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NAMA :

Prof.DR.dr.Harry Isbagio,SpPD K-R,K-GER,FINASIM



TEMPAT/TGL.LAHIR :
Magelang, 24 Desember 1948

JABATAN :
Guru Besar Divisi Reumatologi Dep. Ilmu Penyakit Dalam
FKUI/RSUPN Ciptomangunkusumo Jakarta

PENDIDIKAN :
Tamat Dokter 1972 FKUI
Brevet Spesialis Penyakit Dalam 1979 FKUI
Brevet Subspesialis Reumatologi 1986 FKUI
Brevet Subspesialis Geriatri 1996 FKUI
Doktor 2004 FKUI
Guru Besar 2005 FKUI

ORGANISASI :
Ketua Umum, Ikatan Reumatologi Indonesia, 1994 2005
President , Rheumatology Association of ASEAN 2001 2006
Ketua Bidang Sp Konsultan, Kolegium Ilmu Penyakit Dalam
(KIPD), 2006- 2012
The Role Diacerein in the
Management of Osteoathrosis
Harry Isbagio
Pathogenesis of OA
Wear and tear ?
It is not necessarily age related
It is asymmetrically distribution/ localized
It is progress steadily
The sign & symptoms of inflammation
Role of inflammation in OA, what is the
evidence ?
What are inflammatory factors that could
possibly be involved in genesis of OA
structural changes?
Osteoarthritis chondrocyte
Increase functions
Type II collagen and aggrecan synthesis (early OA)
Cell proliferation
Catabolic cytokine production
MMPs, TPA/plasmin
IL-I receptor type 1, NOS/NO, Cox-2/PGE2
Apoptosis,
Decrease functions
Type II collagen and aggrecan synthesis (late OA)
IL-1 receptor antagonist
Response to IGF-1
Chondrocyte metabolism
Catabolism Anabolism
Chondrocyte
Stimulation
IGFs, TGF-beta, PDGF, EGF
Bone morphogenic protein
Cartilage derived morphogenic
protein
Growth factor
Stimulation
Gamma- Interferon
TNF-alpha
Prostaglandins
Oxygen radicals, NO
IL-1, TNF-alpha, IL-17, FGFs,
gamma interferon
Leukemia inhibitory factor
Glucocorticoid
Pro-collagen fragments
Inhibition
TIMP, Plasminogen activator
inhibitor
Calicrein
Inhibition
Chondrocytes Pro-MMPs Active-MMPs
Extra-cellular
matrix
degradation
Cytokines
IL-1, TNF
+
Growth factors
IGF, TGF-b
+
PKC, NF-KB,
Kinase inhibitors
PA, plasmin
+
+
Thiol, serine proteases,
MT-MMPs
+
TIMPs
-
Heavy metal chelators (Ca,
Zn)
-
Modified from Pelletier JP, Arthritis Rheum 2001;44:1237
NO
NO
+
+
+
+
Management of Osteoarthritis
Non-pharmacological therapy
Pharmacological therapy
Surgery
OA KNEE
Cell
membrane
IL-1
Intracellular
signalling
COX
NOS
Plasmin
PGs NO
Activation of MMPs
Stromelysin
Degrades cartilage
Collagenase
Degrades cartilage
TGF-B
IGF-1
Collagen II
Aggrecans
Hyaluronic acid
Mechanism of action of diacerein
Diacerein
Conclusion
Non-pharmacological therapy is as important as
pharmacological therapy, and should be used in all
cases
There are some evidences that SYSADOAs, eg.
diacerein is effective in osteoarthritis, and when used
for a long term period they might be able to modify
cartilage structure (disease modifying osteoarthritis
drugs: DMOADs).
Diacerein is as effective as NSAIDs in osteoarthritis,
and is well tolerate.
Thank You