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OsteoarthritisOsteoarthritis (OA) is one of the most common forms of arthritis. It is a chronic

condition in which the material that cushions the joints, called cartilage, breaks down.

 This causes the bones to rub against each other, causing stiness, pain and loss of joint

moement. The cause is not full! understood.

"eopleAbout #$ million people in America hae osteoarthritis. %ommon risk factors include

increasing age, obesit!, preious joint injur!, oeruse of the joint, weak thigh muscles,

and genetics.

&!mptomsOsteoarthritis s!mptoms usuall! deelop graduall!. At 'rst, there ma! be soreness or

stiness that seems more like a nuisance than a medical concern.

%ommon s!mptoms include

• &ore or sti joints particularl! the hips, knees, and lower back after inactiit!

or oeruse.

• &tiness after resting that goes awa! after moement.

• "ain that is worse after actiit! or toward the end of the da!.

Osteoarthritis, or OA, ma! also aect the neck, small 'nger joints, the base of the

thumb, ankle, and big toe. The pain ma! be moderate and come and go, without

aecting the abilit! to perform dail! tasks. &ome people*s OA will neer progress pastthis earl! stage. Others will hae their OA get worse. The pain and stiness of more

seere osteoarthritis ma! make it di+cult to walk, climb stairs, sleep, or perform other

dail! tasks.

iagnosisIf !ou hae s!mptoms of osteoarthritis, the doctor will ask -uestions about !our medical

histor! and perform a ph!sical eam and, possibl!, take /0ra!s to con'rm the

diagnosis.

 Treatment There is no cure for osteoarthritis, but there are medications to help reliee pain, when

needed. The doctor ma! recommend ph!sical therap! ("T) or occupational therap! (OT)

to help improe strength and function. 1hen pain is seere and fre-uent or mobilit! and

dail! actiities become di+cult, surger! ma! be considered.

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&elf0care&ta!ing ph!sicall! actie and maintaining a health! weight are the ke!s to liing well

with osteoarthritis. Too little moement can lead to stiness and weak joints. 2osing one

pound can take four pounds of pressure o !our knee joints. Oerall 'tness improes

health in man! wa!s. &trong muscles protect joints. An OA management plan also

inoles eating a nutritious diet, managing stress and depression, and getting a good

balance of rest and actiit! each da!.

3anaging Osteoarthritis &!mptoms

Osteoarthritis, or OA, is a common disease affecting as some 27 million Americans,

causing pain, stiffness and swelling in joints. OA reduces your joints’ mobility,

interfering with your ability to work and live your life normally.

here is no cure for OA at this time. !t will progress and damage your joints further

unless you intervene now. "uckily, there are many ways to manage OA symptoms.

Long-Term Management

As a person with osteoarthritis, you’ll need to take a long#term view of your health. OA

can’t be bested in one day or with a single pill. $ou’ll have to take a comprehensive

approach to your health.

$ou have a team to help you, including your arthritis doctor and other health careprofessionals, your family and friends, and your local Arthritis %oundation office. &ut

you are the manager of that team. $ou must make a commitment to making healthy

changes and choices and sticking with the OA management plan that you and your

doctor will devise.

Top Tactics for Tackling OA

$our plan for taking on OA should include'

•

(anaging OA symptoms, like pain, stiffness and swelling

• !mproving joint mobility and fle)ibility

• *eeping your weight in check

• (aintaining better fitness through physical activity

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hat sounds like a big project, but start by slowly making changes to your current

routine, not trying everything all at once. +ere are tips for managing your OA, and

resources to help you.

Stretch Yourself. low, gentle stretching of joints may improve fle)ibility, lessen

stiffness and reduce pain. (orning is a great time to stretch to get joints ready for the

day’s tasks. he Arthritis %oundation offers stretching routines, including yoga# and tai

chi#based moves, approved for people with OA on -- or in live classes in your area.

%irst, speak to your doctor to gauge your level of fitness and any special considerations.

Get Moving. /hysical activity is a proven way to manage OA symptoms. &efore you

groan about hating e)ercise, just pledge to progress from dedicated couch#sitter to

regular mover. imple activities like walking around the neighborhood or taking a fun,

easy land or water e)ercise class approved for people with OA can reduce pain and

e)tra weight, which only worsens OA.

4ercising 1ith Osteoarthritis

0hile you may worry that e)ercising with osteoarthritis could harm your joints andcause more pain, research shows that people can and should e)ercise when they have

osteoarthritis. 1)ercise is considered the most effective non#drug treatment forreducing pain and improving movement in osteoarthritis.

hree kinds of e)ercise are important for people with osteoarthritis' e)ercises involving

range of motion, also called fle)ibility e)ercises endurance or aerobic e)ercises and

strengthening e)ercises. 1ach one plays a role in maintaining and improving your abilityto move and function.

peak with your doctor or physical therapist about e)ercising with osteoarthritis and thespecific e)ercises that are best for you.

Range of motion/flei!ilit"# 3ange of motion refers to the ability to move your jointsthrough the full motion they were designed to achieve. 0hen you have osteoarthritis,pain and stiffness make it very difficult to move certain joints more than just a little bit,which can make even the simplest tasks challenging.

3ange#of#motion e)ercises include gentle stretching and movements that take joints

through their full span. -oing these e)ercises regularly 4 ideally every day 4 can helpmaintain and even improve the fle)ibility in your joints.

Aero!ic/en$urance# hese e)ercises strengthen your heart and make your lungsmore efficient. his conditioning has the added benefit of reducing fatigue, so you havemore stamina throughout the day. Aerobic e)ercise also helps control your weight byincreasing the amount of calories your body uses. %urthermore, this type of e)ercise

can help you sleep better and improve your mood.

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+ow much should you e)ercise5 6urrent recommendations for

89 minutes of moderate#intensity aerobic e)ercise per week

O3

78 minutes of vigorous#intensity aerobic e)ercise per week

O3

an e:uivalent combination of moderate and vigorous e)ercise

Strengthening# trengthening e)ercises help maintain and improve your musclestrength. trong muscles can support and protect joints that are affected by arthritis.

Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of

osteoarthritis include:

• Pain. Your joint may hurt during or after movement.

• Tenderness. Your joint may feel tender when you apply light pressure to it.

• Stiffness. Joint stiffness may be most noticeable when you wake up in the

morning or after a period of inactivity.

• Loss of flexibility. You may not be able to move your joint through its full range

of motion.

• Grating sensation. You may hear or feel a grating sensation when you use the

 joint.

• Bone spurs. These extra bits of bone, which feel like hard lumps, may form

around the affected joint.

Factors that may increase your risk of osteoarthritis include:

• Older age. The risk of osteoarthritis increases with age.

• Sex. Women are more likely to develop osteoarthritis, though it isn't clear why.

• Obesity. Carrying extra body weight contributes to osteoarthritis in several ways.

It puts added stress on weight-bearing joints, such as your hips and knees. In

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addition, fat tissue produces proteins that may cause harmful inflammation in and

around your joints.

• Joint injuries. Injuries, such as those that occur when playing sports or from an

accident, may increase the risk of osteoarthritis.

• Certain occupations. If your job includes tasks that place repetitive stress on a

particular joint, that joint may eventually develop osteoarthritis.

• Genetics. Some people inherit a tendency to develop osteoarthritis.

• Bone deformities. Some people are born with malformed joints or defective

cartilage, which can increase the risk of osteoarthritis.

• Other diseases. Having diabetes or other rheumatic diseases such as gout and

rheumatoid arthritis can increase your risk of osteoarthritis.

Preparing for your appointment

By Mayo Clinic Staff

Although you may initially bring your concerns to your family doctor, he or she may refer

you to a doctor who specializes in joint disorders (rheumatologist) or orthopedic surgery.

What you can do

You may want to write a list that includes:

• Detailed descriptions of your symptoms

• Information about medical problems you've had

•

Information about the medical problems of your parents or siblings

• All the prescription and over-the-counter medications and dietary supplements you take

and the dosages

• Questions you want to ask the doctor

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What to expect from your doctor

Your doctor may ask some of the following questions:

•

When did your joint pain begin?

• Is the pain continuous, or does it come and go?

• Do any particular activities make the pain better or worse?

• Have you ever injured this joint?

During the physical exam, your doctor will closely examine your affected joint, checking

for tenderness, swelling or redness, and for range of motion in the joint. Your doctor may

also recommend imaging and lab tests.

Imaging tests

Pictures of the affected joint can be obtained during imaging tests. Examples include:

• X-rays. Cartilage doesn't show up on X-ray images, but cartilage loss is revealed by a

narrowing of the space between the bones in your joint. An X-ray may also show bone spurs

around a joint. Some people may have X-ray evidence of osteoarthritis before theyexperience any symptoms.

• Magnetic resonance imaging (MRI). MRI uses radio waves and a strong magnetic field

to produce detailed images of bone and soft tissues, including cartilage. MRI isn't commonly

needed to diagnose osteoarthritis but may help provide more information in complex cases.

Lab tests

Analyzing your blood or joint fluid can help pinpoint the diagnosis.

• Blood tests. Blood tests may help rule out other causes of joint pain, such as

rheumatoid arthritis.

• Joint fluid analysis. Your doctor may use a needle to draw fluid out of the affected joint.

Examining and testing the fluid from your joint can determine if there's inflammation and if

your pain is caused by gout or an infection.

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There's no known cure for osteoarthritis, but treatments can help reduce pain and

maintain joint movement.

Medications

Osteoarthritis symptoms may be helped by certain medications, including:

• Acetaminophen.Acetaminophen (Tylenol, others) can relieve pain, but it doesn't reduce

inflammation. It has been shown to be effective for people with osteoarthritis who have mild

to moderate pain. Taking more than the recommended dosage of acetaminophen can cause

liver damage.

• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may reduce inflammationand relieve pain. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and

naproxen (Aleve, others). Stronger NSAIDs are available by prescription. NSAIDs can cause

stomach upset, ringing in your ears, cardiovascular problems, bleeding problems, and liver

and kidney damage. They should not be used by people over 65 years of age and those who

have stomach bleeding. Topical NSAIDS have fewer side effects and may relieve pain just as

well.

Therapy

Exercising and achieving a healthy weight are the best and most important ways to treat

osteoarthritis. Your doctor also may suggest:

• Physical therapy. A physical therapist can work with you to create an individualized

exercise program that will strengthen the muscles around your joint, increase your range of

motion and reduce pain.

• Occupational therapy. An occupational therapist can help you discover ways to do

everyday tasks or do your job without putting extra stress on your already painful joint. For

instance, a toothbrush with a large grip could make brushing your teeth easier if you havefinger osteoarthritis. A bench in your shower could help relieve the pain of standing if you

have knee osteoarthritis.

• Braces or shoe inserts. Your doctor may recommend shoe inserts or other devices that

can help reduce pain when you stand or walk. These devices can immobilize or support your

 joint to help take pressure off it.

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• A chronic pain class. The Arthritis Foundation and some medical centers have classes

for people with osteoarthritis and chronic pain. Ask your doctor about classes in your area or

check with the Arthritis Foundation. These classes teach skills that help you manage your

osteoarthritis pain. And you'll meet other people with osteoarthritis and learn their tips and

tricks for reducing and coping with joint pain.

Surgical and other procedures

If conservative treatments don't help, you may want to consider procedures such as:

• Cortisone shots. Injections of corticosteroid medications may relieve pain in your joint.

During this procedure your doctor numbs the area around your joint, then places a needle

into the space within your joint and injects medication. The number of cortisone shots you

can receive each year is limited, because the medication can worsen joint damage over

time.

