CLINICAL SCIENCE SESSION

OSTEOARTHRITIS
Oleh:
IRMA GIANOVA LESTARI

Preseptor:
Hidayat Wahyu Aji, dr., Sp.Rad
Arthritic Disorder
 Degenerative Disorders
 Degenerative Joint Disease
 Osteoarthritis / Osteoarthrosis
 Inflamatory Disorders
 Rheumatoid Arthritis
 etc
 Metabolic Disorders
 Gout
 etc
 DEFINISI
Osteoarthritis adalah penyakit dengan karakteristik degenerasi
cartilago dan tulang disekitarnya pada sendi disertai bony
overgrowth. (CDC)

Osteoarthritis (OA) / osteoarthrosis / degenerative joint disease

(DJD), adalah penyakit progresif pada sendi yang disebabkan
kehilangan secara gradual cartilage dan membentuk bony spur dan
kista pada batas sendi. (medical-dictionary.thefreedictionary.com)

Penyakit degeneratif yang umum terjadi pada sendi dan berciri

khas hilangnya kartilago sendi dan adanya formasi tulang tulang
baru
 EPIDEMIOLOGI
 OA dialami oleh 13,9% orang dewasa usia 25+, dan 33,6% (12,4
juta) pada 65+

 Insidensi gejala OA:

 OA tangan : 100/100.000 populasi/tahun
 OA pinggang : 88/100.000 populasi/tahun
 OA lutut : 240/100.000 populasi/tahun

 Insidensi OA lebih tinggi pada wanita, terutama 50+

 Insidensi OA lutut dan OA pinggang lebih rendah 45% dan 36% pada
pria.
 OA lutut pada wanita memiliki gejala yang lebih parah.
 KLASIFIKASI
Primer
 Penyebab tak diketahui, akibat proses penuaan alami.
 Penurunan proteoglikan, sehingga kartilago rentan
terhadap degradasi.
 Inflamasi di kapsul sendi.
 Pertumbuhan tulang baru, disebut “spurs” atau osteophyte,
pada margin sendi

Sekunder
 Dialami sebelum usia 45 tahun, penyebab trauma (instability)
yang menyebabkan luka pada sendi (misalnya patah tulang
atau permukaan sendi tidak sejajar), akibat sendi yang
longgar dan pembedahan pada sendi. Penyebab lain adalah
faktor genetik dan penyakit metabolik.
 FAKTOR RISIKO
OA dialami baik pria dan wanita, segala ras, dan usia di atas 40
tahun, namun akan lebih cepat terjadi dengan faktor risiko berikut:
 Usia lanjut
 Riwayat keluarga dengan OA
 Obesitas
 Cidera sendi atau penggunaan sendi yang repetitif (overuse)
 Deformitas sendi, seperti panjang kaki tidak seimbang
RISIKO OSTEOARTHRITIS

46%
Lutut

25%
Pinggang

29%
Tempat
lain
Johnston County Osteoarthritis Project
 ANATOMI
Bagian sendi sinovial:
• Subchondral bone
• Articular cartilage
• Synovial membrane
(ultrafiltrasi cairan
sinovial)
• Synovial fluid
(hyaluronic acid,
glycosaminoglycan)
• Joint capsule
 TANDA DAN GEJALA
 Nyeri sendi dan kaku
 Pembengkakan pada sendi
 Suara “cracking” atau “grinding”
pada pergerakan sendi
 Penurunan fungsi sedi
 Pada jari-jari seringkali terdapat
“Heberden’s Node” di distal
interphalang atau “Bouchard’s
node” di proximal interphalang.
Criteria for Osteoarthritis of the Knee
(Altman)
Clinical & Laboratory Clinical & Clinical
Radiographic
Knee pain (+ 5) Knee pain (+ 1) Knee pain (+ 3)
1.Age > 50 yo 1.Age > 50 yo 1.Age > 50 yo
2.Stiffness < 30’ 2.Stiffness < 30’ 2.Stiffness < 30’
3.Crepitus 3.Crepitus 3.Crepitus
4.Bony tenderness 4.(+) 4.Bony tenderness
5.Bony enlargement 5.Osteophytes 5.Bony enlargement
6.No palpable warmth 6.No palpable warmth
7.ESR < 40mm / h
8.RF < 1:40
9.Synovial fluid for OA

