Arthritis
Content
Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a form of joint disorder that involves inflammation of one or more joints.[1] [2] There are over 100 different forms of arthritis.[3][4] The most common form, osteoarthritis (degenerative joint disease), is a result of trauma to the joint, infection of the joint, or age. Other arthritis forms are rheumatoid arthritis, psoriatic arthritis, and related autoimmune diseases. Septic arthritis is caused by joint infection. The major complaint by individuals who have arthritis is joint pain. Pain is often a constant and may be localized to the joint affected. The pain from arthritis is due to inflammation that occurs around the joint, damage to the joint from disease, daily wear and tear of joint, muscle strains caused by forceful movements against stiff painful joints and fatigue.
Contents
[hide]
1 Classification 2 Signs and symptoms o 2.1 Disability 3 Diagnosis o 3.1 Osteoarthritis o 3.2 Rheumatoid arthritis o 3.3 Lupus o 3.4 Gout o 3.5 Other 4 Treatment o 4.1 Physical and occupational therapy o 4.2 Medications 5 Epidemiology 6 History 7 See also 8 References 9 External links
[edit] Classification
There are several diseases where joint pain is primary, and is considered the main feature. Generally when a person has "arthritis" it means that they have one of these diseases, which include:
Osteoarthritis Rheumatoid arthritis Gout and pseudo-gout Septic arthritis Ankylosing spondylitis Juvenile idiopathic arthritis Still's disease
Joint pain can also be a symptom of other diseases. In this case, the arthritis is considered to be secondary to the main disease; these include:
Psoriasis (Psoriatic arthritis) Reactive arthritis Ehlers-Danlos Syndrome Haemochromatosis Hepatitis Lyme disease Inflammatory bowel disease (Including Crohn's Disease and Ulcerative Colitis) Henoch-Schönlein purpura Hyperimmunoglobulinemia D with recurrent fever Sarcoidosis TNF receptor associated periodic syndrome Wegener's granulomatosis (and many other vasculitis syndromes) Familial Mediterranean fever Systemic lupus erythematosus
An undifferentiated arthritis is an arthritis that does not fit into well-known clinical disease categories, possibly being an early stage of a definite rheumatic disease.[5]
[edit] Signs and symptoms
Regardless of the type of arthritis, the common symptoms for all arthritis disorders include varied levels of pain, swelling, joint stiffness, and sometimes a constant ache around the joint(s). Arthritic disorders like lupus and rheumatoid can also affect other organs in the body with a variety of symptoms.[7]
Inability to use the hand or walk Malaise and a feeling of tiredness Weight loss Poor sleep Muscle aches and pains Tenderness Difficulty moving the joint
Extra-articular features of joint disease[6] Cutaneous nodules Cutaneous vasculitis lesions Lymphadenopathy Oedema Ocular inflammation Urethritis Tenosynovitis (tendon sheath effusions) Bursitis (swollen bursa) Diarrhea Orogenital ulceration
It is common in advanced arthritis for significant secondary changes to occur. For example, in someone who has limited their physical activity:
Muscle weakness Loss of flexibility Decreased aerobic fitness
These changes can also impact on life and social roles, such as community involvement.
[edit] Disability
Arthritis is the most common cause of disability in the USA.[8] More than 20 million individuals with arthritis have severe limitations in function on a daily basis. Absenteeism and frequent visits to the physician are common in individuals who have arthritis. Arthritis makes it very difficult for individuals to be physically active and many become home bound.[9] It is estimated that the total cost of arthritis cases is close to $100 billion of which nearly 50% is from lost earnings. Each year, arthritis results in nearly 1 million hospitalizations and close to 45 million outpatient visits to health care centers.[10] Arthritis can make it very difficult for an individual to remain physically active, contributing to an increased risk of obesity, high cholesterol or vulnerability to heart disease. Individuals with arthritis are also at increased risk of depression, which may be related to fear of worsening symptoms.
[edit] Diagnosis
Diagnosis is made by clinical examination from an appropriate health professional, and may be supported by other tests such as radiology and blood tests, depending on the type of suspected arthritis. All arthritides potentially feature pain. Pain patterns may differ depending on the arthritides and the location. Rheumatoid arthritis is generally worse in the morning and associated with stiffness; in the early stages, patients often have no symptoms after a morning shower. Osteoarthritis, on the other hand, tends to be worse after exercise. In the aged and children, pain might not be the main presenting feature; the aged patient simply moves less, the infantile patient refuses to use the affected limb. Elements of the history of the disorder guide diagnosis. Important features are speed and time of onset, pattern of joint involvement, symmetry of symptoms, early morning stiffness, tenderness, gelling or locking with inactivity, aggravating and relieving factors, and other systemic symptoms. Physical examination may confirm the diagnosis, or may indicate systemic disease. Radiographs are often used to follow progression or help assess severity.
