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Patofisiologi gout arthritis

Pendahuluan

Gout arthritis, atau lebih dikenal dengan nama penyakit asam urat, adalah salah satu penyakit inflamasi yang menyerang persendian. Gout arthritis disebabkan oleh penimbunan asam urat (kristal mononatrium urat), suatu produk akhir metabolisme purin, dalam jumlah berlebihan di jaringan. Penyakit ini sering menyerang sendi metatarsophalangeal 1 dan prevalensinya lebih tinggi pada laki-laki dibandingkan perempuan. Kadang-kadang terbentuk agregat kristal besar yang disebut sebagai tofi (tophus) dan menyebabkan deformitas.

Patofisiologi gout arthritis

Peningkatan kadar asam urat serum dapat disebabkan oleh pembentukan berlebihan atau penurunan eksresi asam urat, ataupun keduanya. Asam urat adalah produk akhir metabolisme purin. Secara normal, metabolisme purin menjadi asam urat dapat diterangkan sebagai berikut:

http://sectiocadaveris.files.wordpress.com/2009/12/sintesis-asam-urat.jpg

Sintesis purin melibatkan dua jalur, yaitu jalur de novo dan jalur penghematan (salvage pathway).

Jalur de novo melibatkan sintesis purin dan kemudian asam urat melalui prekursor nonpurin. Substrat awalnya adalah ribosa-5-fosfat, yang diubah melalui serangkaian zat antara menjadi nukleotida purin (asam inosinat, asam guanilat, asam adenilat). Jalur ini dikendalikan oleh serangkaian mekanisme yang kompleks, dan terdapat beberapa enzim yang mempercepat reaksi yaitu: 5-fosforibosilpirofosfat (PRPP) sintetase dan amidofosforibosiltransferase (amido-PRT). Terdapat suatu mekanisme inhibisi umpan balik oleh nukleotida purin yang terbentuk, yang fungsinya untuk mencegah pembentukan yang berlebihan.

Jalur penghematan adalah jalur pembentukan nukleotida purin melalui basa purin bebasnya, pemecahan asam nukleat, atau asupan makanan. Jalur ini tidak melalui zat-zat perantara seperti pada jalur de novo. Basa purin bebas (adenin, guanin, hipoxantin) berkondensasi dengan PRPP untuk membentuk prekursor nukleotida purin dari asam urat. Reaksi ini dikatalisis oleh dua enzim: hipoxantin guanin fosforibosiltransferase (HGPRT) dan adenin fosforibosiltransferase (APRT).

Asam urat yang terbentuk dari hasil metabolisme purin akan difiltrasi secara bebas oleh glomerulus dan diresorpsi di tubulus proksimal ginjal. Sebagian kecil asam urat yang diresorpsi kemudian diekskresikan di nefron distal dan dikeluarkan melalui urin.

Pada penyakit gout-arthritis, terdapat gangguan kesetimbangan metabolisme (pembentukan dan ekskresi) dari asam urat tersebut, meliputi:

Penurunan ekskresi asam urat secara idiopatik

Penurunan eksreksi asam urat sekunder, misalnya karena gagal ginjal

Peningkatan produksi asam urat, misalnya disebabkan oleh tumor (yang meningkatkan cellular turnover) atau peningkatan sintesis purin (karena defek enzim-enzim atau mekanisme umpan balik inhibisi yang berperan)

Peningkatan asupan makanan yang mengandung purin

Peningkatan produksi atau hambatan ekskresi akan meningkatkan kadar asam urat dalam tubuh. Asam urat ini merupakan suatu zat yang kelarutannya sangat rendah sehingga cenderung membentuk kristal. Penimbunan asam urat paling banyak terdapat di sendi dalam bentuk kristal mononatrium urat. Mekanismenya hingga saat ini masih belum diketahui.

http://sectiocadaveris.files.wordpress.com/2009/12/inflamasi-akibat-penimbunan-asam-urat.jpg

Adanya kristal mononatrium urat ini akan menyebabkan inflamasi melalui beberapa cara:

Kristal bersifat mengaktifkan sistem komplemen terutama C3a dan C5a. Komplemen ini bersifat kemotaktik dan akan merekrut neutrofil ke jaringan (sendi dan membran sinovium). Fagositosis terhadap kristal memicu pengeluaran radikal bebas toksik dan leukotrien, terutama leukotrien B. Kematian neutrofil menyebabkan keluarnya enzim lisosom yang destruktif.

