BEDAH SOAL IPD

(All source from PPT)

1. Pembagian arthritis

2. Patologi
A. Umur dan Penyakit
B. Gout
=a disorder with on the one hand an autoinflammatory
syndrome, and on the other hand, dysmetabolism characterized
by a positive urate balance leading to hyperuricemia &
articular as well as extraarticular crystallization & chronic
subinflammation.

=Risk Factors
• High Purine Diet (Red Meat, Fatty Poultry, High Fat Dairy,
Seafood)
• Alcohol Consumption
• Trauma
=Tahapan:
-Asymptomatic tissue deposition
-Acute gout
-Intercritical gout
-Chronic articular and tophaceous gout
=Acute Gout: involvement of a single joint or
multiple joints in the lower extremities: first
metatarsophalangeal (podagra; 50% of people with
gout), midtarsal, ankle & knee joints
-Nyeri, erythema, bengkak, desquamation of skin, panas,
leukocystosis
-Bisa hilang tanpa pengobatan
=Chronic Gout: Karakteristiknya meliputi arthritis kronik dan
tophi

Diagnosis: MCU kristal dari sendi synovial

Radiograph: juxta-articular erosions
C.Osteoarthritis
=Penyakit degeneratif yang berkaitan dengan kerusakan kartilago
sendi
=Di sendi penyangga berat badan (vertebra, panggul, lutut,
pergelangan kaki)
=Faktor Risiko
-Older age
-Female
=Signs
-Kaku
-Gangguan pergerakan
-Pembengkakkan
-Nodus Herbeden dan Bouchard
-Deformitas
=Pemeriksaan fisik:
-Gerak terhambat
-Pembengkakan sendi asimetris
-Krepitasi
-Tanda peradangan
-Deformitas sendi
-Perubahan /gait
=Imaging: Penyempitan sendi, sclerosis subchondral, bone cyst,
osteophyte, deformity

D. Rheumatoid arthritis
=Autoimmune disease characterized by chronic systemic &
progresif inflammatory disease
=Periarticular osteoporosis is an early finding, but can also see
generalized osteoporosis
=Sering di articular & extraarticuricular
=Risk factor: Fem, keturunan, smoking, infeksi
=Karakteristik: synovial proliferation (pannus), bursitis, nodules
=Signs
-Ga spesifik: fatigue, weakness, anokresia, subferile
-Articular: synovitis (PIP/MCP), deformitas
-Extraarticular: Rheumatoid factor (nodul, pleuririts, dsb)\
=Lab: Complete blood count, rheumatoid factor, C-reactive
protein, ANA, Anti RA-33 anti CCP, liver kidney fucntion test
=Imaging test: Plain radiograph, MRI, osteopenia juxtaarticular,
erosi sendi, efussion sendi, soft tissue swelling, deformty di ulnar
dan swan-neck, boutoniere.
E. Differences
=Diagnosis

=Beda RA dan OA
3. Treatment

A. Gout

B. OA
-Weight loss
-Participate in cardiovascular (aerobic)
-Oral/topical analgesic
-TENS (Terapi)
C. RA
--DMARDs (Disease-modyfying anti-rheumatic drugs)
-Olahraga
-Cod liver oil
-Essential fatty acid
-NSAID
-Steroid