LAHIR DI: BALI 16 SEPTEMBER 1960

RIWAYAT PENDIDIKAN
1987 DOKTER UMUM UNIV. UDAYANA
1998 INTERNIST UNIV. GADJAH MADA
1999-2001 PENDIDIKAN RHEUMATO - IMMUNOLOGY &
PHYTOPHARMACY ROYAL PERTH HOSPITAL
UNIVERSITY OF WESTERN AUSTRALIA
2000 KURSUS AKUPUNTUR DI BEIJING - CINA
2002 KONSULTAN REUMATOLOGI
2009 LULUS DOKTOR DI UNIVERSITAS GADJAH MADA

RIWAYAT PEKERJAAN
19998-2000 : PENELITI OBAT TRADISIONAL BADAN LITBANGKES DEPKES RI
2001-2004 : KEPALA BIDANG RISET KLINIK
PUSAT STUDI OBAT TRADISIONAL UNIV. GADJAH MADA
2003 SEKARANG : KEPALA. SUB.BAG. REUMATOLOGI
BAG IPD, FK-UGM / RS. DR. SARDJITO YOGYAKARTA
2004-2006 : PENELITI ETNOMEDICINE DAN OBAT ASLI INDONESIA
BADAN PENGAWAS OBAT DAN MAKANAN RI
2004- SEKARANG: STAF PENGAJAR FITOFARMAKA
FAKULTAS KEDOKTERAN UNIVERSITAS GADJAH MADA
2008-SEKARANG: KETUA TIM KEDOKTERAN HERBAL RSUP DR SARDJITO
2008-SEKARANG: KEPALA SENTRA PENGEMBANGAN DAN PENERAPAN
PENGOBATAN TRADISIONAL PROPINSI DAERAH ISTIMEWA
YOGYAKARTA
2010SEKARANG: KETUA KOMISI II DEWAN RISET DAERAH DIY
2010SEKARANG: ANGGOTA KOMISI NASIONAL SAINTIFIKASI JAMU

ORGANISASI
IDI, PAPDI, IRA, APLAR
IPS (Indonesian Pain Society)
IASP(International Association for the Study of Pain)
 NYOMAN KERTIA

Section of Rheumatology, Internal Medicine Department

Faculty of Medicine GMU / Dr. Sardjito General Hospital
LUMBOSACRAL SPONDYLOSIS
 MAY CAUSE LOCALIZED LOW BACK PAIN
LBP INCREASES ET THE END OF THE DAY AND
RADIATES ACROSS THE LOW BACK
NARROWING OF THE SPINAL CANAL
SPINAL STENOSIS & COMPRESSION OF
NEURAL ELEMENTS
PAIN WORSENS WITH SPINAL EXTENSION
AND IPSILATERAL BENDING
RO: OSTEOPHYTE, FACET JOINT NAROWING,
PERIARTICULAR SCLEROSIS
SOME SOURCES OF LOW BACK PAIN
Posterior
Longitudinale
Ligament
Discus

Corpus
vertebrae Procesus
spinosus
Nucleus
Flavum
Annulus
Ligament

Joint
capsul

Spinal cordae and

Nerve capsule (dura)
OSTEOARTHRITIS
 70
60
Prevalence (%)

50
40
30
Knee, man
20 DIP, man

Knee, women
10
DIP, women
0
30 40 50 60 70
Age (years)
 CHANGES IN ARTICULAR CARTILAGE &
SUBCHONDRAL BONE
FAILURE OF CHONDROCYTES TO
MAINTAIN THE BALANCE BETWEEN
DEGRADATION AND SYNTHESIS OF
EXTRACELLULAR MATRIX
PROTEINASES AND PROINFLAMMATORY
CYTOKINES HAVE AN IMPORTANT ROLE
MECHANICAL STRESS CONTRIBUTES
SIGNIFICANTLY TO DISEASE INITIATION &
PROGRESSION
OSTEOARTHRITIS