[edit] Osteoarthritis
Osteoarthritis is the most common form of arthritis.[11] It can affect both the larger and the smaller joints of the body, including the hands, feet, back, hip, and knee. The disease is essentially one acquired from daily wear and tear of the joint; however, osteoarthritis can also occur as a result of injury. Osteoarthritis begins in the cartilage and eventually causes the two opposing bones to erode into each other. Initially, the condition starts with minor pain during activities, but soon the pain can be continuous and even occur while in a state of rest. The pain can be debilitating and prevent one from doing some activities. Osteoarthritis typically affects the weight-bearing joints, such as the back, spine, and pelvis. Unlike rheumatoid arthritis, osteoarthritis is most commonly a disease of the elderly. More than 30 percent of women have some degree of osteoarthritis by age 65. Risk factors for osteoarthritis include prior joint trauma, obesity, and a sedentary lifestyle. Osteoarthritis, like rheumatoid arthritis, cannot be cured, but one can prevent the condition from worsening. Physical therapy to strengthen muscles and joints is very helpful. Pain medications are widely required by individuals with osteoarthritis. For some patients, weight
loss can reduce the stress on the joints. When the disease is far advanced and the pain is continuous, surgery may be an option. Unlike rheumatoid arthritis, joint replacement does help many individuals with osteoarthritis.[12]
[edit] Rheumatoid arthritis
Rheumatoid arthritis is a disorder in which the body's own immune system starts to attack body tissues. The attack is not only directed at the joint but to many other parts of the body. In rheumatoid arthritis, most damage occurs to the joint lining and cartilage which eventually results in erosion of two opposing bones. Rheumatoid arthritis often affects joints in the fingers, wrists, knees and elbows. The disease is symmetrical (appears on both sides of the body) and can lead to severe deformity in a few years if not treated. Rheumatoid arthritis occurs mostly in people aged 20 and above. In children, the disorder can present with a skin rash, fever, pain, disability, and limitations in daily activities. Often, it is not clear why the rheumatoid arthritis occurred. With earlier diagnosis and aggressive treatment, many individuals can lead a decent quality of life. The drugs to treat rheumatoid arthritis range from corticosteroids to monoclonal antibodies given intravenously. The latest drugs like Remicade can significantly improve quality of life in the short term. In rare cases, surgery may be required to replace joints but there is no cure for the illness.[13]
[edit] Lupus
This is a common collagen vascular disorder that can be present with severe arthritis. Other features of lupus include a skin rash, extreme photosensitivity, hair loss, kidney problems, lung fibrosis and constant joint pain.[14]
[edit] Gout
Gout is caused by deposition of uric acid crystals in the joint, causing inflammation. There is also an uncommon form of gouty arthritis caused by the formation of rhomboid crystals of calcium pyrophosphate known as pseudogout. In the early stages, the gouty arthritis usually occurs in one joint, but with time, it can occur in many joints and be quite crippling. The joints in gout can often become swollen and lose function. Gouty arthritis can become particularly painful and potentially debilitating when gout cannot successfully be treated.[15] When uric acid levels and gout symptoms cannot be controlled with standard gout medicines that decrease the production of uric acid (e.g., allopurinol, febuxostat) or increase uric acid elimination from the body through the kidneys (e.g., probenecid), this can be referred to as refractory chronic gout or RCG.[16] Comparison of some major forms of arthritis[17] Osteoarthritis Rheumatoid arthritis Gouty arthritis Speed of onset Main locations Months Weight-bearing joints (such as knees, hips, vertebral column) and hands Weeks-months[18] Hours for an attack[19]
Hands (proximal interphalangeal and Great toe, ankles, knees metacarpophalangeal and elbows joint) wrists, ankles and knees
May occur, though often mild compared to Yes Inflammation inflammation in rheumatoid arthritis Narrowed joint space Osteophytes Radiologic Local changes osteosclerosis Subchondral cysts
Yes
Narrowed joint space Bone erosions
"Punched out" bone erosions
Anemia, elevated ESR and C-reactive protein Laboratory None (CRP), rheumatoid Crystal in joints findings factor, anti-citrullinated protein antibody Extra-articular features are common No systemic signs Ulnar deviation, Tophi Bouchard's and Other swan neck- and Nephrolithiasis Heberden's nodes features Boutonniere deformity of the hand
[edit] Other
Infectious arthritis is another severe form of arthritis. It presents with sudden onset of chills, fever and joint pain. The condition is caused by bacteria elsewhere in the body. Infectious arthritis must be rapidly diagnosed and treated promptly to prevent irreversible and permanent joint damage.[20] Psoriasis can develop into psoriatic arthritis. With psoriatic arthritis, most individuals develop the skin problem first and then the arthritis. The typical features are of continuous joint pains, stiffness and swelling. The disease does recur with periods of remission but there is no cure for the disorder. A small percentage develop a severe painful and destructive form of arthritis which destroys the small joints in the hands and can lead to permanent disability and loss of hand function.[21]
[edit] Treatment
There is no cure for either rheumatoid or osteoarthritis. Treatment options vary depending on the type of arthritis and include physical therapy, lifestyle changes (including exercise and weight control), orthopedic bracing, medications. Joint replacement surgery may be required in eroding forms of arthritis. Medications can help reduce inflammation in the joint which decreases pain. Moreover, by decreasing inflammation, the joint damage may be slowed.[22]
[edit] Physical and occupational therapy
In general, studies have shown that physical exercise of the affected joint can have noticeable improvement in terms of long-term pain relief. Furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person.[23] Individuals with arthritis can benefit from both physical and occupational therapy. In arthritis the joints become stiff and the range of movement can be limited. Physical therapy has been shown to significantly improve function, decrease pain, and delay need for surgical intervention in advanced cases.[24] Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteoarthritis of the knee. Exercise often focuses on improving muscle strength, endurance and flexibility. In some cases, exercises may be designed to train balance. Occupational therapy can provide assistance with activities as well as equipment.