Makrofag yang juga terekrut pada pengendapan kristal urat dalam sendi akan melakukan aktivitas fagositosis, dan juga mengeluarkan berbagai mediator proinflamasi seperti IL-1, IL-6, IL-8, dan TNF. Mediator-mediator ini akan memperkuat respons peradangan, di samping itu mengaktifkan sel sinovium dan sel tulang rawan untuk menghasilkan protease. Protease ini akan menyebabkan cedera jaringan.

http://sectiocadaveris.files.wordpress.com/2009/12/gouty-arthritis.jpg

Penimbunan kristal urat dan serangan yang berulang akan menyebabkan terbentuknya endapan seperti kapur putih yang disebut tofi/tofus (tophus) di tulang rawan dan kapsul sendi. Di tempat tersebut endapan akan memicu reaksi peradangan granulomatosa, yang ditandai dengan massa urat amorf (kristal) dikelilingi oleh makrofag, limfosit, fibroblas, dan sel raksasa benda asing. Peradangan kronis yang persisten dapat menyebabkan fibrosis sinovium, erosi tulang rawan, dan dapat diikuti oleh fusi sendi (ankilosis). Tofus dapat terbentuk di tempat lain (misalnya tendon, bursa, jaringan lunak). Pengendapan kristal asam urat dalam tubulus ginjal dapat mengakibatkan penyumbatan dan nefropati gout.

Referensi:

Kumar V, Cotran R, Robbins S. Buku Ajar Patologi. 7th ed. Jakarta: EGC; 2000. p. 864-8

Underwood JCE. General and Systemic Pathology. 4th ed. USA: Elsevier; 2004. P. 729-30.

Murray RK, Granner DK, Rodwell VW. Biokimia Harper. 27th ed. Jakarta: EGC; p. 317.

http://arthritis.webmd.com/tc/gout-topic-overview

What is gout?

Gout is a kind of arthritis. It can cause an attack of sudden burning pain, stiffness, and swelling in a joint, usually a big toe. These attacks can happen over and over unless gout is treated. Over time, they can harm your joints, tendons, and other tissues. Gout is most common in men.

What causes gout?

Gout is caused by too much uric acid in the blood. Most of the time, having too much uric acid is not harmful. Many people with high levels in their blood never get gout. But when uric acid levels in the blood are too high, the uric acid may form hard crystals in your joints.

Your chances of getting gout are higher if you are overweight, drink too much alcohol, or eat too much meat and fish that are high in chemicals called purines. Some medicines, such as water pills (diuretics), can also bring on gout.

What are the symptoms?

The most common sign of gout is a nighttime attack of swelling, tenderness, redness, and sharp pain in your big toe . You can also get gout attacks in your foot, ankle, or knees. The attacks can last a few days or many weeks before the pain goes away. Another attack may not happen for months or years.

See your doctor even if your pain from gout is gone. The buildup of uric acid that led to your gout attack can still harm your joints.

How is gout diagnosed?

Your doctor will ask questions about your symptoms and do a physical exam. Your doctor may also take a sample of fluid from your joint to look for uric acid crystals. This is the best way to test for gout. Your doctor may also do a blood test to measure the amount of uric acid in your blood.

How is it treated?

To stop a gout attack, your doctor can give you a shot of corticosteroids, or prescribe a large daily dose of one or more medicines. The doses will get smaller as your symptoms go away. Relief from a gout attack often begins within 24 hours if you start treatment right away.

To ease the pain during a gout attack, rest the joint that hurts. Taking ibuprofen or another anti-inflammatory medicine can also help you feel better. But don't take aspirin. It can make gout worse by raising the uric acid level in the blood.

