A women 60 years old Came to Rissa Hospital complaining her left knee pain.

The pain is
getting worse when she does a lot of activity, but it is getting better with rest. She feels of
warm on the joint and stiffness on the knee especiallyin the morning or when she sits for a
while. She Decrease her mobility of her knee and making it difficult, for her to get down and
up of chair, to walk on stairs and to walk on far distance. In physical examination, the doctor
found a cracking sound when the left knee joint moves. The doctor sent patient to radiology
division for radiograph examination and to laboratory for blood tests.
A 60-year-old woman came to the hospital complaining of pain in his left knee Rissa. The
pain got worse when he did a lot of activities, but it is getting better with rest. She felt warm
in the joints and stiffness in the knee, especially in the morning or when he sat down for a
while. He lowered his knee mobility and makes it difficult for him to go down and up from a
chair, walking on stairs and walking long distances. On physical examination, the doctor
found a crack sound when moving the left knee joint. Doctors send patients to the radiology
division for radiographic examination and laboratory for blood tests.
Step 1:
Radiology: is the branch or specialty of medicine that offer section with the study and
application of imaging technology like x-ray and radiation to diagnosing and treating disease.
Radiograph: is an imaging technique that uses electromagnetic radiation other than visible
light , especially X-rays , to view the internal structure of a non-uniformly composed and
opaque object (ie a non-transparent objects of varying density and composition) such as the
human body.
RADIOLOGY: is the branch or specialty of medicine that deals with the study and
application of imaging technologies such as x-ray and radiation to diagnose and treat disease.
Radiography: is an imaging technique that uses electromagnetic radiation other than visible
light, especially X-rays, to see the internal structure of an object composed of non-uniform
and opaque (ie non-transparent objects of different densities and compositions) as the human
body.
Step 2:
1. How morphology and classification of joints that normal
Morphology
a. Joint cartilage
a layer of cartilage that lines the ends of bones that are jointed. Composed of
hyaline cartilage that serves to protect the bones from impact and reduce the
pressure.
b. Joint cavity
The space between two bones that jointed, filled with synovial fluid joint capsule

c. Capsule send i: cover joint cavity

d. Synovial fluid
Synovial fluid is a liquid albumin derived from blood filtration fibroblasts
secreted in the synovial membrane, this liquid serves as a lubricant for ease of
movement.
e. Synovial membrane
melapisis part in the joint cavity except in cartilage
f. Reinforcing ligament
Some synovial joints strengthened and hardened by ligaments that cover it. Serves
to strengthen the joint capsule, ligaments reinforcing divided into two
extracapsular ligament that is outside the joint capsule and intracapsularligamen
inside
g. Stock: small cell.2 contain synovial fluid useful to reduce friction.
h. Nerve
Will detect nerve pain in joints and monitor stretch the joints.
i. Blood vessel
Supply of blood vessels to form the synovial fluid. (Sloane, 2003)

1. Why hurt his left knee and it got worse when he did a lot of activities but is getting
better with rest?
2. Why was warm and stiff joints in the knees, especially in the morning and when he
sat down for a while?
3. What are the signs and symptoms of the disease in the scenario?
Joint pain

Mechanical pain

Inflammatory pain

Pain that arises after activity and disappear

at rest and does not arise in the morning

Gain weight in the morning when waking

up and accompanied by stiff joints or
severe pain at the start of the motion and

reduced the time after doing the activity

Rheumatoid arthritis

Pain is most severe in the morning, better

during the day and slightly heavier at night

Osteoarthritis

Pain is most severe at night, early morning

feel lighter and better during the day.

Gouty arthritis

Pain in the form of onslaught on the

morning wake-up time, while in the
evening before the patient does not feel
anything.

Stiff joints
Flavors such as patient strapped difficult to move. By the pressure of the fluid that is around
the inflamed tissue. Stiff joints are becoming apparent during morning ari or after the break.
Having moved about the liquid will spread from tissue inflammation and the patient feels
detached from the bonds. Pain or stiff joints can arise after immobility, such as sitting in a
chair or a car in a long time or even after waking.
Enlargement joints (deformity)
One joint slowly enlarges
Changes in gait
Ankle, heel, knee or pelvis evolved into a limp. Walking disorders and malfunctioning of
other joints.
Kresipitasi
Taste rattling on a sore joint often heard.
IPD Ed V Volume III
4. How physical examination of the disease in the scenario?
Barriers Motion:
Kresipitasi
Swelling of joints often asymmetric

Signs of inflammation
Changes in the form of permanent joints
Changes in gait
5. Any investigation of scenario?
Radiographic affected joint
Picture:

Narrowing gap joints often asymmetric

Increase in subchondral bone density

Bone cyst

Osteophytes at the joint edge

Changes in the structure of the joint anatomy

Laboratory examination
Blood Bank:
Hb, leukocytes, LED within normal limits
Immunology:
ANA, rheumatoid factor and normal complement
In OA accompanied by inflammation may be obtained decrease the viscosity, mild to
moderate pleocytosis, mild increase in inflammatory cells (<8000) and an increase in protein.
6. What is the differential diagnosis and diagnosis of scenario?
Osteoarthritis
Rheumatoid arthritis
Gout
LES
Osteoporosis
7. What is the etiology of the diagnosis and dd?

Osteoarthritis

There are 2 primary and secondary:

Primer:
Unknown cause
Secondary:
Endocrine disorders, metabolic diseases

8. What pathophysiology of diagnosis and dd?

Osteoarthritis:

Joint cartilage has a strategic location, namely at the ends of the bones to perform
two functions: 1). Ensure the movement almost without friction in the joints,
thanks to the synovial fluids; and 2) the joint as the recipient of the load, spreading
the load across the surface of the joint so that the underlying bone can receive the
impact and weight without damage. Both of these functions require cartilage
elastic and has a high tensile strength. Both of these traits produced by the two
major components of cartilage: a special type of collagen (type II) and
proteoglycans, and both were released by chondrocytes. As in adult bone, joint
cartilage is not static; This bone experience exchange; The bone matrix
components that wear out and replaced described. This balance is maintained by
chondrocytes.
Osteoarthritis is characterized by significant changes in the nature and
composition of the cartilage. An increase in water content, and a decrease in
proteoglycan concentration compared to healthy cartilage. Looks weakening the
collagen network, perhaps due to a decrease in local synthesis of type II collagen
and increased collagen breakdown.
9. How is the management of the diagnosis?
Non-pharmacological therapy

Education

Patient education, how menjaga illness from getting parah serta joints can still be
used

Physical therapy

Train patients to keep joints can be used and train the patient to protect the sore
joint

Weight loss

Excessive weight is a factor that aggravate OA disease.

Pharmacologic therapy

Oral non-opiate analgesic

Topical Analgesic

NSAIDs

Memilikki analgesic and anti-inflammatory effects

Chondroprotective

Drugs that can maintain or stimulate repair of joint cartilage in patients with
osteoarthritis. (Tetracycline, hyaluronic acid, chondroitin sulfate)

Intra-articular steroid

Surgical therapy (in case of deformity correction)

Osteotomy

Total joint arthroplasty