Diagnosis dan Pengelolaan SPONDILOARTRITIS PDF

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                   Diagnosis dan Pengelolaan SPONDILOARTRITIS REKOMENDASI Perhimpunan Reumatologi Indonesia 2021                     Diagnosis dan Pengelolaan SPONDILOARTRITIS REKOMENDASI Perhimpunan Reumatologi Indonesia 2021 Diagnosis dan Pengelolaan Spondiloartritis Gambar sampul oleh: Anita Suhamto xlix + 48 halaman ISBN 978-979-3730-37-0 Hak Cipta Dilindungi Undang-undang: Dilarang memperbanyak, mencetak, dan menerbitkan sebagian atau seluruh isi buku ini dengan cara dan bentuk apapun tanpa seizin penulis dan penerbit Diterbitkan oleh: Perhimpunan Reumatologi Indonesia This program is funded by “Projects for global growth of medical technologies, systems and services through human resource development in 2020” conducted by the National Center for Global Health and Medicine under the Ministry of Health, Labor and Welfare, Japan.  TIM PENYUSUN Ketua tim penyusun: Dr. dr. Arief Nurudhin, Sp.PD-KR, FINASIM Anggota: dr. Ayu Paramaiswari, Sp.PD-KR dr. R.M. Suryo Anggoro Kusumo Wibowo, Sp.PD-KR dr. Yulyani Werdiningsih, Sp.PD-KR, FINASIM dr. Surya Darma, Sp.PD, FINASIM dr. Lita Diah Rahmawati, Sp.PD-KR Dr. dr. Sumartini Dewi, Sp.PD-KR, M. Kes. Dr. dr. Rudy Hidayat, Sp.PD-KR, FINASIM dr. Sumariyono, Sp.PD-KR, MPH, FINASIM iii UCAPAN TERIMA KASIH dr. Tristira Rosyida dr. Nadya Safira iv  KATA PENGANTAR Assalamu’alaikum warohmatullahi wabarokatuh, Puji syukur ke hadirat Allah subhanahu wata`ala, atas tersusunnya buku rekomendasi spondiloartritis ini. Ucapan terima kasih kami sampaikan kepada semua pihak yang telah berkontribusi pada penyusunan buku “Diagnosis dan Pengelolaan Spondiloartritis” ini. Spondiloartritis merupakan suatu kelompok penyakit yang saat ini semakin sering ditemui dalam praktik sehari-hari, sehingga diperlukan kewaspadaan para dokter. Spondiloartritis merupakan kumpulan beberapa penyakit dengan manifestasi yang berbeda, tetapi mempunyai beberapa karakteristik yang hampir sama yaitu artritis perifer, uveitis anterior, sakroiliitis, faktor rheumatoid negatif, dengan riwayat keluarga positif dan pada umumnya HLA-B27 positif. Upaya deteksi dan diagnosis sedini mungkin sangat penting, yaitu pada setiap kasus nyeri pinggang inflamasi ≥3 bulan (spondiloartritis aksial), maupun artritis perifer yang asimetris, dan/atau yang predominan di ekstremitas bawah (spondiloartritis perifer), terutama pada laki-laki 3 bulan dan usia saat onset > COX 1 Asam asetat heteroaryl Diklofenak 2–3 1–2 q 8 - 12 jam COX 2 >> COX 1 Ketorolak 0,5 – 1 5 q 4 - 6 jam tad Asam arylpropionat Ibuprofen 1–2 2 q 6 - 8 jam COX 1 > COX 2 Naproxen 2 14 q 12 jam COX 1 > COX 2 Ketoprofen 1–2 2 q 6-8 jam tad Asam enolat Piroxicam 3–5 45 – 50 qd COX 1 > COX 2 Meloxicam 5 – 10 15 – 20 qd COX 2 >COX 1 Alkanone Nabumetone 4–5 24 q 12 - 24 jam COX 1 = COX 2 Coxib Celecoxib 2–3 11 q 12 - 24 jam COX 2 >> COX 1 Etoricoxib 2–3 15 – 22 qd COX 2 >> COX 1 Keterangan : tad (tidak ada data) xxxviii Lampiran 16. Perincian Diagnosis Spondilopati menurut ICD-1070 Spondiloartritis nonspesifik menurut ICD-10 tergolong dalam spondilopati, dengan perincian diagnosis menurut ICD-10 sebagai berikut. Kelompok Diagnosis Spondilopati Menurut ICD-10 Subkelompok SpA Kode ICD- Diagnosis 10 AS M45 Spondilitis ankilosa UspA M46.0 Spinal enthesopathy M46.1 Sacroiliitis, not elsewhere classified M46.8 Other specified inflammatory spondylopathies M46.9 Inflammatory spondylopathy, unspecified Catatan: ICD-10, the International Classification of Diseases, 10th revision; AS, ankylosing spondylitis; UspA, undifferentiated spondyloarthritis; SpA, spondyloarthritis. xxxix Lampiran 17. Leeds Enthesitis Index (LEI)71 Leeds Enthesitis Index Nyeri sendi maupun nyeri tekan pada sendi diidentifikasi pada beberapa lokasi berikut ini dengan memberikan tekanan (4 kg - hingga kuku dari pemeriksa menjadi pucat) : Nyeri/Nyeri Tekan Lokasi Ada Tidak Kanan € (0) € (1) 1. Epikondilus lateral humerus Kiri € (0) € (1) Kanan € (0) € (1) 2. Kondilus medial femur Kiri € (0) € (1) 3. Insersi tendon Achilles/Achilles Kanan € (0) € (1) bagian proksimal Kiri € (0) € (1) Total Nilai (Jumlah poin “Ada” pada setiap lokasi di atas) = ….. / 6 CATATAN INSTRUKSI : Hasil positif (nilai 1 pada setiap lokasi) yaitu ketika terdapat rasa nyeri/nyeri tekan saat diberikan tekanan, bukan hanya rasa nyeri yang dinyatakan oleh pasien (diadaptasi dari https://medicinehealth.leeds.ac.uk/download/downloads/id/113/leeds_ enthesitis_index_lei.pdf) xl Lampiran 18. Health Assessment Questionnaire (HAQ)72 xli xlii  DAFTAR PUSTAKA 1. Koh L. Seronegative spondyloarthropathies. Singapore Fam Physicians. 2019; 43:19-22. doi: 10.33591/sfp.43.2.u3. 2. Picchianti-Diamanti A, Lorenzeti R, Chimenti MS, Luchetti MM, Conigliaro P, Canofari C, et al. Enteropathic spondyloarthritis: results from a large nationwide database analysis. 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