[edit] Medications
There are several types of medications that are used for the treatment of arthritis. Treatment typically begins with medications that have the fewest side effects with further medications being added if insufficiently effective.[25] Treatment also depends on the type of the arthritis. For example, the first-line treatment for osteoarthritis is acetaminophen (paracetamol) while for inflammatory arthritis it involves non-steroidal anti-inflammatory drugs like ibuprofen.
[edit] Epidemiology
Arthritis is predominantly a disease of the elderly, but children can also be affected by the disease. More than 70% of individuals in North America affected by arthritis are over the age of 65. Arthritis is more common in women than men at all ages and affects all races, ethnic groups and cultures. In the United States a CDC survey based on data from 2007–2009 showed 22.2% (49.9 million) of adults aged ≥18 years had self-reported doctor-diagnosed arthritis, and 9.4% (21.1 million or 42.4% of those with arthritis) had arthritis-attributable activity limitation (AAAL). With an aging population this number is expected to increase.[26]
[edit] History
While evidence of primary ankle (kaki) osteoarthritis has been discovered in dinosaurs, the first known traces of human arthritis date back as far as 4500 BC. In early reports, arthritis was frequently referred to as the most common ailment of prehistoric peoples.[27] It was noted in skeletal remains of Native Americans found in Tennessee and parts of what is now Olathe, Kansas. Evidence of arthritis has been found throughout history, from Ötzi, a mummy (circa 3000 BC) found along the border of modern Italy and Austria, to the Egyptian mummies circa 2590 BC[28] In 1715 William Musgrave published the second edition of his most important medical work De arthritide symptomatica which concerned arthritis and its effects.[29]
Blood tests and X-rays of the affected joints often are performed to make the diagnosis. Screening blood tests are indicated if certain arthritides are suspected. These might include: rheumatoid factor, antinuclear factor (ANF), extractable nuclear antigen, and specific antibodies.
Seiring dengan semakin meningkatnya populasi lansia, pemerintah telah merumuskan berbagai kebijakan pelayanan kesehatan usia lanjut ditujukan untuk meningkatkan derajat kesehatan dan mutu kehidupan lansia untuk mencapai masa tua bahagia dan berdaya guna dalam kehidupan kelu-arga dan masyarakat sesuai dengan keberadaannya. Sebagai wujud nyata pelayanan sosial dan kesehatan pada kelompok usia lanjut ini, pemerintah telah mencanangkan pelayanan pada lansia melalui beberapa jenjang. Pelayanan kesehatan di tingkat masyarakat adalah Posyandu lansia, pelayanan kesehatan lansia tingkat dasar adalah Puskesmas, dan pelayanan kesehatan tingkat lanjutan adalah Rumah Sakit. Posyandu lansia adalah pos pelayanan terpadu untuk masyarakat usia lanjut di suatu wilayah tertentu yang sudah disepakati, yang digerakkan oleh masyarakat dimana mereka bisa mendapatkan pelayanan kesehatan Posyandu lansia merupakan pengembangan dari kebijakan pemerintah melalui pelayanan kesehatan bagi lansia yang penyelenggaraannya melalui program Puskesmas dengan melibatkan peran serta para lansia, keluarga, tokoh masyarakat dan organisasi sosial dalam penyelenggaraannya. Tujuan Posyandu Lansia Tujuan pembentukan posyandu lansia secara garis besar antara lain : a. Meningkatkan jangkauan pelayanan kesehatan lansia di masyarakat, sehingga terbentuk pelayanan kesehatan yang sesuai dengan kebutuhan lansia b. Mendekatkan pelayanan dan meningkatkan peran serta masyarakat dan swasta dalam pelayanan kesehatan disamping meningkatkan komunikasi antara masyarakat usia lanjut. Mekanisme Pelayanan Posyandu Lansia Berbeda dengan posyandu balita yang terdapat sistem 5 meja, pelayanan yang diselenggarakan dalam posyandu lansia tergantung pada mekanisme dan kebijakan pelayanan kesehatan di suatu wilayah kabupaten maupun kota penyelenggara. Ada yang menyelenggarakan posyandu lansia sistem 5 meja seperti posyandu balita, ada juga hanya menggunakan sistem pelayanan 3 meja, dengan kegiatan sebagai berikut : - Meja I : pendaftaran lansia, pengukuran dan penimbangan berat badan dan atau tinggi badan - Meja II : Melakukan pencatatan berat badan, tinggi badan, indeks massa tubuh (IMT). Pelayanan kesehatan seperti pengobatan sederhana dan rujukan kasus juga dilakukan di meja II ini. - Meja III : melakukan kegiatan penyuluhan atau konseling, disini juga bisa dilakukan pelayanan pojok gizi. Kendala Pelaksanaan Posyandu Lansia Beberapa kendala yang dihadapi lansia dalam mengikuti kegiatan posyandu antara lain : a. Pengetahuan lansia yang rendah tentang manfaat posyandu. Pengetahuan lansia akan manfaat posyandu ini dapat diperoleh dari pengalaman pribadi dalam kehidupan sehari-harinya. Dengan menghadiri kegiatan posyandu, lansia akan mendapatkan penyuluhan tentang bagaimana cara hidup sehat dengan segala keterbatasan atau masalah kesehatan yang melekat pada mereka. Dengan pengalaman ini, pengetahuan lansia menjadi meningkat, yang menjadi dasar pembentukan sikap dan dapat mendorong minat atau motivasi mereka untuk selalu mengikuti kegiatan posyandu lansia