To prevent future attacks, your doctor can prescribe a medicine to reduce uric acid buildup in your blood. If your doctor prescribes medicine to lower your uric acid levels, be sure to take it as directed. Most people continue to take this medicine for the rest of their lives.

Paying attention to what you eat may help you manage your gout. Eat moderate amounts of a healthy mix of foods to control your weight and get the nutrients you need. Avoid regular daily intake of meat, seafood, and alcohol (especially beer). Drink plenty of water and other fluids.

Gout - Cause

Gout is caused by too much uric acid in the blood (hyperuricemia). Hyperuricemia usually does no harm, and many people with high levels of uric acid in the blood never develop gout. The exact cause of hyperuricemia sometimes is not discovered, although inherited factors (genes) seem to play a role. When uric acid levels in the blood are too high, uric acid may form crystals that build up in the joints. Gout can seem to flare up without specific cause or can be brought on by factors such as:

Certain conditions related to diet and body weight, such as:

Obesity.

Moderate to heavy alcohol ingestion, particularly beer.

A diet rich in meat and seafood (high-purine foods).

Very low-calorie diets.

Medicines that may increase uric acid concentration, such as:

Regular use of aspirin or niacin.

Medicines that reduce the amount of salt and water in the body (diuretics).

Medicines that cause rapid cell death (chemotherapy, usually used to treat cancer).

Medicines that suppress the immune system, such as cyclosporine, that are used to prevent your body from rejecting an organ transplant.

Major illness or certain medical conditions, such as:

Rapid weight loss, as might happen in hospitalized patients who have changes in diet or medicines.

Chronic kidney disease.

High blood pressure.

Conditions that cause an abnormal rapid turnover of cells, such as psoriasis, multiple myeloma, hemolytic anemia, or tumors.

Lead poisoning.

Hypothyroidism.

Surgery.

Having been born with a rare condition that causes high blood uric acid levels. People with Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome have a partial or complete deficiency in an enzyme that helps to control uric acid levels.

Gout - Symptoms

Gout usually develops after a number of years of buildup of uric acid crystals in the joints and surrounding tissues. Symptoms include:

Warmth, pain, swelling, and extreme tenderness in a joint, usually a big toe joint . This symptom is called podagra. Symptoms sometimes start in a different joint, such as the ankle or knee.

Pain that starts during the night and is so intense that even light pressure from a sheet is intolerable.

Rapid increase in discomfort, lasting for some hours of the night and then easing during the next few days.

As the gout attack subsides, the skin around the affected joint may peel and feel itchy.

Other symptoms may include:

Very red or purplish skin around the affected joint, which may appear to be infected.

Limited movement in the affected joint.

Symptoms of gout vary.

Symptoms may occur after an illness or surgery.

Some people may not experience gout as many painful attacks but rather develop chronic gout. Chronic gout in older adults may be less painful and can be confused with other forms of arthritis.

Gout may first appear as nodules (tophi) on the hands, elbows, or ears. There may be no classic symptoms of a gout attack.

By the time you have the symptoms of a gout attack, uric acid has been building up in your blood, and uric acid deposits have been forming on one or more of your joints.

The big toe joint is most commonly affected. But the joints of the feet, ankles, knees, wrists, fingers, and elbows may also be involved. Inflammation of the fluid sacs (bursae) that cushion tissues may occur, particularly in the elbow (olecranon bursitis) and knee (prepatellar bursitis).

There are many other conditions with symptoms similar to gout.

Gout - What Happens

Gout usually develops after a number of years of buildup of uric acid crystals in the joints and surrounding tissues. A gout attack usually starts during the night with moderate pain that grows worse. A gout attack typically causes pain, swelling, redness, and warmth (inflammation) in a single joint, most often the big toe (this symptom is called podagra), followed by the eventual disappearance of all symptoms.

Most gout attacks stop after about a week.

Mild attacks may stop after several hours or last for 1 to 2 days. These attacks are often misdiagnosed as "tendinitis" or "sprain" even though there was no trauma or overuse.

Severe attacks may last up to several weeks, with soreness lasting for up to 1 month.

