INTERNA MEDICINE

RHEUMATOLOGY
OSTEOARTHRITIS
NATIJAH SYUHADA BINTI ZUBIR
C11112812
NUR HIDAYAH BINTI AZIZ
C11112813

CASE STUDY
A man 64 y. o, come to the hospital with chief complain pain on
knees since 3 years ago, worsening 4 days before, increase with
movement, decrease when get rest. Stiffness on knees in the
morning less than 15 minutes. Patient has history of black feces
about 8 months ago. Physical examination finding are anemic
conjunctiva, and swelling and crepitation on knees.
KEY WORDS
Male, 64 years old
Pain on knees

-> 3 years, worsening 4 days

-> increase with movement, decrease when rest
-> morning stiffness < 15 minutes
History of black feces
-> 8 months
Physical exam
Anemic conjunctiva

Patient is male,
64 years old

DIAGNOSIS
DIAGNOSTIC CLASIFICATION
OSTEOARTHRITIS : KNEES
Joint pain + at least 3 of 6 criteria
1. Crepitus
2. Stiffness < 30 minutes
3. > 50 years old
4. Enlargement of knees joint
5. Palpable pain
6. Absent of tenderness on synovial
joint
DIAGNOSIS

: OSTEOARTHRITIS

Based on case study,

this patient suffered
pain on knees
3 years, worsening
4 days
increase with
movement,
decrease when rest
morning stiffness
< 15 minutes
Swelling +
crepitation on
knees

RELATED PROBLEMS
Patient is male,
64 years old

Patient is male,
64 years old

Based on physical
examination on
the patient of case
study, this patient
has anemic
conjunctiva

Based on study
case, this patient
came with history
of black feces for 8
months

: ANAEMIA

: MELENA

DIFFERENTIAL DIAGNOSIS
Osteoathritis
Etiology

Age
Gender
Joints abnormality

Systemic symptoms
Signs and symptoms

Rheumatoid Arthritis

Gout Arthritis

Degenerative disorder Autoimmune reaction of Caused by monosodium

arising from
unknown cause, leading
urate monohydrate
biochemical breakdown to synovial hypertrophy
crystals
of articular (hyaline)
and chronic joint
cartilage in synovial
inflammation
joint
> 60 y/o

35 - 45 y/o

> 35 y/o

Female = Male

Female > Male

Female > Male

Large joints (ankles,

knees, elbows, wrists),
asymmetries

Small joints (PIP, MCP,

MTP), symmetrical and
bilateral

Often on MTP,
asymmetries

No

Yes

Yes

< 30 minutes
morning stiffness
Crepitus
Enlargement of
knees joint
Palpable pain

> 1 hour morning

stiffness
Overly swollen,
warm joints
Constitutional
symptoms

Podagra (gouty
inflammation
of the great
toe)
Single (most
common) or

FURTHER ANAMNESIS
Chief complain (pain on knee)
Onset- first appearance,
duration
Pain description
Frequency
On what conditions?activities or rest
Other complains
Stiffness on affected joint
o How long it last? When?
Joint motion became
restricted.
Crepitation

History of past illness.

DM, hypertension.

Family history.
o Allergy, hypertension, DM
Drugs history
o Past and present.
Lifestyle
o Smoking, alcohol, drugs
abuse,

FURTHER DIAGNOSTIC TEST

Weight measurement, BMI [18.5- 24.9]
Vital signs : BP, HR,RR, Temp
Inspection, palpation, ROM
- Stiffness
- Inflammation signs
- Crepitating
- Joint deformities
- Asymmetrical joint swollen
- Walking gait
Rheumatology Status
Gait
Arms
Legs: Genu (Dextra/ Sinistra)
Spine

 Laboratory Studies (Not often)

Blood smear
Hemoglobin
Leukocyte
LED
Immunology examination - normal
ANA test
rheumatic factor
Imaging Studies
Plain radiography
Computed tomography (CT) scanning
Magnetic resonance imaging (MRI)
Ultrasonography
Bone scanning
Arthrocentesis : aspiration of a joint with subsequent analysis of

DIAGNOSTIC CRITERIA
Osteoarthritis Classification Diagnosis; Knee
Osteoarthritis ICD 10 code: M17
Based on clinical criteria
Joint pain + at least 3 of 6 criteria
1. Crepitus
2. Stiffness < 30 minutes
3. > 50 years old
4. Enlargement of knees joint
5. Palpable pain
6. Absent of tenderness on synovial joint

Based on clinical criteria and radiology

Pain on knee joint and osteophytes at least 1 of 3 criteria
Stiffness< 30 minutes
Age> 50 minutes
Crepitating on active motion
Based on clinical criteria and laboratory investigation.
Pain on knee joint & at least 5 from 9 criteria below:
Age > 50 y/o
Stiffness< 30 minutes
Crepitating on active motion
Tenderness around joint
Bone enlargement
No warmness on affected synovial joint
LED< 40 mm/hour

Kellgren-Lawrence Classification
Grade I

Grade II

Grade III

normal joint surface

minimal ostophytes (Arrow)
Osteophytes (arrow) on the tibia and
patella. (slightly)
Asymmetric joins surface narrows
Presence of osteophytes moderately in
some places (arrow)
joint surface narrowing (arrow)
Subchondral sclerosis

Grade IV

there is a large osteophytes

Complete joint surfaces narrowed
Severe subchondral sclerosis
Joint surface damage.

PATOMEKANISME

MANAGEMENT THERAPY
Rehabilitation and supportive measures.
Patient education.
Exercises - increase tendons capacity and muscle to absorb stress
during joint motion.
Lifestyle modifications.
Weight managements: especially patient with obesity
Drug therapy/pharmacology
Acetaminophen 1 g P.O/ 8 hours
may relieve pain.
NSAIDs
to treat inflammation.
Tramadol

Grade OA
I

II

(-)ve Symptoms
(+)ve Symptoms
Chondroitin),

Therapy
: No treatment.
: Supplements (Glucosamine ,

Regular Exercise
Non- pharmacology : obese-> lose weight (diet &
exercise)
normal weight-> low impact
aerobic exercise.
Pharmacology

: NSAIDs/acetaminophen

III

Pharmacology

: Cortison injection.
Viscosupplements
(Hyaluronic acid intra-artikuler)

IV

Bone realignment surgery/ osteotomy

Artroplasty/ total knee replacement

THANK YOU.