b. Jarak rumah dengan lokasi posyandu yang jauh atau sulit dijangkau Jarak posyandu yang dekat akan membuat lansia mudah menjangkau posyandu tanpa harus mengalami kelelahan atau kecelakaan fisik karena penurunan daya tahan atau kekuatan fisik tubuh. Kemudahan dalam menjangkau lokasi posyandu ini berhubungan dengan faktor keamanan atau keselamatan bagi lansia. Jika lansia merasa aman atau merasa mudah untuk menjangkau lokasi posyandu tanpa harus menimbulkan kelelahan atau masalah yang lebih serius, maka hal ini dapat mendorong minat atau motivasi lansia untuk mengikuti kegiatan posyandu. Dengan demikian, keamanan ini merupakan faktor eksternal dari terbentuknya motivasi untuk menghadiri posyandu lansia. c. Kurangnya dukungan keluarga untuk mengantar maupun mengingatkan lansia untuk datang ke posyandu. Dukungan keluarga sangat berperan dalam mendorong minat atau kesediaan lansia untuk mengikuti kegiatan posyandu lansia. Keluarga bisa menjadi motivator kuat bagi lansia apabila selalu menyediakan diri untuk mendampingi atau mengantar lansia ke posyandu, mengingatkan lansia jika lupa jadwal posyandu, dan berusaha membantu mengatasi segala permasalahan bersama lansia. d. Sikap yang kurang baik terhadap petugas posyandu. Penilaian pribadi atau sikap yang baik terhadap petugas merupakan dasar atas kesiapan atau kesediaan lansia untuk mengikuti kegiatan posyandu. Dengan sikap yang baik tersebut, lansia cenderung untuk selalu hadir atau mengikuti kegiatan yang diadakan di posyandu lansia. Hal ini dapat dipahami karena sikap seseorang adalah suatu cermin kesiapan untuk bereaksi terhadap suatu obyek. Kesiapan merupakan kecenderungan potensial untuk bereaksi dengan cara-cara tertentu apabila individu dihadapkan pada stimulus yang menghendaki adanya suatu respons Bentuk Pelayanan Posyandu Lansia Pelayanan Kesehatan di Posyandu lanjut usia meliputi pemeriksaan Kesehatan fisik dan mental emosional yang dicatat dan dipantau dengan Kartu Menuju Sehat (KMS) untuk mengetahui lebih awal penyakit yang diderita (deteksi dini) atau ancaman masalah kesehatan yang dihadapi. Jenis Pelayanan Kesehatan yang diberikan kepada usia lanjut di Posyandu Lansia seperti tercantum dalam situs Pemerintah Kota Jogjakarta adalah: a. Pemeriksaan aktivitas kegiatan sehari-hari meliputi kegiatan dasar dalam kehidupan, seperti makan/minum, berjalan, mandi, berpakaian, naik turun tempat tidur, buang air besar/kecil dan sebagainya. b. Pemeriksaan status mental. Pemeriksaan ini berhubungan dengan mental emosional dengan menggunakan pedoman metode 2 (dua ) menit. c. Pemeriksaan status gizi melalui penimbangan berat badan dan pengukuran tinggi badan dan dicatat pada grafik indeks masa tubuh (IMT). d. Pengukuran tekanan darah menggunakan tensimeter dan stetoskop serta penghitungan denyut nadi selama satu menit. e. Pemeriksaan hemoglobin menggunakan talquist, sahli atau cuprisulfat f. Pemeriksaan adanya gula dalam air seni sebagai deteksi awal adanya penyakit gula (diabetes mellitus) g. Pemeriksaan adanya zat putih telur (protein) dalam air seni sebagai deteksi awal adanya penyakit ginjal. h. Pelaksanaan rujukan ke Puskesmas bilamana ada keluhan dan atau ditemukan kelainan pada pemeriksaan butir 1 hingga 7. dan i. Penyuluhan Kesehatan. Kegiatan lain yang dapat dilakukan sesuai kebutuhan dan kondisi setempat seperti
Pemberian Makanan Tambahan (PMT) dengan memperhatikan aspek kesehatan dan gizi lanjut usia dan kegiatan olah raga seperti senam lanjut usia, gerak jalan santai untuk meningkatkan kebugaran. Untuk kelancaran pelaksanaan kegiatan di Posyandu Lansia, dibutuhkan, sarana dan prasarana penunjang, yaitu: tempat kegiatan (gedung, ruangan atau tempat terbuka), meja dan kursi, alat tulis, buku pencatatan kegiatan, timbangan dewasa, meteran pengukuran tinggi badan, stetoskop, tensi meter, peralatan laboratorium sederhana, thermometer, Kartu Menuju Sehat (KMS) lansia
Contents
