LBM 3

Step 1
1. Oedem genu sinistra
Oedem = swelling
Genu = regio lutut
Sinistra = left side
2. Crepitation
- The sound of “gemeretak” in the joint
- Sensation like “diparut” eg in lutut, physical examination by palpation, will occur
‘gemeretak’ sound
3. Rheumatic
Pain due to musculo or joint that experience swelling or inflammation

Step 2 :
1. The anatomical structure of joint knee
2. Why does the woman feel pain in her knee
3. Why the pain get worse by time?
4. What causes the woman get problem to walk
5. What are signs and symptoms from the scenario?
6. What is the risk factor of the scenario?
7. What is the diagnose and the differencial diagnose of the scenario?
8. What is the pathogenesis of the scenario?
9. What is the epidemiology of the disease?
10. What are the examinations for the case?
11. What are the complications which can occur from the scenario?
12. What is the treatment for the scenario

Step 3 :
1. The anatomical structure of joint knee
Synovial : meningkat => destruction at cartilage. ONLY IN OSTEARTHRITIS (OA)
The function
- IL 1
- Tnf alfa
- Metaloproteinase
Version 2
- IL 1
- Tnf alfa
- Metaloproteinase, mendegradasi collagen tipe 2
Bursa
Kantung berisi cairan synovial
In OA, synovial is decreased
- Kantong untuk mempermudah gesekan dan gerakan
 Matriks
Function : component of
- Water
- Proteoglican
- Collagen
OA progressif :
Perubahan struktural menimbulkan perubahan progresif
Anatomical, histological, physiological properties about joint
2. Why does the woman feel pain in her knee
- Decreased of synovial liquid
- Because there’s inflammation, change of the funcion of the joint
- Because of ‘gesekan’ due to decreased synovial fluid
- Limitation of mobility of the joint and the pillow of the cartilago is lost, that will cause
‘gesekan’ intraossa (between bones), cause there’s no synovial
What makes synovial loss?
- Cartilage destruction lead to degradation enzyme and collagen increase. That leads to
synovial liquid decrease
- Obese => imbalance syntesis and degradation of cartilage => degradation enzyme and
collagen increase
3. Why does she feel piercing and pulsing sensation?
Piercing:
Pulsing : has relation with bloos vessel in the knee, inflammation leads to angiogenesis
Pain :
Because of the lack of the synovial liquid that cause ‘gesekan’ of the cartilage
4. What causes the woman get problem (difficult) to walk
- Inflammation + pain + deformity => difficulty to walk
- Stiffness =>
o matrix degradation and,
o cartilage destruction => Proteolytic enzyme => destruct matrix => microfracture =>
- cartilago => sklerosis IN OA
5. Why the pain get worse by walking and get better by sitting and rest
- Memperberat : walking, bcs the cartilages ‘bergesek’, oedem
- Memperingan : sitting and rest
6. What is the risk factor of the scenario?
7. What are the examinations for the case?
8. What causes stiffnessny for the last 6 months that occurs in the morning that only last for 30
minutes and get better by moving the leg
9. What are signs and symptoms from the scenario?
- Swollen
- Crepitation
10. What is the diagnose and the differencial diagnose of the scenario?
11. What is the pathogenesis of the scenario?
12. What is the epidemiology of the disease?
13. What are the complications which can occur from the scenario?
14. What is the treatment for the scenario
OA, RA, gout