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INTRA ARTICULAR THERAPY IN OSTEOARTHRITIS
Basuki SupartonoDisampaikan pada Seminar Ilmiah, Musyawarah Kerja ke-2
Bulan Sabit Merah Indonesia,Sabtu, 24 Januari 2004
MEDICAL MANAGEMENT OF OSTEOARTHRITIS
A. NON PHARMACOLOGICAL THERAPY
1. PATIENT EDUCATION
2. PHYSICAL THERAPY
3. OCCUPATIONAL THERAPY
4. DIET
5. OTHERS (ACUPUNTURE)
B. PHARMACOLOGICAL THERAPY
1. ANALGESIC
2. NSAID & COX 2 INHIBITORS
3. INTRAARTICULAR THERAPY
4. HERBAL MEDICINE
5. SUPLEMENTS
MEDICAL MANAGEMENT OF OSTEOARTHRITIS
INTRAARTICULAR THERAPY
MATERIAL LIDOCAIN STEROID KETOROLAC NON STEROID
RATIONALE
ENTERING JOINT SPACE ASPIRATE ANY EXCESS FLUID INSTILL SUSPENSION
INDICATION
1. Pain relief and suppress inflammation
2. Adjunctive therapy
3. Facilitate a rehabilitative and physical
therapy program or orthopedic
corrective procedures
4. To prevent capsular and ligamentous
laxity
5. To bring “ medical synovectomy ”
6. To treat patients unresponsive to or
intolerant of oral systemic therapy
7. To treat acute effusioins with
associated crystal deposition disease
INDICATION
CLINICAL EFFICACY
HIGHLY EFFECTIVE
CONTRAINDICATIONS
1. INFECTION
2. ANTICOAGULANT THERAPY
3. HEMORRHIAGIC EFFUSIONS
4. UNCONTROLLED DIABETES
COMPLICATIONS
INFECTION
INJECTABLE CORTICOSTEROIDS
Repository Prefations Mg/mL
Range of Usual Dosage (mg)
Hydocortisone tebutate (hydrocortone-TBA) 50 25-100
Predinisolone tebutate (Hydeltra-TBA) 20 5-40
Betamethasone acetate and betamethasone sodium phosphate (Celestone Soluspan)
6+ 1.5-6
Methylprednisolone acetate (Depo-Medrol) 20 4-40
Triamicinolone acetonide (Kenalog 40) 40 5-40
Triamicinolone diacetate (Aristocort Forte) 40)
40 5-40
Triamicinolone hexacetonide (Aristospan) 20 5-40
DOSAGE (Prednosolone tebutate)
HAND & FOOT : 2,5-10 mg WRIST & ELBOW : 10-25 mg KNEE, ANKLE, SHOULDER : 20-25
mg HIP : 25-40 mg
ADMINISTRATION INTERVAL : 4 WEEK (NWB
JOINT) 6-12 (WB JOINT)
BED REST : 3-4 DAYS CRUTCHES
RESPONS FACTORS TO INTRAARTICULAR THERAPY
1. SIZE OF JOINTS
2. VOLUME OF SYNOVIAL PREPARATION
3. DOSAGE AND TECHNIQUE
4. SEVERITY OF SYNOVITIS
5. POSTINJECTION ACTIVITY
PREPARATION OF INJECTION SITE
ASEPTIC
LANDMARK
POINT OF ENTRY
STERILE DRAPES & GLOVES
STERILE GAUZE
INJECTION TECHNIQUES
GENERAL CONSIDERATIONS
SPECIFIC JOINT & ADJACENT SITES
GENERAL CONSIDERATIONS
EXTENSOR SURFACE
OPTIMAL POSITIONING
LOCAL ANAESTHETIC
SPECIFIC JOINTS
THE KNEE
THE KNEE REGION
THE SHOULDER
THE ELBOWS
FINGER AND TOE JOINTS
HIP JOINT
HIP REGION
TEMPOROMANDIBULAR JOINT
ANKLE JOINT
THE FOOT
SPECIFIC JOINTS
LYING
MEDIALLY
LATERALLY
INFRA PATELLAR
THE KNEE
THE KNEE REGION
PREPATELLA BURSITIS
SUPRA PATELLAR BARSITIS
ANSERINE BURSITIS
SEMI MEMBRANOSES TENOSYNOVITIS
PERIARTHRITIS
THE SHOULDER
SCAPULOHUMERAL JOINT
ACROMIOCLAVICULAR JOINT
STERNOCLAVICULAR JOINT
THE ELBOW
FINGER AND THE JOINT
FIRST CMC JOINT
I.P JOINT
MTP JOINT
HIP JOINT
ANTERIOR APP
LATERAL APP
THE HIP REGION
PERIARTICULAR PAIN
TTO CHANTERIC BURSA
TEMPOROMANDIBULAR JOINT
ANKLE JOINT
THE FOOT CALCAVERAL BURSITIS WITH SPOR
Wassalam
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