[hide]
1 Classification 2 Signs and symptoms o 2.1 Disability 3 Diagnosis o 3.1 Osteoarthritis o 3.2 Rheumatoid arthritis o 3.3 Lupus o 3.4 Gout o 3.5 Other 4 Treatment o 4.1 Physical and occupational therapy o 4.2 Medications 5 Epidemiology 6 History 7 See also 8 References 9 External links
[edit] Classification
There are several diseases where joint pain is primary, and is considered the main feature. Generally when a person has "arthritis" it means that they have one of these diseases, which include:
Osteoarthritis Rheumatoid arthritis Gout and pseudo-gout Septic arthritis Ankylosing spondylitis Juvenile idiopathic arthritis Still's disease
Joint pain can also be a symptom of other diseases. In this case, the arthritis is considered to be secondary to the main disease; these include:
Psoriasis (Psoriatic arthritis) Reactive arthritis Ehlers-Danlos Syndrome Haemochromatosis Hepatitis Lyme disease Inflammatory bowel disease (Including Crohn's Disease and Ulcerative Colitis) Henoch-Schönlein purpura Hyperimmunoglobulinemia D with recurrent fever Sarcoidosis TNF receptor associated periodic syndrome Wegener's granulomatosis (and many other vasculitis syndromes) Familial Mediterranean fever Systemic lupus erythematosus
An undifferentiated arthritis is an arthritis that does not fit into well-known clinical disease categories, possibly being an early stage of a definite rheumatic disease.[5]
[edit] Signs and symptoms
Regardless of the type of arthritis, the common symptoms for all arthritis disorders include varied levels of pain, swelling, joint stiffness, and sometimes a constant ache around the joint(s). Arthritic disorders like lupus and rheumatoid can also affect other organs in the body with a variety of symptoms.[7]
Inability to use the hand or walk Malaise and a feeling of tiredness Weight loss Poor sleep Muscle aches and pains Tenderness Difficulty moving the joint
Extra-articular features of joint disease[6] Cutaneous nodules Cutaneous vasculitis lesions Lymphadenopathy Oedema Ocular inflammation Urethritis Tenosynovitis (tendon sheath effusions) Bursitis (swollen bursa) Diarrhea Orogenital ulceration
It is common in advanced arthritis for significant secondary changes to occur. For example, in someone who has limited their physical activity:
Muscle weakness Loss of flexibility Decreased aerobic fitness
These changes can also impact on life and social roles, such as community involvement.
[edit] Disability
Arthritis is the most common cause of disability in the USA.[8] More than 20 million individuals with arthritis have severe limitations in function on a daily basis. Absenteeism and frequent visits to the physician are common in individuals who have arthritis. Arthritis makes it very difficult for individuals to be physically active and many become home bound.[9] It is estimated that the total cost of arthritis cases is close to $100 billion of which nearly 50% is from lost earnings. Each year, arthritis results in nearly 1 million hospitalizations and close to 45 million outpatient visits to health care centers.[10] Arthritis can make it very difficult for an individual to remain physically active, contributing to an increased risk of obesity, high cholesterol or vulnerability to heart disease. Individuals with arthritis are also at increased risk of depression, which may be related to fear of worsening symptoms.
[edit] Diagnosis
Diagnosis is made by clinical examination from an appropriate health professional, and may be supported by other tests such as radiology and blood tests, depending on the type of suspected arthritis. All arthritides potentially feature pain. Pain patterns may differ depending on the arthritides and the location. Rheumatoid arthritis is generally worse in the morning and associated with stiffness; in the early stages, patients often have no symptoms after a morning shower. Osteoarthritis, on the other hand, tends to be worse after exercise. In the aged and children, pain might not be the main presenting feature; the aged patient simply moves less, the infantile patient refuses to use the affected limb. Elements of the history of the disorder guide diagnosis. Important features are speed and time of onset, pattern of joint involvement, symmetry of symptoms, early morning stiffness, tenderness, gelling or locking with inactivity, aggravating and relieving factors, and other systemic symptoms. Physical examination may confirm the diagnosis, or may indicate systemic disease. Radiographs are often used to follow progression or help assess severity.
