PATIENT IDENTITY

Name : Mr. Warni

Age : 65 yo (01/01/1951)
Date of admission: 19/12/2016
Address : BTN Citra Blok C3, Hamzi. Mks
Job : House wife
Religion : Moslem
Race : Makassarese
Room
: Policlinic Rheumatologi
Medical Record : 326048

HISTORY TAKING
Chief complaint: Bilateral knee joint pain
Further anamnesis:
Felt since 8 months ago (October 2016) and worsen 3 months before
admission. It occured in both knee but greater in the left knee. Pain
continuously occur, is worse with movement, not relieved by rest. Patient
also complain about stiffness in knee joint that last more than 20 minutes.
Pain was first experienced 20 years ago in the left knee because falled at
the house with a left foot hit the first falls on the ground but made her just
pain and a little difficult to walk. Now, she has diffcult to walk without
walking aid because of pain in both knees since 8 months ago.
There is History hospital on 11 november 2016 with the same complaint.
Bilateral knees effusion aspiration was done in 3 month ago at Wahiddin
Sudirohusodo Hospital. She was given injection articulation in both knees
at Polyclinic Rheumatology RSWS 3 months ago and prescribed with
meloxicam. He still felt pain on his knee joint after intra articular injection.

HISTORY TAKING
Theres History of hypertension since 20 years ago.
Regular treatment with antihypertensive drug
amlodipine.
Theres History of DM since 1 year ago. Regular
treatment with drug acarbose.
There is no family history with same complain
There is no complain of fever, history of fever and
chilling
There is no complain of cough, SOB, nausea,
vomit, and chest pain
Defecation usual, yellow. Urination smooth, yellow.

PHYSICAL EXAMINATION
General Description
Moderate illness/ well nourished/ compos mentis
Vital Signs
BP: 150/90 mmHg
RR: 20 x/min
VAS : 5/10

HR: 84x/min
Temp: 36,8C

Physical Examination
Face: Normal expression, deformity (-), symmetry left & right
Eye: Pallor conjunctiva (+), icteric scleric (-)
ENT: Deformity (-), secretion (-)
Neck: Lymph node enlargement (-), mass (-)

PHYSICAL EXAMINATION
Thorax:
I: Symmetrical left & right
P: No tumor mass, no tenderness
P: Sonor on both lung fields
A: Vesicular sound, Additional sound: rhonki (-/-), wheezing
(-/-)
Heart:
I: Ictus cordis unseen
P: Ictus cordis unpalpable
P: Right heart border in ICS IV linea parasternalis dextra;
Left heart border in ICS V linea medioclavicularis sinistra
A: S1/S2 pure, regular. No gallop, no murmur

PHYSICAL EXAMINATION
ABDOMINAL EXAMINATION
Abdomen
I: Convex, follow the motion of
breath
A: Peristaltic (+) normal impression
P: Liver and spleen are not palpable
P: Tympani (+), no ascites

RHEUMATOLOGY STATUS
GAIT: can not be evaluated
ARM: normal
LEG
- Genu dextra: Warm (-), dolor (-), tenderness (-),
bony enlargement (-), crepitation (+), effusion
(+) minimal, tophus (-), limited ROM (+)
- Genu sinistra: Warm (+), dolor (-), tenderness
(+), bony enlargement (-), crepitation (+),
effusion (+) tophus (-), limited ROM (+),

SPINE: normal

clinical features

Pain at the weight bearing joint, exacerbated by joint use

and relieved by rest, but in advanced cases, pain also
persists at rest and at night
Morning stiffness, last < 30 minutes
Decreased range of motion
Crackling noise called crepitus when affected joint is
moved
Localized tenderness along the joint line.

diagnostic criteria of OA

The ACR Clinical

The ACR
Classification Criteria of Knee
Clinical/Radiographic
OA :
Classification Criteria :
Presence of knee pain + 3 of
Presence of knee pain + 1
the following:
of the following +
1. Age > 50 years old
osteophyte in knee X-Ray :
2. Morning stiffness < 30
1. Age > 50 years old
minutes
2. Morning stiffness < 30
3. Crepitus on knee motion
minutes
4. Bony tenderness
3. Crepitus on knee motion
5. Bony enlargement
6. No palpable warmth

The ACR
Clinical/Laboratory
Classification Criteria:
Presence of knee pain + 5
of the following:
1. Age > 50 years old
2. Morning stiffness < 30
minutes
3. Crepitus on knee
motion
4. Bony tenderness
5. Bony enlargement
6. No palpable warmth
7. ESR < 40 mm/hr
8. RF <

Kellgren-Lawrence Grading Scale

differential diagnosis
Osteoarthritis

Rheumatoid arthritis

Gout

Prevalence

68% of women, and 58%

of men over the age of
65

Affects about one per

cent of the population.

Varies between
populations

Gender

Woman predominate
from age 40-70 years,
after which men and
women are equally
affected

More common in women

than men

More common in men,

than women

Age of Onset

Usually old age

Any age but usually

between 35-50 years of
age

Usually developes during

middle age in men and
after menopause in
women

Genetic Predisposition

Yes

Yes

Yes

Joint symmetry

Asymmetrical joints are

affected initially

Characteristically
symmetrical

Usually one joint is

affected initially
(asymmetrical)

Joint commonly affected

Knees, hips, and the

small joints in the hands

Small joints of the hands

and the feet

Big toe

Duration of morning
stiffnes

< 30 minutes

> 60 minutes

None

Associated Symptoms

none

Rheumatoid nodules
(hard, firm, swellings).
Generalised afternoon
fatigue, anorexia,
generalised weakness,
and low grade fever

Possible fever during

acute attack. Tophi
(urate crystals) may
form. They are usually
yellow or white nodules,
commonly appearing on

treatments

Rehabilitation and supportive.

Patient education.
Exercises - increase tendons capacity and muscle to absorb
stress during joint motion
Lifestyle modifications.
Weight managements: especially obese.

THANK YOU