• Lubrication injections. Injections of hyaluronic acid may offer pain relief by providing

some cushioning in your knee. Hyaluronic acid is similar to a component normally found in

your joint fluid.

• Realigning bones. During a surgical procedure called an osteotomy, the surgeon cuts

across the bone either above or below the knee to realign the leg. Osteotomy can reduce

knee pain by shifting your body weight away from the worn-out part of your knee.

• Joint replacement. In joint replacement surgery (arthroplasty), your surgeon removes

your damaged joint surfaces and replaces them with plastic and metal parts. The hip and

knee joints are those most commonly replaced. Surgical risks include infections and blood

clots. Artificial joints can wear out or come loose and may need to eventually be replaced.

Repeat joint replacements are more challenging and less successful than the original

surgery.

Lifestyle changes and home treatments also can help reduce osteoarthritis symptoms.

You might want to try some of the following tips:

• Exercise. Exercise can increase your endurance and strengthen the musclesaround your joint, making your joint more stable. Try walking, biking or swimming. If

you feel new joint pain, stop. New pain that lasts for hours after you exercise

probably means you've overdone it but doesn't mean you should stop exercising

altogether.

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• Lose weight. Being overweight or obese increases the stress on your weight-

bearing joints, such as your knees and your hips. Even a small amount of weight

loss can relieve some pressure and reduce your pain. Talk to your doctor about

healthy ways to lose weight. Most people combine changes in their diet with

increased exercise.

• Use heat and cold to manage pain. Both heat and cold can relieve pain in your

 joint. Heat also relieves stiffness, and cold can relieve muscle spasms and pain.

• Apply over-the-counter pain creams. Creams and gels available at drugstores

may provide temporary relief from osteoarthritis pain. Some creams numb the pain

by creating a hot or cool sensation. Other creams contain medications, such as

aspirin-like compounds, that are absorbed into your skin. Pain creams work best on

 joints that are close to the surface of your skin, such as your knees and fingers.

• Use assistive devices. Assistive devices can make it easier to go about your

day without stressing your painful joint. A cane may take weight off your knee or hip

as you walk. Carry the cane in the hand opposite the leg that hurts. Gripping and

grabbing tools may make it easier to work in the kitchen if you have osteoarthritis in

your fingers. Your doctor or occupational therapist may have ideas about what sorts

of assistive devices may be helpful to you. Catalogs and medical supply stores also

may be places to look for ideas.

People who aren't helped by medications for osteoarthritis pain sometimes turn tocomplementary and alternative medicine practices for relief. Common treatments that

have shown some promise for osteoarthritis include:

• Acupuncture. Some studies indicate that acupuncture can relieve pain and

improve function in people who have knee osteoarthritis. During acupuncture, hair-

thin needles are inserted into your skin at precise spots on your body. Risks include

infection, bruising and some pain where needles are inserted into your skin.

•

Glucosamine and chondroitin. Studies have been mixed on these nutritionalsupplements. A few have found benefits for people with osteoarthritis, while most

indicate that these supplements work no better than placebo. Don't use glucosamine

if you're allergic to shellfish. Glucosamine and chondroitin may interact with blood

thinners such as warfarin and cause bleeding problems.

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• Avocado-soybean unsaponifiables. This nutritional supplement — a mixture of

avocado and soybean oils — is widely used in Europe to treat knee and hip

osteoarthritis. It acts as an anti-inflammatory, and some studies have shown it may

slow down or even prevent joint damage.

• Tai chi and yoga. These movement therapies involve gentle exercises and

stretches combined with deep breathing. Many people use these therapies to reduce

stress in their lives, though small studies have found that tai chi and yoga may

reduce osteoarthritis pain. When led by a knowledgeable instructor, these therapies

are safe. Avoid moves that cause pain in your joints.

There's no known cure for osteoarthritis, but treatments can help reduce pain and

maintain joint movement.

Medications

Osteoarthritis symptoms may be helped by certain medications, including:

• Acetaminophen.Acetaminophen (Tylenol, others) can relieve pain, but it doesn't reduce

inflammation. It has been shown to be effective for people with osteoarthritis who have mild

to moderate pain. Taking more than the recommended dosage of acetaminophen can cause

liver damage.

• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may reduce inflammation

and relieve pain. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and

naproxen (Aleve, others). Stronger NSAIDs are available by prescription. NSAIDs can cause

stomach upset, ringing in your ears, cardiovascular problems, bleeding problems, and liver

and kidney damage. They should not be used by people over 65 years of age and those who

have stomach bleeding. Topical NSAIDS have fewer side effects and may relieve pain just as

well.

5heumatoid Arthritis

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5heumatoid arthritis (5A) is an autoimmune disease in which !our bod!*s immune

s!stem which protects !our health b! attacking foreign substances like bacteria and

iruses mistakenl! attacks !our joints. The abnormal immune response causes

in6ammation that can damage joints and organs, such as the heart. 4arl! diagnosis

and prompt treatment is the ke! to preenting joint destruction and organ damage.

"eople

About 7.8 million people in the 9nited &tates hae rheumatoid arthritis (5A). :earl!

three times as man! women hae the disease as men. In women, 5A most commonl!

begins between ages ;< and =<. In men, it often occurs later in life.

&!mptoms

 The seerit! of the disease can ar! from person to person. &!mptoms can change from

da! to da!. &udden increases in s!mptoms and illness are called 6ares. A 6are can lastfor da!s or months. >e! rheumatoid arthritis s!mptoms are pain, fatigue and warm,

swollen, reddish joints. 2ong periods of joint stiness in the morning are common.

In6ammation in the small joints of the wrist and hand is t!pical. If a joint on one side of

the bod! is aected, the same one on the other side is usuall! aected, too.