[edit] Osteoarthritis
Osteoarthritis is the most common form of arthritis.[11] It can affect both the larger and the smaller joints of the body, including the hands, feet, back, hip, and knee. The disease is essentially one acquired from daily wear and tear of the joint; however, osteoarthritis can also occur as a result of injury. Osteoarthritis begins in the cartilage and eventually causes the two opposing bones to erode into each other. Initially, the condition starts with minor pain during activities, but soon the pain can be continuous and even occur while in a state of rest. The pain can be debilitating and prevent one from doing some activities. Osteoarthritis typically affects the weight-bearing joints, such as the back, spine, and pelvis. Unlike rheumatoid arthritis, osteoarthritis is most commonly a disease of the elderly. More than 30 percent of women have some degree of osteoarthritis by age 65. Risk factors for osteoarthritis include prior joint trauma, obesity, and a sedentary lifestyle. Osteoarthritis, like rheumatoid arthritis, cannot be cured, but one can prevent the condition from worsening. Physical therapy to strengthen muscles and joints is very helpful. Pain medications are widely required by individuals with osteoarthritis. For some patients, weight
loss can reduce the stress on the joints. When the disease is far advanced and the pain is continuous, surgery may be an option. Unlike rheumatoid arthritis, joint replacement does help many individuals with osteoarthritis.[12]
[edit] Rheumatoid arthritis
Rheumatoid arthritis is a disorder in which the body's own immune system starts to attack body tissues. The attack is not only directed at the joint but to many other parts of the body. In rheumatoid arthritis, most damage occurs to the joint lining and cartilage which eventually results in erosion of two opposing bones. Rheumatoid arthritis often affects joints in the fingers, wrists, knees and elbows. The disease is symmetrical (appears on both sides of the body) and can lead to severe deformity in a few years if not treated. Rheumatoid arthritis occurs mostly in people aged 20 and above. In children, the disorder can present with a skin rash, fever, pain, disability, and limitations in daily activities. Often, it is not clear why the rheumatoid arthritis occurred. With earlier diagnosis and aggressive treatment, many individuals can lead a decent quality of life. The drugs to treat rheumatoid arthritis range from corticosteroids to monoclonal antibodies given intravenously. The latest drugs like Remicade can significantly improve quality of life in the short term. In rare cases, surgery may be required to replace joints but there is no cure for the illness.[13]
[edit] Lupus
This is a common collagen vascular disorder that can be present with severe arthritis. Other features of lupus include a skin rash, extreme photosensitivity, hair loss, kidney problems, lung fibrosis and constant joint pain.[14]
[edit] Gout
Gout is caused by deposition of uric acid crystals in the joint, causing inflammation. There is also an uncommon form of gouty arthritis caused by the formation of rhomboid crystals of calcium pyrophosphate known as pseudogout. In the early stages, the gouty arthritis usually occurs in one joint, but with time, it can occur in many joints and be quite crippling. The joints in gout can often become swollen and lose function. Gouty arthritis can become particularly painful and potentially debilitating when gout cannot successfully be treated.[15] When uric acid levels and gout symptoms cannot be controlled with standard gout medicines that decrease the production of uric acid (e.g., allopurinol, febuxostat) or increase uric acid elimination from the body through the kidneys (e.g., probenecid), this can be referred to as refractory chronic gout or RCG.[16] Comparison of some major forms of arthritis[17] Osteoarthritis Rheumatoid arthritis Gouty arthritis Speed of onset Main locations Months Weight-bearing joints (such as knees, hips, vertebral column) and hands Weeks-months[18] Hours for an attack[19]
Hands (proximal interphalangeal and Great toe, ankles, knees metacarpophalangeal and elbows joint) wrists, ankles and knees
May occur, though often mild compared to Yes Inflammation inflammation in rheumatoid arthritis Narrowed joint space Osteophytes Radiologic Local changes osteosclerosis Subchondral cysts
Yes
Narrowed joint space Bone erosions
"Punched out" bone erosions
Anemia, elevated ESR and C-reactive protein Laboratory None (CRP), rheumatoid Crystal in joints findings factor, anti-citrullinated protein antibody Extra-articular features are common No systemic signs Ulnar deviation, Tophi Bouchard's and Other swan neck- and Nephrolithiasis Heberden's nodes features Boutonniere deformity of the hand
[edit] Other
Infectious arthritis is another severe form of arthritis. It presents with sudden onset of chills, fever and joint pain. The condition is caused by bacteria elsewhere in the body. Infectious arthritis must be rapidly diagnosed and treated promptly to prevent irreversible and permanent joint damage.[20] Psoriasis can develop into psoriatic arthritis. With psoriatic arthritis, most individuals develop the skin problem first and then the arthritis. The typical features are of continuous joint pains, stiffness and swelling. The disease does recur with periods of remission but there is no cure for the disorder. A small percentage develop a severe painful and destructive form of arthritis which destroys the small joints in the hands and can lead to permanent disability and loss of hand function.[21]
[edit] Treatment
There is no cure for either rheumatoid or osteoarthritis. Treatment options vary depending on the type of arthritis and include physical therapy, lifestyle changes (including exercise and weight control), orthopedic bracing, medications. Joint replacement surgery may be required in eroding forms of arthritis. Medications can help reduce inflammation in the joint which decreases pain. Moreover, by decreasing inflammation, the joint damage may be slowed.[22]
[edit] Physical and occupational therapy
In general, studies have shown that physical exercise of the affected joint can have noticeable improvement in terms of long-term pain relief. Furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person.[23] Individuals with arthritis can benefit from both physical and occupational therapy. In arthritis the joints become stiff and the range of movement can be limited. Physical therapy has been shown to significantly improve function, decrease pain, and delay need for surgical intervention in advanced cases.[24] Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteoarthritis of the knee. Exercise often focuses on improving muscle strength, endurance and flexibility. In some cases, exercises may be designed to train balance. Occupational therapy can provide assistance with activities as well as equipment.
