearly swelling, and morning stiffness lasting two hours. In
the afternoon, she often felt low grade fever, fatigue and less appetite. There is
no back pain.
a. Apa penyebab dan mekanisme nyeri sendi, sendi bengkak dan kaku di pagi hari
yang berlangsung selama 2 jam?9 5
b.Apa makna dari tidak ada nyeri punggung?3 9

Laboratory evaluation revealed that her rheumatoid factor was positive, anti-cyclic
citrullinated peptide (CCP) negative, 60 mm/hour of sedimentation rate and 35 mg/dl

of C reactive protein. All other routine laboratory findings were normal.

X-rays of her affected joint show minimal periarticular osteopenia and no erosions.
a. Bagaimana interpretasi dan mekanisme dari pemeriksaan laboratorium:
- Anti-CCP negatif 9 5

3.6

Hipotesis: Ny. Ani 43 tahun mengalami nyeri sendi sejak 3 bulan diduga
mengalamipoliartritis kronik (rheumatoid artritis)

a.

DD 4 9

b.

Faktor resiko 9 4

c.

Komplikasi (pemakaian obat steroid, ibuprofen jangka panjang) 4 9