 Treatment

 There is no cure for 5A, but there are a number of medications aailable to help ease

s!mptoms, reduce in6ammation, and slow the progression of the disease. :o one drug

works for eer!one but man! people 'nd treatments that are er! eectie. The goal oftreatment is remission, a state when in6ammation is gone or is er! low. A doctor, likel!

a rheumatologist a specialt! doctor who treats people with arthritis should monitor

!our leels of disease actiit!, or in6ammation, on a regular basis through eams and

blood tests that reeal how well treatment is working. The doctor ma! add or change

!our medications or adjust the dosage after a few months, if the disease is still actie.

&elf0care

&elf0management is an important part of rheumatoid arthritis care. &ta!ing ph!sicall!

actie is the ke! to keeping joints 6eible. Too little moement can lead to joint stiness.

&trong muscles protect joints. Oerall 'tness improes health in man! wa!s. 3anaging

!our weight, eating a nutritious diet and getting a good balance of rest and actiit! each

da! are important, too.

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Rheumatoid Arthritis Medications

There are many rheumatoid arthritis medications available to lower joint pain, swelling,

and inflammation. Some of these drugs prevent or slow the progression of the disease.

Drugs that offer relief of arthritis symptoms joint pain, stiffness, and swelling! include"

•  Anti#inflammatory pain$illers, such as aspirin, ibuprofen, or napro%en

• Topical applied directly to the s$in! pain relievers

• &orticosteroids, such as prednisone

• 'arcotic pain relievers

There are also many strong medications called disease#modifying antirheumatic drugs

DMARDs!, which wor$ by interfering with or suppressing the immune system(s attac$on the joints. They include"

• )la*uenil originally used to treat malaria!

• +mmune suppression drugs, such as methotre%ate, +muran, and &yto%an

• iologic treatments, such as Actemra, &im-ia, ineret, Simponi, /nbrel, 0umira,

Remicade, 1rencia, and Ritu%an

• 1ther drugs, such as A-ulfidine, Arava, and 2eljan-

Differential diagnoses3edit4

Several other medical conditions can resemble RA, and usually need to be distinguished from it at

the time of diagnosis"35543564

• &rystal induced arthritis gout, and pseudogout! 7 usually involves particular joints $nee,

MT)8, heels! and can be distinguished with aspiration of joint fluid if in doubt. Redness,

asymmetric distribution of affected joints, pain occurs at night and the starting pain is less than

an hour with gout.

• 1steoarthritis 7 distinguished with 2#rays of the affected joints and blood tests, age mostly

older persons!, starting pain less than an hour, a#symmetric distribution of affected joints and

pain worsens when using joint for longer periods.

• Systemic lupus erythematosus S9/! 7 distinguished by specific clinical symptoms and blood

tests antibodies against double#stranded D'A!

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• 1ne of the several types of  psoriatic arthritis resembles RA 7 nail changes and s$in

symptoms distinguish between them

• 9yme disease causes erosive arthritis and may closely resemble RA 7 it may be

distinguished by blood test in endemic areas

• Reactive arthritis previously Reiter(s disease! 7 asymmetrically involves

heel, sacroiliac joints, and large joints of the leg. +t is usually associated

with urethritis, conjunctivitis,iritis, painless buccal ulcers, and $eratoderma blennorrhagica.

•  An$ylosing spondylitis 7 this involves the spine, although a RA#li$e symmetrical small#joint

polyarthritis may occur in the conte%t of this condition.

• 0epatitis &  7 RA#li$e symmetrical small#joint polyarthritis may occur in the conte%t of this

condition. 0epatitis & may also induce Rheumatoid :actor auto#antibodies

Rarer causes that usually behave differently but may cause joint pains"3554

• Sarcoidosis, amyloidosis, and ;hipple(s disease can also resemble RA.

• 0emochromatosis may cause hand joint arthritis.

•  Acute rheumatic fever can be differentiated from RA by a migratory pattern of joint

involvement and evidence of antecedent streptococcal infection. acterial arthritis such as

streptococcus! is usually asymmetric, while RA usually involves both sides of the body

symmetrically.

• <onococcal arthritis another bacterial arthritis! is also initially migratory and can

involve tendons around the wrists and an$les.

 Tendinitis

1hat is it?Arthritis is a comple famil! of musculoskeletal disorders consisting of more than 7<<

dierent diseases or conditions that destro! joints, bones, muscles, cartilage and other

connectie tissues, hampering or halting ph!sical moement. A tendon is a cord of

tough tissue that connects muscle to bone. The tendon is surrounded b! a sheath that

protects and lubricates the tendon. This sheath is lined b! a la!er of cells called the

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s!noium. Occasionall!, the tendon will become in6amed (called tendinitis) or the

tendon sheath will become in6amed (called tenos!noitis). These conditions together

are known as tendinitis and result in pain, stiness and sometimes swelling.

 Tendinitis usuall! is caused b! a speci'c injur! or b! repetitie oeruse, especiall! when

using poor bod! position. Tendinitis can occur in !oung athletic people in response tosports injuries and oeruse. @oweer, tendons become less 6eible with aging and

tendinitis is common in middle aged and older adults.

In general, tendinitis can occur suddenl!, ma! last for da!s, weeks or longer, and then

go awa!. It can, howeer, occur again in the same place. 1hen properl! treated, it

general doesn*t result in permanent damage or disabilit!.

1hat are the eects? Tendons all oer the bod! can become in6amed, including shoulders, elbows, wrists,

'ngers, hips, back, knees, ankles and feet. The s!mptoms usuall! include pain, stinessand swelling.

@ow is it diagnosed?iagnosing tendinitis is based primaril! on a ph!sical eam and a medical histor!. our

doctor will look for swelling and tenderness in the area that is bothering !ou. @e or she

will rule out infection if there is no heat and redness associated with the swelling and

tenderness. @e or she will ask !ou about the pain and about what t!pes of actiities !ou

are inoled in. That is usuall! enough for the doctor to diagnose tendinitis. If the

diagnosis is in -uestion or if the doctor suspects that !ou ma! hae an underl!ing

in6ammator! disease, he or she ma! run some routine laborator! tests and /0ra!s.