[edit] Medications
There are several types of medications that are used for the treatment of arthritis. Treatment typically begins with medications that have the fewest side effects with further medications being added if insufficiently effective.[25] Treatment also depends on the type of the arthritis. For example, the first-line treatment for osteoarthritis is acetaminophen (paracetamol) while for inflammatory arthritis it involves non-steroidal anti-inflammatory drugs like ibuprofen.
[edit] Epidemiology
Arthritis is predominantly a disease of the elderly, but children can also be affected by the disease. More than 70% of individuals in North America affected by arthritis are over the age of 65. Arthritis is more common in women than men at all ages and affects all races, ethnic groups and cultures. In the United States a CDC survey based on data from 2007–2009 showed 22.2% (49.9 million) of adults aged ≥18 years had self-reported doctor-diagnosed arthritis, and 9.4% (21.1 million or 42.4% of those with arthritis) had arthritis-attributable activity limitation (AAAL). With an aging population this number is expected to increase.[26]
[edit] History
While evidence of primary ankle (kaki) osteoarthritis has been discovered in dinosaurs, the first known traces of human arthritis date back as far as 4500 BC. In early reports, arthritis was frequently referred to as the most common ailment of prehistoric peoples.[27] It was noted in skeletal remains of Native Americans found in Tennessee and parts of what is now Olathe, Kansas. Evidence of arthritis has been found throughout history, from Ötzi, a mummy (circa 3000 BC) found along the border of modern Italy and Austria, to the Egyptian mummies circa 2590 BC[28] In 1715 William Musgrave published the second edition of his most important medical work De arthritide symptomatica which concerned arthritis and its effects.[29]
Blood tests and X-rays of the affected joints often are performed to make the diagnosis. Screening blood tests are indicated if certain arthritides are suspected. These might include: rheumatoid factor, antinuclear factor (ANF), extractable nuclear antigen, and specific antibodies.
Seiring dengan semakin meningkatnya populasi lansia, pemerintah telah merumuskan berbagai kebijakan pelayanan kesehatan usia lanjut ditujukan untuk meningkatkan derajat kesehatan dan mutu kehidupan lansia untuk mencapai masa tua bahagia dan berdaya guna dalam kehidupan kelu-arga dan masyarakat sesuai dengan keberadaannya. Sebagai wujud nyata pelayanan sosial dan kesehatan pada kelompok usia lanjut ini, pemerintah telah mencanangkan pelayanan pada lansia melalui beberapa jenjang. Pelayanan kesehatan di tingkat masyarakat adalah Posyandu lansia, pelayanan kesehatan lansia tingkat dasar adalah Puskesmas, dan pelayanan kesehatan tingkat lanjutan adalah Rumah Sakit. Posyandu lansia adalah pos pelayanan terpadu untuk masyarakat usia lanjut di suatu wilayah tertentu yang sudah disepakati, yang digerakkan oleh masyarakat dimana mereka bisa mendapatkan pelayanan kesehatan Posyandu lansia merupakan pengembangan dari kebijakan pemerintah melalui pelayanan kesehatan bagi lansia yang penyelenggaraannya melalui program Puskesmas dengan melibatkan peran serta para lansia, keluarga, tokoh masyarakat dan organisasi sosial dalam penyelenggaraannya. Tujuan Posyandu Lansia Tujuan pembentukan posyandu lansia secara garis besar antara lain : a. Meningkatkan jangkauan pelayanan kesehatan lansia di masyarakat, sehingga terbentuk pelayanan kesehatan yang sesuai dengan kebutuhan lansia b. Mendekatkan pelayanan dan meningkatkan peran serta masyarakat dan swasta dalam pelayanan kesehatan disamping meningkatkan komunikasi antara masyarakat usia lanjut. Mekanisme Pelayanan Posyandu Lansia Berbeda dengan posyandu balita yang terdapat sistem 5 meja, pelayanan yang diselenggarakan dalam posyandu lansia tergantung pada mekanisme dan kebijakan pelayanan kesehatan di suatu wilayah kabupaten maupun kota penyelenggara. Ada yang menyelenggarakan posyandu lansia sistem 5 meja seperti posyandu balita, ada juga hanya menggunakan sistem pelayanan 3 meja, dengan kegiatan sebagai berikut : - Meja I : pendaftaran lansia, pengukuran dan penimbangan berat badan dan atau tinggi badan - Meja II : Melakukan pencatatan berat badan, tinggi badan, indeks massa tubuh (IMT). Pelayanan kesehatan seperti pengobatan sederhana dan rujukan kasus juga dilakukan di meja II ini. - Meja III : melakukan kegiatan penyuluhan atau konseling, disini juga bisa dilakukan pelayanan pojok gizi. Kendala Pelaksanaan Posyandu Lansia Beberapa kendala yang dihadapi lansia dalam mengikuti kegiatan posyandu antara lain : a. Pengetahuan lansia yang rendah tentang manfaat posyandu. Pengetahuan lansia akan manfaat posyandu ini dapat diperoleh dari pengalaman pribadi dalam kehidupan sehari-harinya. Dengan menghadiri kegiatan posyandu, lansia akan mendapatkan penyuluhan tentang bagaimana cara hidup sehat dengan segala keterbatasan atau masalah kesehatan yang melekat pada mereka. Dengan pengalaman ini, pengetahuan lansia menjadi meningkat, yang menjadi dasar pembentukan sikap dan dapat mendorong minat atau motivasi mereka untuk selalu mengikuti kegiatan posyandu lansia
