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