1hat are the treatment options? Tendinitis is common in people who are otherwise health!. It ma! go awa! on its own

oer time. In most cases, a primar!0care ph!sician can treat tendinitis. &ome people

ma! need to be referred to a rheumatologist, an orthopaedic surgeon or a ph!sical

therapist for treatment.

 Tendinitis is treated with a conseratie approach. our doctor ma! recommend a

combination of rest, actiit! modi'cation, heat and cold, medications, and ph!sical

therap!.

• Rest: The aected tendon should be rested so it can heal. ou ma! hae to stop

performing the oending actiit! for a short period of time.

• Activity modifcation: The actiit! that caused the injur! should be modi'ed in

such a wa! as to reliee the stress on the tendon. Bor eample, if running gae !ou

Achilles tendinitis, !ou ma! need to reduce !our mileage, wear dierent shoes and then

increase !our mileage slowl!.

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• Splints &ometimes splints are used to keep the aected joint in alignment

during actiities so stress is taken o the tendon (such splints and wraps are aailable

for tennis elbow). &plints ma! also be used during the initial resting period to allow the

tendon to heal.

• Cold and heat %old packs, slush baths, and ice rubs can reduce pain and

swelling when the tendon is newl! injured or is reall! bothering !ou. @ot packs, heatingpads, or warm baths can feel good for the long0term ache that !ou ma! feel from an

oeruse injur!.

• Medication:

o :onsteroidal anti0in6ammator! drugs (:&AIs) can be taken to reliee the

pain and swelling of tendinitis. Other analgesics can be added for pain relief.

o &teroids can be injected into the tendon sheath for er! direct pain and

in6ammation relief. %ertain tendons should not be injected with steroids because it puts

the tendon as risk of rupture (the Achilles for eample).

• Physical therapy A ph!sical therapist can teach techni-ues to stretch the

aected tendon, thereb! reducing the likelihood of reinjur!. @e or she can also assess

!our bod! mechanics and teach !ou better wa!s to perform the actiities that gie !ou

trouble. &hoe inserts (orthotics) ma! be needed to adjust !our running form, relieing

pressure on !our knee and Achilles tendons.

• Surgery 5arel! surger! ma! be needed to reliee the s!mptoms of tendinitis.

&urger! would also be necessar! if the aected tendon tore or ruptured.

osteoartritisOverview

entu$ paling umum dari artritis yaitu 1steoarthritis 1A! mempengaruhi se$itar =>? dari populasiorang dewasa. Dari semua orang ini, hanya 8>? yang mencari pengobatan medis dan hanya 8? yangbenar#benar lumpuh.

Penyebab

1steoartritis 1A! berarti radang sendi, walaupun lebih di$enali sebagai penya$it degeneratif yang$arena disebab$an oleh peradangan sendi dengan penipisan tulang rawan yang ber$aitan. Tulangrawan pada persendian $ita memung$in$an pergera$an sendi yang mulus. eti$a tulang rawan inirusa$ $arena cedera, infe$si, atau efe$ penuaan, pergera$an sendi menjadi terganggu. A$ibatnya,

 jaringan di dalam sendi mengalami iritasi serta menyebab$an rasa nyeri dan pembeng$a$an.

Gejala

Dalam 1A, Anda tida$ a$an mengalami masalah saat bangun di pagi hari, namun masalah timbul saathari beranja$ siang.

Di petang hari, pasien dapat merasa$an rasa sa$it dalam intensitas sedang di daerah persendian yangbermasalah.

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<ejala umum lainnya termasu$"

• 'yeri

• eng$a$ sendi

• )embeng$a$an pada sendi yang bermasalah

• )erubahan di daerah se$itar sendi

• Rasa hangat 7 Sendi yang mengalami artritis terasa hangat ji$a disentuh

• &repitation 7 )erasaan seperti diparut atau diasah pada sendi yang bermasalah $arena saling

bergese$annya permu$aan tulang rawan

• ista 7 )ada 1A yang terjadi pada tangan, $ista beru$uran $ecil dapat tumbuh, inimenyebab$an timbulnya benjolan atau le$u$an pada bagian luar $u$u jari yang sa$it

)erubahan yang disebab$an oleh artritis degeneratif cenderung terjadi pada persendian yang sejenis.Sedang$an dalam artritis degeneratif pasca#trauma yang memili$i riwayat trauma a$ut atau $ronis,perubahan ini cenderung terjadi hanya pada persendian yang sa$it.

Faktor Resiko

Usia LanjutSeiring bertambahnya usia, $emung$inan ber$urangnya fungsi tulang rawan juga sema$in bertambah.

1A jarang dijumpai pada orang yang berusia di bawah => tahun.

Jenis Kelamin;anita lebih tinggi $emung$inannya untu$ menderita 1A, terutama setelah menopause.

edera !endi !ebelumnyaSeseorang yang sebelumnya pernah menderita cedera tulang rawan pada sendi, misalnya setelahpatah tulang di daerah sendi atau cedera olahraga pada sendi berisi$o lebih tinggi ter$ena 1A di$emudian hari.

"erat "adanerat badan diatas berat ideal memberi$an te$anan e$stra pada persendian yang berfungsi menahanbeban seperti panggul dan lutut, sehingga persendian di $edua tempat ini besar $emung$inannyaa$an memuncul$an 1A.

Deformitas atau Kelainan "entuk #ulang1rang yang menderita $elainan bentu$ persendian atau tulang rawan seja$ lahir lebih berisi$omenderita 1A.

Penyakit Lainnya $ang %em&engaru'i Persendian)enya$it tulang dan sendi yang mening$at$an risi$o terjadinya 1A juga menca$up $ondisi artritislainnya seperti artritis rematoid dan gout asam urat!.

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Genetik:a$tor geneti$ mempengaruhi per$embangan 1A.