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Synovial fluid sign for OA: clear, viscous, or WBC < 2000/mm3
GAMBARAN RADIOLOGIS
 Hand
 Joint space narrowing
 Bouchard and Heberden Nodes
 Knee
 Osteophytes
 Subchondral sclerosis
 Varus deformity
 Spine
 Narrowed disc space and osteophytes
 Sclerosis
 Hip
 Hip sclerosis
Joint space narrowing
Bouchard and Heberden
Nodes
Marginal osteophytes
Subchondral sclerosis
Subchondral cyst
Varus deformity
ANTERO-POSTERIOR VIEW OF
HAND
ANTERO-POSTERIOR VIEW OF
KNEE
FRIK TUNNEL VIEW OF THE
KNEE
Joint Space Narrowing
OA typically asymmetrical
Bouchard and Heberden Nodes
Cartilage loss with
narrowing of
interphalangeal joints

B: Bouchard nodes
(osteophytes proximal
interphalangeal joints)

H: Heberden nodes
(osteophytes distal
interphalangeal joints)
Osteophytes
Bone spurs
Subchondral Sclerosis
Increased bone density or thickening in the
subchondral layer
Subchondral Cysts
Fluid-filled sacs in subchondral bone
Varus Deformity
PA HAND WITH OA
narrowing,
osteophytes,
and
subchondral
cysts
affecting the
distal
interphalang
eal joints
Joint space
narrowing of
radiocarpal,
carpometacrapal
joint of thumb and
metacarpophalang
eal joints
AP KNEE WITH OA
Menunjukkan
penyempitan
bilateral pada
kompartemen
femorotibial dan
penajaman
spina tibia.
Arowheads point to narrowed medial compartments and osteophytes.
Arrows point to the varus deformity of both tibia.
• Black arrows point to
subchondral
sclerosis.

• White arrow points to

osteophytes.

• Black arrowheads
point to joint
narrowing. Medial
compartment
narrrowing.
LATERAL VIEW OF KNEE
Patellofemoral
compartment
narrowing and
osteophytosis.
A prominent
Parson bump
is also seen.
Large ossified
intra-articular
bodies are
evident.
(A) Anteroposterior view of the left knee of patient 1 shows medial joint space
narrowing (arrow). (B) Lateral view of the left knee shows sclerosis with marked
osteophyte formation(arrows). The osteophytes are best seen in this view.
(C) Patient 2 has marked osteoarthritic changes with medial joint space
narrowing (white arrow) causing a varus deformity of the knee and
collapse of the joint space with destruction of the medial cartilage and the
subchondral cortex (open arrowheads). (D)Subchondral cysts (solid
arrowhead) are noted.
Black arrows point
to osteophytes.

White arrow points

to narrowed medial
compartment.
ANTERO-POSTERIOR VIEW OF
HIP
AP HIP WITH OA
reveals severe
superior migration of
the femoral head
(which reflects loss of
articular cartilage),
subchondral
sclerosis, prominent
osteophytes, and a
large Egger cyst in
the superior
acetabulum. Mild
flattening of the
superior aspect of the
femoral head is
present.
White arrow points to osteophytes.
White arrowheads point to narrowed joint space and sclerosis.
SPINE WITH OA
Oblique
projection
demonstrates
gradual
narrowing and
sclerosis of the
facet joints as
one progresses
down the lumbar
spine.
White arrowheads
point to osteophytes.

White arrows point to

narrowed joint space.

Black arrows point to

sclerosis.
KLASIFIKASI OSTEOARTHRITIS
BERDASARKAN GAMBARAN
RADIOLOGIS
Grade Classification Description
0 Normal No features of OA
1 Doubtfull Minute osteophyte
Doubtful significance

2 Mild Definite osteophyte. Normal joint

space

3 Moderate Moderate joint space reduction

4 Severe Joint space greatly reduced

Subchondral sclerosis
Kellgreen & Lawrence (Ostearthritis)
 Grade 0: normal
 Grade 1: tampak osteofit minimal
 Grade 2: Osteofit pasti pada 2 titik, sclerosis
subchondral, subchondral cyst minimal, celah sendi
masih baik.
 Grade 3: Osteofit sedang, beberapa deformitas pada
ujung tulang, celah sendi sempit.
 Grade 4: Osteofit besar & deformitas pada ujung tulang,
celah sendi hilang, sclerosis & subchondral cyst.

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TERIMA KASIH
WASSALAM