ACRFP
INFLAMMATORY
ARTHROPATY
 Normal Joint OA Joint

Thickness of Capsul
Capsul
Bone Cyst
Cartilage Subchondral
Sclerosis
Sinovium
Cartilage Fibrillation
Bone Sinovium Hypertrophy
Osteophyte Formation
 THE MOST COMMONLY AFFECTED ARE:
CERVICAL & LUMBAR SPINE, DIP, KNEE, HIP
STRONGLY AGED RELATED; ADDITIONAL
RISK: FEMALE, OBESITY, TRAUMA, FAMILY
HISTORY
SIGNS& SYMPTOMS: PAIN, SHORT-
LASTING STIFFNESS, CRACKING &
CREPITUS, MILD SWELLING, FUNCTIONAL
LIMITATION
RADIOGRAPHS IS IMPORTANT IN MAKING
THE DIAGNOSIS
 ACR Guidlines
Drug Therapy Options in Osteoarthritis

Baseline program
(Weight loss / exercise)
Mild or moderate pain Moderate or severe pain
/ inflammation / inflammation

Acetaminophen Steroids COX-2 selective

intra articular Inhibitors NSAIDs

NSAIDs Hyaluronans Traditional NSAIDs

Tramadol intra articular ( plus gastroprotection)
Propoxyphene
Opioids
Surgery
 INFLAMMATORY
VS DEGENERATIVE ARTHROPATY

RHEUMATOID ARTHRITIS OSTEOARTHRITIS

RHEUMATOID ARTHRITIS

ACRFP
SOFT TISSUE RHEUMATISM
CHEIROARTHROPATHY
TENDINITIS
BURSITIS
ANKYLOSING SPONDYLITIS
NORMAL NON- PURULENT HEMORAGIK
BACTERIAL
INFLAMASI
Cognitive-Behavioral
Relaxation
Preparatory information
Imagery
Hypnosis
Physical Agents
Application of superficial heat and cold
Massage
Exercise
Immobilization
Electro-analgesia (eg, TENS)
Acupuncture

Carr DB, et al. AHCPR Pub. No. 92-0032. 1992.

 Nonopioid analgesics
paracetamol
tramadol
anti-inflammatory agents
Opioid analgesics
Local anesthetics, nerve block
Co-analgesic such B-vitamin, anti-epilepticum (carbamazephin,
gabaphentin, pregabalin) &
tricyclic antidepressan
DMOADs (Disease Modifying Osteoarthritis Drugs)
SURGERY
 Bone

Cartilage
HA
Capsule
Chondrocytes

HA

Synovial
lining Osteoblast Osteoclast

Bone

Synthesis: Synoviocyte, chondrocyte

 Hyaluronan

Inflammatory cells synoviocytes Chondrocytes

Decreases cells activity viscoinduction Improves cells metabolism

Neosynthesis of endogenous HA

JOINT CARTILAGE
Decreased inflammatory Reconstruction on Matrix synthesis
process supervicial level

Improves tissue integration

Pharmacologic activities of HA
Right Standing wrong

Right wrong
Sitting

Right Sleeping Wrong

 ARTHRITIS

INFLAMMATION NO/MILD

INFLAMMATION
MONO/ OLYGO POLY
ARTICULAR ARTICULAR
DEGENERATIVE

RECURRENCE SYMETRICAL NON-SYMETRICAL

GOUT, CPPD RA, SLE AS, Ps. A, REITER
NON- RECURRENCE
SEPTIC REMEMBER THE OTHER CLINICAL SIGNS,
SYMPTOMS AND LABORATORY RESULTS
SELAMAT DATANG DALAM SEMINAR NASIONAL
RHEUMATOLOGY, OSTEOPOROSIS &
HERBAL MEDICINE
YOGYAKARTA 14-16 JULI 2011

MATUR SEMBAH NUWUN