Diagnosa

Spesialis a$an mulai mencatat riwayat masalah Anda dan masalah $esehatan sebelumnya, dilanjut$andengan pemeri$saan fisi$. +ni dapat dilanjut$an dengan tes lain, seperti"

!inar() *Rontgen++ni adalah tes paling umum yang dila$u$an untu$ mengevaluasi status sendi dan $esejajaran sendiyang bermasalah. Sinar#2 aman, mudah dan tida$ sa$it.

#es Dara'Tergantung dari hasil pemeri$saan $linis, darah dapat diambil untu$ pemeri$saan $husus untu$mengesamping$an penyebab nyeri sendi yang lain seperti artritis rematoid, gout asam urat!, atauinfe$si.

Pengambilan airan !endiadang#$adang, terutama apabila sendi sangat membeng$a$, do$ter mengambil sejumlah cairan darisendi yang beng$a$ untu$ pemeri$saan $husus. )embuangan cairan sendi $adang#$adang juga dapatmenghilang$an rasa sa$it.

Pengobatan

Tujuan pengobatan osteoartritis "

i. Menghilang$an rasa sa$itii. Mempertahan$an fungsiiii. Mencegah deformitas atau $elainan bentu$iv. Mendidi$ pasien

)erawatan 1A tergantung pada ting$at $eparahan penya$itnya dan harapan gaya hidup pasien

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sendiri.

1A tahap dini pada umumnya dapat diobati dengan"

• +stirahat dan perubahan gaya hidup, seperti menurun$an berat badan dan berhenti mero$o$

• )enggunaan alat bantu misalnya tong$at jalan!. Mema$ai sepatu yang sesuai juga membantu

untu$ mengurangi gejala pada beberapa $asus 1A

• 9atihan dan fisioterapi untu$ memper$uat otot dan mening$at$an fle$sibilitas sendi

• )engobatan

@ntu$ 1A pada tangan, tangan dapat diistirahat$an dengan membebat sendi dengan splintbidai agartida$ bergera$. )enggunaan splint atau bidai ini pada awalnya dila$u$an selama B 7 = minggu, dimana splint dipa$ai secara terus menerus.

+ni biasanya di$ombinasi$an dengan obat#obatan anti#peradangan nonsteroidal anti#inflammatorydrugs, 'SA+Ds! pada wa$tu yang sama. Ci$a gejalanya membai$, penggunaan splint di siang haridapat mulai di$urangi selama beberapa bulan mendatang. Penggunaan ,!-.D/fe$nya pada saluran pencernaan tetap menjadi salah satu fa$tor utama yang membatasipenggunaan 'SA+Ds dan mung$in mengharus$an penghentian penggunaan bahan anti#peradanganini secara permanen. )enggunaan penghambat 0, omepra-ol, atau misoprostol, serta bahan serupaprostaglandin yang meniada$an efe$ mu$us atau lendir dari 'SA+Ds, dapat mengurangi sebagian efe$pada pencernaan perut. 'eproto$sisitas adalah $ompli$asi yang umum terjadi sebagai a$ibat daripenggunaan 'SA+Ds, dan pasien yang ginjalnya tida$ berfungsi penuh tida$ boleh mengguna$an'SA+Ds dalam jang$a wa$tu lama.

Jenis(jenis PengobatanSaat ini tida$ ada satu pun obat yang dapat menyembuh$an 1A atau menumbuh$an $embali tulangrawan pada persendian osteoartritis.

1bat yang paling umum diberi$an pada resep adalah obat penghilang rasa sa$it. Cenis obatpenghilang rasa sa$it yang diresep$an tergantung pada $eparahan rasa sa$itnya. @ntu$ penya$itting$at awal yang rasa nyerinya masih ringan dan terjadi sese$ali, obat penghilang rasa sa$itsederhana seperti paracetamol )anadolE! bisa efe$tif, walaupun untu$ rasa sa$it yang lebih parahmung$in membutuh$an penggunaan obat anti#peradangan 'SA+Ds! untu$ menguranginya. rimanalgesi$ penghilang rasa sa$it! dan $oyo$ dapat juga diguna$an.

<lu$osamin, dengan atau tanpa $ondroitin, juga menjadi opsi pengobatan yang sema$in populerdalam beberapa tahun tera$hir. 1bat ini dapat dibeli tanpa resep dari do$ter.

;alaupun demi$ian, obat ini tida$ efe$tif pada $ebanya$an pasien, terutama yang menderita 1Aparah. Redanya gejala juga cenderung berlangsung sementara. Selain itu, tida$ ada bu$ti bahwaglu$osamin atau $ondroitin dapat memulih$an tulang rawan.

!untik@ntu$ perawatan 1A, do$ter Anda ter$adang mere$omendasi$an sunti$an steroid $e dalam atau diseputar sendi ji$a perawatan $onservatif yang disebut sebelumnya tida$ memberi$an hasil yangdiingin$an. ;alaupun penggunaan penghilang rasa sa$it dapat sangat memuas$an, biasanya efe$nyahanya untu$ sementara, dan do$ter Anda a$an membatasi jumlah sunti$an steroid yang boleh diterima

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$arena pema$aian berulang dapat melemah$an tendon sehingga memperburu$ $ondisi tulang rawanyang sudah rusa$.

"eda')embedahan biasanya ditawar$an untu$ penya$it dengan ting$at $eparahan a$ut yang tida$ berea$siterhadap perawatan yang telah disebut di atas. Cenis pembedahan maupun $eputusan mela$u$anpembedahan biasanya dila$u$an setelah dis$usi panjang dengan do$ter Anda.

@ntu$ sebagian besar persendian pada tangan, artodesis atau fusi sendi sering menjadi metode yangdipilih. Dalam fusi sendi, permu$aan artritis dihilang$an, dan tulang pada $edua sisi sendi dipadu$anuntu$ menghilang$an gera$an pada sendi yang bermasalah.

