Professional Documents
Culture Documents
* Budi Darmoyo, 1991; ** Dwi Sutanegara, 1993; *** Kalim dkk, 1994
Classification
Primary or idiopatic
Localized form; affect one to two joint group.
ie DIP, PIP, CMC, cervical or lumbar spine,
MTP, knee or hip joint.
Secondary
If a patient develops OA in atypical joints,
such as MCP, wrist, ankles, shoulder or
elbows
Assessment should be made for previous
trauma, metabolic disease, blood dyscrasias
or neuropathic joint
Erosive OA
Inflammatory OA, affect DIP and PIP joints
of hand
Risk factors
History
Patients complain of pain or locking of affected
joints that are mechanical in nature and
worsening with activity.
Stiffness can become a manifestation but is
typically less than 30 minutes.
Diagnosis
Phisycal examination
the joints most commonly involved are knee,
hip, ankle, vertebrae, spine and manus (PIP,
DIP and 1st CMC)
mild tenderness to palpation, usually without
evidance inflammation
crepitus
bony enlargement
decrease ranged of motion
joint effusion
Diagnostic criteria
Knee OA
Knee pain plus three of the following: age > 50 yo,
ESR < 20 mm/hr, stiffness < 30, crepitus, bony
hypertrophy and no palpable warmth
Hip OA
Hip pain plus two of the following ESR < 20 mm/hr,
radiographic acetabular or femoral osteophyte and
joint space narrowing.
Diagnostic criteria
Hand OA
Hand pain or stiffness plus at least three of the
following:
hard tissue enlargement of more than one of the
selected joints 2nd and 3rd DIP or PIP joint or 1st
CMC of each hand
Hard tissue enlargement of more than one DIP
joint
deformity of at least one of ten selected
joints
fewer than three swollen MCP joints
Radiograph of a hand showing osteoarthritis of the distal interphalangeal
(DIP), proximal interphalangeal (PIP), and first carpometacarpal (CMC)
joints.
Differential diagnosis
Laboratories
No laboratory test confirming the diagnosis
Imaging
Radiographic
Medication
nonpharmacologic modalities
pharmacologic agents
Surgery
Treatment
Nonpharmacologic modalities
Physical therapy Insoles
Aerobic Thermal modalities
Weight reduction Transcutaneus
Walking aids electrical nerve
Knee brace stimulation
Acupuncture
Foot wear
Education
Knee brace
Treatment
Pharmacologic agents
First line
Acetaminophen 2 3 gr/day up to 4 gr/day
Second line
Nonsteroid anti-inflamatory drug (NSAID)
ie. Ibuprofen 3 x 200-600 mg/day, sodium
diclofenac 2-3 x 25-50 mg/day, piroxicam 1 x 10-
20 mg/day and meloxicam 1x7,5-15 mg/d
Treatment
Pharmacologic agents
Third line
opioid theraphy, ie. Codein 3-4 x 10-30
mg/day, tramadol 2-3 x 50-100 mg/day
Fourth line
corticosteroid injection
hyaluronic acid injection
Treatment
Pharmacologic agents
Topical therapies
Capsaicin cream 0,025%, four times a day
Diclofenac solution (1,5% w/w), four times a day
Novel therapy
Diacerein 2 x 50 mg/day
Surgical management
Arthroscopic irrigation
Knee and hip arthroplasty or total joint replacements
Prosthetic joints
QUESTIONS
Sites of hand or wrist involvement and their potential disease
associations.