b. Jarak rumah dengan lokasi posyandu yang jauh atau sulit dijangkau Jarak posyandu yang dekat akan membuat lansia mudah menjangkau posyandu tanpa harus mengalami kelelahan atau kecelakaan fisik karena penurunan daya tahan atau kekuatan fisik tubuh. Kemudahan dalam menjangkau lokasi posyandu ini berhubungan dengan faktor keamanan atau keselamatan bagi lansia. Jika lansia merasa aman atau merasa mudah untuk menjangkau lokasi posyandu tanpa harus menimbulkan kelelahan atau masalah yang lebih serius, maka hal ini dapat mendorong minat atau motivasi lansia untuk mengikuti kegiatan posyandu. Dengan demikian, keamanan ini merupakan faktor eksternal dari terbentuknya motivasi untuk menghadiri posyandu lansia. c. Kurangnya dukungan keluarga untuk mengantar maupun mengingatkan lansia untuk datang ke posyandu. Dukungan keluarga sangat berperan dalam mendorong minat atau kesediaan lansia untuk mengikuti kegiatan posyandu lansia. Keluarga bisa menjadi motivator kuat bagi lansia apabila selalu menyediakan diri untuk mendampingi atau mengantar lansia ke posyandu, mengingatkan lansia jika lupa jadwal posyandu, dan berusaha membantu mengatasi segala permasalahan bersama lansia. d. Sikap yang kurang baik terhadap petugas posyandu. Penilaian pribadi atau sikap yang baik terhadap petugas merupakan dasar atas kesiapan atau kesediaan lansia untuk mengikuti kegiatan posyandu. Dengan sikap yang baik tersebut, lansia cenderung untuk selalu hadir atau mengikuti kegiatan yang diadakan di posyandu lansia. Hal ini dapat dipahami karena sikap seseorang adalah suatu cermin kesiapan untuk bereaksi terhadap suatu obyek. Kesiapan merupakan kecenderungan potensial untuk bereaksi dengan cara-cara tertentu apabila individu dihadapkan pada stimulus yang menghendaki adanya suatu respons Bentuk Pelayanan Posyandu Lansia Pelayanan Kesehatan di Posyandu lanjut usia meliputi pemeriksaan Kesehatan fisik dan mental emosional yang dicatat dan dipantau dengan Kartu Menuju Sehat (KMS) untuk mengetahui lebih awal penyakit yang diderita (deteksi dini) atau ancaman masalah kesehatan yang dihadapi. Jenis Pelayanan Kesehatan yang diberikan kepada usia lanjut di Posyandu Lansia seperti tercantum dalam situs Pemerintah Kota Jogjakarta adalah: a. Pemeriksaan aktivitas kegiatan sehari-hari meliputi kegiatan dasar dalam kehidupan, seperti makan/minum, berjalan, mandi, berpakaian, naik turun tempat tidur, buang air besar/kecil dan sebagainya. b. Pemeriksaan status mental. Pemeriksaan ini berhubungan dengan mental emosional dengan menggunakan pedoman metode 2 (dua ) menit. c. Pemeriksaan status gizi melalui penimbangan berat badan dan pengukuran tinggi badan dan dicatat pada grafik indeks masa tubuh (IMT). d. Pengukuran tekanan darah menggunakan tensimeter dan stetoskop serta penghitungan denyut nadi selama satu menit. e. Pemeriksaan hemoglobin menggunakan talquist, sahli atau cuprisulfat f. Pemeriksaan adanya gula dalam air seni sebagai deteksi awal adanya penyakit gula (diabetes mellitus) g. Pemeriksaan adanya zat putih telur (protein) dalam air seni sebagai deteksi awal adanya penyakit ginjal. h. Pelaksanaan rujukan ke Puskesmas bilamana ada keluhan dan atau ditemukan kelainan pada pemeriksaan butir 1 hingga 7. dan i. Penyuluhan Kesehatan. Kegiatan lain yang dapat dilakukan sesuai kebutuhan dan kondisi setempat seperti
Pemberian Makanan Tambahan (PMT) dengan memperhatikan aspek kesehatan dan gizi lanjut usia dan kegiatan olah raga seperti senam lanjut usia, gerak jalan santai untuk meningkatkan kebugaran. Untuk kelancaran pelaksanaan kegiatan di Posyandu Lansia, dibutuhkan, sarana dan prasarana penunjang, yaitu: tempat kegiatan (gedung, ruangan atau tempat terbuka), meja dan kursi, alat tulis, buku pencatatan kegiatan, timbangan dewasa, meteran pengukuran tinggi badan, stetoskop, tensi meter, peralatan laboratorium sederhana, thermometer, Kartu Menuju Sehat (KMS) lansia