+ni mung$in menga$ibat$an gera$an tertentu tida$ dapat dila$u$an lagi, namun penghilangan rasanyeri dan stabilitas pada sendi bisa mening$at$an fungsi sendi yang terpengaruh oleh penya$it sendidegeneratif.

 Arthritis adalah istilah umum yang berarti peradangan pada sendi. Radang sendi ditandai

dengan $emerahan, rasa hangat, beng$a$, dan nyeri di dalam sendi.

Rheumatoid arthritis adalah jenis peradangan sendi $ronis yang biasanya terjadi pada sendi

di $edua sisi tubuh, seperti tangan, pergelangan tangan, atau lutut. esimetrian ini

membantu membeda$an rheumatoid arthritis dari jenis arthritis yang lain.

Selain mempengaruhi sendi, rheumatoid arthritis sese$ali dapat mempengaruhi $ulit, mata,

paru#paru, jantung, darah, atau saraf.

-&aka' Gejala R'eumatoid -rt'ritis/

<ejala#gejala dari rheumatoid arthritis meliputi"

• 'yeri sendi dan beng$a$

• e$a$uan, terutama di pagi hari atau setelah dudu$ untu$ wa$tu yang lama

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• elelahan

Rheumatoid arthritis ini berbeda#beda pengaruhnya pada masing#masing orang. )ada

beberapa orang, gejala sendi ber$embang secara bertahap selama beberapa tahun.

Sedang$an pada beberapa yang lain,rheumatoid arthritis dapat ber$embang dengan cepat.serta ada juga yang mung$in memili$i rheumatoid arthritis untu$ jang$a wa$tu tertentu dan

$emudian memasu$i masa remisi.

!ia&a yang Da&at #erkena Rheumatoid Arthritis/

Rheumatoid arthritis adalah penya$it autoimun yang mempengaruhi se$itar 8? populasi di

 Ameri$a Seri$at. )enya$it ini dua sampai tiga $ali lebih sering terjadi pada wanita

dibanding$an pria. 'amun pada pria yang ter$ena penya$it ini, cenderung pengaruhnya

lebih parah. Rheumatoid arthritis biasanya terjadi pada usia pertengahan, namun ana$#

ana$ dan orang tua juga dapat ter$ena rheumatoid arthritis.

-&a Penyebab Rheumatoid Arthritis/

)enyebab pasti dari rheumatoid arthritis, belum di$etahui pasti, tetapi diduga penya$it ini

disebab$an oleh $ombinasi dari fa$tor geneti$, ling$ungan, dan hormonal. )ada rheumatoid 

arthritis, ada suatu hal yang memicu sistem $e$ebalan tubuh untu$ menyerang sendi dan

$adang#$adang organ lainnya. eberapa teori menyaran$an bahwa ada virus atau ba$teri

yang mung$in mengubah sistem $e$ebalan tubuh, sehingga menyebab$an sistem

$e$ebalan tersebut menyerang sendi. Teori lain menyaran$an bahwa mero$o$ dapat

menyebab$an ter$ena rheumatoid arthritis.

)enelitian belum sepenuhnya menentu$an secara pasti apa peran geneti$a bermain

dalam rheumatoid arthritis. 'amun, beberapa orang tampa$nya memili$i fa$tor geneti$ atau

turunan yang mening$at$an $emung$inan mere$a ter$ena rheumatoid arthritis.

"agaimana Rheumatoid Arthritis %em&engaru'i #ubu' Kita/

Setelah sistem $e$ebalan tubuh dipicu, sel#sel $e$ebalan bermigrasi dari darah $e dalamsendi dan sendi#lapisan jaringan, disebut sinovium. Di tempat tersebut, sel#sel $e$ebalan

tubuh menghasil$an -at inflamasi yang menyebab$an iritasi, mengi$is tulang rawan bahan

bantalan pada bagian a$hir tulang!, serta pembeng$a$an dan peradangan pada lapisan

sendi. Seiring tulang rawan ter$i$is, ruang antara tulang#tulang menyempit. Ci$a $ondisi

tersebut memburu$, ma$a tulang bisa bergese$an satu dengan yang lain.

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Radang lapisan sendi menimbul$an cairan berlebih terhadap sendi. Seiring lapisan

mengembang, ma$a hal ini mung$in mengi$is tulang yang berde$atan, sehingga

menga$ibat$an $erusa$an pengi$at antara tulang.

Semua hal diatas menyebab$an sendi menjadi sangat sa$it, beng$a$, dan terasa hangatsaat disentuh.

"agaimana Rheumatoid Arthritis Didiagnosis/

Diagnosis rheumatoid arthritis didasar$an pada $ombinasi bernacam fa$tor, termasu$

diantaranya"

• 9o$asi dan $esimetrian nyeri sendi yang spesifi$, terutama sendi tangan

•  Adanya $e$a$uan sendi di pagi hari

•  Adanya benjolan dan nodul di bawah $ulit nodul rheumatoid !

• 0asil tes %#ray yang menunju$$an adanya rheumatoid arthritis

• 0asil fa$tor rheumatoid  positif dari tes darah yang dila$u$an serta tes darah lainnya

ebanya$an orang yang ter$ena rheumatoid arthritis memili$i antibodi

fa$tor rheumatoid  R:! dalam darah mere$a. 'amun ter$adang ada orang yang tida$

memili$i antibodi ini dan ter$ena rheumatoid arthritis $arena ada penya$it lain yang bisa

menyebab$an fa$tor rheumatoid  untu$ diprodu$si dalam darah. 1leh $arena

itu, diagnosis rheumatoid arthritis didasarkan dari kombinasi kelainan sendi serta

'asil tes dara'0

Tes darah yang baru dan lebih spesifi$ untu$ rheumatoid arthritis adalah tes

antibodi citrulline cyclic , juga disebut anti#&&). ehadiran antibodi anti#&&) ini

menunju$$an $ecenderungan bentu$ rheumatoid arthritis yang lebih agresif.

