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Nama : dr.

Mukti Fahimi, SppD


Tgl Lahir : Gresik, 17 Mei 1972
Jabatan :
- Ketua Komite Medik Rumkital Ilyas Tarakan
- Kepala Bagian Klinik Rukmkital Ilyas Tarakan
- Kasubdept. Bedah Anestesi Rumkital Ilyas Tarakan
Pendidikan :
- Lulus Pendidikan dokter umum FK Unair (1998)
- Lulus Pendidikan dokter Spesialis Penyakit dalan FK Unair (2013)
Pendidikan Tambahan :
- Pelatihan Rhematology Update (2011)
- Pelatihan Ultrasonografi (Jakarta, 2013)
- Pelatihan Diabetes Kontrol Amerika Diabetes Association (2013)
- Pelatihan Advance Diabetes Kontrol Amerika Diabetes Association (2014)
- Pelatihan Hepatitis B dan C (Jakarta, 2014)
- Pelatihan Penatalaksanaan Hepatitis bagi Petugas
- Pelaksana PNPK Hepatitis (Jakarta, 2014)
Organisasi :
- Anggota IDI (1998-Sekarang)
- Anggota PAPDI (2008-sekarang)

eumatoid
ritis
dr. MUKTI FAHIMI, Sp PD

INTRODUCTION
Rheumatoid Arthritis (RA) :

Chronic, systemic, inflammatory


autoimmune
Primary target : synovial tissues
Symmetric polyarthritis
It leads to substansial disability &
premature death

Early detection
Early treatment

PROGNOSIS
Mortality of RA 2-3 times than normal
population
Cause of death :
Infection and gastrointestinal
disorders
Prognostic factors:
Socio-demografic
Clinical feature
Laboratory findings
Radiographic changes

EPIDEMIOLOGY

Prevalence 1-2% of adults


worldwide
Asia and Africa < USA /
Europe

5% in Women > 55

years of age More common in women


( 40-50 years of age)
Female : male ratio 3:1
5

PATHOGENESIS of
RA

Immunopathogenesis of RA not fully understood


Geneti
c

Environme
nt
Infection

Molecular
mimicry

Rheumatoid
Arthritis

PATOGENESIS

sinovial : dikenali
sebagai antigen spesifik
oleh sel T inflamasi
bahan bahan inflamasi
IL-1,TNF,IFN,IL-10
Kronik progresive
sinovial inflamasi &
destruksi sendi
hiperplasi sinovia ke
kartilago & tulang
panus

PATHOLOGICAL

EXAMINATION

Sinovial hyperplasia
Villi hypertrophy
>> A and B synoviocyte
Inflammatory cells
infiltration
Neovascularization
The worst : cartilage-pannus
junction
Late stage periarticular
damage & bone erosion
8

GEJALA KLINIS

Poliartritis simetris sendi kecil, kaku sendi


Gejala sistemik:

Demam,Malaise,Anemia

Pemeriksaan fisik sendi bengkak (sinovitis)


tanda radang/inflamasi
Stadium lanjut deformitas Swan neck

Erosion of Joint can occur early in the course of the disease


maximal rate at 2 years course the diseases

Gejala klinik
Poliartritis
simetris

Inflamed joints that are


senditender,
kecil, swollen,
kaku sendi
warm,
Gejala
often red
andsistemik:
painful, and
difficult toDemam,
move
Malaise,
Anemia

Fatigue
Loss of appetite,
Pemeriksaan fisik
weight loss,
sendi
bengkak (sinovitis)
flu-like symptoms,
tanda radang/inflamasi
depression,
Stadium lanjut
anemia

deformitas Swan neck

Early phase

Clinical features

simetric Poliarthritis
Late phase

diagnosis

Permasalahan
Keterlambatan Diagnosis sering terjadi
Most GP refer new arthritis patients to a
rheumatologist more than 3-6 months

80 % pasien RA dapat terdiagnosis rheumatologist


dalam waktu 2 minggu pada gejala awal

It can be difficult, particularly in the early stage of


the disease, No definite test

KRITERIA DIAGNOSIS ARTRITIS


REUMATOID

Manifestasi
ekstraartrikuler
Kulit : nodul rheumatoid
Mata : keratokonjuctivitis sicca
Paru : intersisial lung diseases,pleuritis
Jantung : pericarditis, myocarditis
Ginjal : amiloidosis
CNS : C1-C2 subluxasi cervical myelopati
Hematologi : anemia , felty syndrome

RA: Chronic Joint Destruction and


Disability What We Try to Prevent

Prediction of diseases
severity :
Large joint involment
higher overall joint count
upper extremities diseases
female
RF +
CRP/ESR
HLA DRB1
malaise/weakness

TUJUAN PENGOBATAN
Menekan

proses inflamasi
Mengurangi rasa nyeri
Mencegah deformitas
Memelihara produktivitas dan
aktivitas sehari-hari

PENGOBATAN FARMAKOLOGIS
1.
2.

3.

Anti inflamasi non steroid (NSAID) menekan


keradangan dan rasa nyeri
Kortikosteroid

efek
anti
inflamasi
dan
imunosupresif sebagai bridging therapy dlm
mengatasi gejala sinovitis
Disease modifying anti rheumatic drugs (DMARD):
Penicillamine
Garam emas oral/intra muscular
Sulphazalazine
Antimalaria (choroquine & hydroxychloroquine)
Methotrexate
Azathioprine
Cyclosporine
Leflunomide
Digunakan sedini mungkin mencegah kerusakan sendi

Biologic Therapies
What is meant by the term Biologic
Therapy?
Double meaning:

Organic compounds made by living cells


As opposed to products from a chemistry lab

Modify biologic responses


Antibody-antigen interactions
Cytokine-receptor interactions (both ends)
Cell signaling proteins, inhibitors, or ligands

Families of Biologic Therapies

Anti-Tnf medications
Etanercept (cytokine receptor fusion protein)
Infliximab (anti-cytokine antibody)
Adalimumab (anti-cytokine antibody)

B-cell depleting agents (monoclonal


antibody)
Rituximab

T-cell costimulation inhibitors (receptorligand )


Abatacept

Il-1 Inhibitors (Il-1 cytokine receptor decoy)


Anakinra

Anti TNF

B Cell Depletion

Anti IL-6

TERIMA
KASIH