1rang#orang dengan rheumatoid arthritis mung$in mempunyai anemia ringan. Tes darah

 juga dapat mengung$ap$an ting$at sedimentasi eritrosit /SR! atau pening$atan ting$at

protein &#reactive &R)!, yang merupa$an penanda adanya peradangan.

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eberapa orang dengan rheumatoid arthritis  juga mung$in memili$i hasil positif pada tes

antibodi antinuclear A'A!, yang menunju$$an adanya gangguan autoimun, apa$ah

gangguan tersebut rheumatoid arthritis atau penya$it autoimun yang lain.

"agaimana %engobatiRheumatoid Arthritis

/

 Ada bermacam cara untu$ mengobati rheumatoid arthritis. )engobatan termasu$ obat#

obatan, istirahat dan olahraga, serta tinda$an operasi untu$ memperbai$i $erusa$an pada

sendi.

Cenis pengobatan yang diguna$an tentunya tergantung pada beberapa fa$tor, yang

termasu$ diantaranya yaitu usia, $esehatan secara $eseluruhan, riwayat $esehatan, dan

ting$at $eparahan arthritis.

Obat(obatan untuk Rheumatoid Arthritis

Terdapat banya$ obat#obatan rheumatoid arthritis yang tersedia untu$ mengurangi nyeri

sendi, beng$a$, dan peradangan. eberapa obat tersebut untu$ mencegah atau

meminimal$an per$embangan penya$it. )erlu diingat, obat#obat ini ada yang memerlu$an

resep do$ter. Cadi Anda perlu $onsultasi$an dahulu dengan do$ter Anda sebelum

meng$onsumsinya demi efe$tivitas dan $eamanan.

1bat#obatan yang membantu mengurangi gejala arthritis, seperti nyeri sendi, $e$a$uan,

dan pembeng$a$an, antara lain"

• 1bat anti#inflamasi penghilang rasa sa$it, seperti aspirin, ibuprofen, atau napro%en

• )enghilang rasa sa$it topi$al dioles$an langsung $e $ulit!

• orti$osteroid, seperti prednison

• 1bat penghilang rasa sa$it golongan nar$oti$a

 Ada juga obat $eras yang disebut disease-modifying anti-rheumatic drugs DMARDs!, yang

be$erja dengan menghalangi atau mene$an serangan sistem $e$ebalan tubuh pada sendi.

1bat#obat tersebut antara lain"

• )la*uenil awalnya diguna$an untu$ mengobati malaria!

• 1bat pene$anan $e$ebalan tubuh, seperti methotre%ate, +muran, dan &yto%an

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• )engobatan iologis , seperti /nbrel, 0umira, Remicade, 1rencia, Ritu%an, dan

2eljan-

• 1bat#obat lain, seperti A-ulfidine dan Arava

%enga&a .stira'at dan Lati'an Ola'raga !angat Penting untuk Rheumatoid Arthritis/

eseimbangan antara istirahat dan olahraga sangat penting dalam mengobati rheumatoid 

arthritis. Sewa$tuflare-up, yaitu memburu$nya radang sendi, tinda$an yang terbai$ adalah

untu$ mengistirahat$an sendi yang meradang. 0al ini dapat dicapai dengan penggunaan

sementara tong$at atau joint splints, yaitu perang$at yang diguna$an agar sendi tida$ dapat

digera$$an.

eti$a peradangan sendi ber$urang, program panduan olahraga diperlu$an untu$

mempertahan$an fle$sibilitas sendi dan memper$uat otot#otot yang mengelilingi sendi.

Rentang gera$an olahraga harus dila$u$an secara teratur untu$ menjaga mobilitas sendi.

Ka&an #indakan "eda' Di&erlukan untuk Rheumatoid Arthritis/

eti$a $erusa$an sendi dari rheumatoid arthritis telah parah atau nyeri yang tida$ bisa

di$endali$an dengan obat#obatan, ma$a operasi mung$in menjadi pilihan untu$ membantu

memulih$an fungsi sendi yang rusa$.

Da&atka' Rheumatoid Arthritis Disembu'kan/

;alaupun tida$ ada obat untu$ menyembuh$an rheumatoid arthritis, namun pengobatan

dini dan agresif telah terbu$ti membantu mencegah $ecacatan.

!umber1 2eb%D

edera Ligamen

 Ada = ligamen, yaitu tough band tissues, pada lutut yang menstabilisasi$an sendi. 9igamen yangpaling sering cedera adalah anterior cruciate ligament A&9!.

Mencegah gera$an menyamping abnormal dari lutut adalah ligamen $olateral, ligamen $olateral

medial M&9!, dan ligamen $olateral lateral 9&9!, yang terleta$ di dalam dan di luar setiap lutut.

&edera pada ligamen $olateral, seperti ligamen $olateral medial M&9!, dan ligamen $olateral lateral

9&9! biasanya disebab$an oleh tumbu$an langsung pada pinggir lutut atau cedera $arena terpuntir.

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+ni dapat terjadi sendiri atau bersama dengan cedera A&9 atau )&9.

Diagnosis

Diagnosis didasar$an pada riwayat dan pemeri$saan $linis. <ejalanya dapat berupa rasa sa$it dan

pembeng$a$an pada lo$asi cedera dan lutut terasa tida$ stabil.

)engobatan &edera 9igamen

)engobatan cedera ligamen diantaranya adalah istirahat, mengang$at dan $ompres es pada $a$i yang

sa$it. )enggunaan $ru$ untu$ mengurangi beban pada lutut dan penopang untu$ menahan lutut juga

dapat diberi$an.

:isioterapi untu$ memper$uat otot penyo$ong dan menambah $emampuan berbagai gera$an

biasanya juga dila$u$an sebagai bagian dari pengobatan.

Tergantung pada situasinya, do$ter Anda dapat menyaran$an dila$u$annya pembedahan untu$

memperbai$i atau membentu$ $embali ligamen.