Many people have a second attack of gout within 6 months to 2 years after their first attack, but there may be intervals of many years between attacks. If untreated, the frequency of attacks usually increases with time.

There are three stages of gout.1 Many people never experience the third stage.

First stage: High blood uric levels

The uric acid level in the blood may be higher than normal, but there are no symptoms of gout.

High uric acid in the blood (hyperuricemia) may never progress beyond this stage, and symptoms of gout may never develop.

Some people may have kidney stones before having their first attack of gout.

Second stage: Episodes of acute gouty arthritis separated by periods without symptoms

This stage is also called intercritical or interval gout.

Uric acid crystals begin to form in the joint fluid, usually in one joint-most commonly the big toe-and the body often responds with a sudden inflammatory reaction: a gout attack.

Although the big toe is the most common site for a gout attack, gout may develop in other joints, including the knee, ankle, and joints in the foot, wrist, and fingers.

After the gout attack is over, the affected joint and surrounding tissues feel normal within days until the next attack, which often occurs within 2 years.

For many people this period becomes progressively shorter as attacks occur more often. Later attacks may be more severe, last longer, and involve more than one joint.

Third stage: Chronic tophaceous gout

If gout symptoms have occurred off and on without treatment for several years, they may become ongoing (chronic) and frequently affect more than one joint. There may no longer be periods of time between attacks. This stage of gout is frequently confused with other forms of arthritis, most commonly osteoarthritis.

By this time, enough uric acid crystals have accumulated in the body to form gritty nodules called tophi. When located just under the surface of the skin, these deposits are usually firm and movable. The overlying skin may be thin and red. Tophi that are very near the skin may appear cream-colored or yellow.

At first, tophi are usually found on or near the elbow, over the fingers and toes, or on the outer edge of the ear.

If the condition progresses without treatment, tophi may form in the cartilage of the external ear or the tissues around the joint (bursae, ligaments, and tendons), resulting in pain, swelling, redness, and warmth (inflammation). Progressive crippling and destruction of cartilage and bone is possible.

This stage of gout is uncommon because of advances in the early treatment of gout.

http://www.arthritis.org/disease-center.php?disease_id=42&df=diagnosed

Seorang dokter yang memiliki pengalaman dengan serangan gout mungkin dapat mengenali jenis arthritis inflamasi hanya dengan mengevaluasi tanda-tanda dan gejala , seperti:

seberapa cepat serangan itu datang

keparahan dari peradangan dan nyeri

sendi yang terlibat

jumlah sendi yang terkena

Anda riwayat kesehatan, termasuk obat yang kita pakai

Anda makan dan kebiasaan minum

tingkat asam urat dalam darah Anda, seperti yang ditentukan oleh tes laboratorium

Gout serangan biasanya terjadi pada malam hari. Anda dapat pergi ke tempat tidur perasaan halus dan bangun dengan salah satu atau semua hal berikut di dalam dan sekitar sendi yang terkena:

tiba-tiba sakit, parah dan pembengkakan

mengkilap merah atau ungu kulit

ekstrim kelembutan

Satu-satunya cara bagi dokter untuk membuat diagnosis yang pasti dari gout adalah untuk menguji cairan sinovial - cairan pelumas yang ditemukan di dalam sendi - di bawah mikroskop. Kehadiran kristal asam urat menandakan gout. Tes darah dapat menentukan apakah kadar urat Anda asam meningkat, namun tidak semua orang dengan tingkat tinggi asam urat mengembangkan gout.

Langkah Berikutnya: Bekerja dengan dokter Anda untuk mengembangkan rencana perawatan.

Mendapatkan diagnosis yang akurat sangat penting karena berbagai kondisi meniru gout, termasuk infeksi dan kaki patah. Gout mudah keliru untuk bentuk-bentuk lain dari arthritis dan ada kondisi serupa yang mempengaruhi lutut .

Gout Diagnosis

Joint aspiration

This is the most important diagnostic test. It is the ultimate method of being certain of a diagnosis of gouty arthritis, as opposed to other causes such as an infection in the joint.

A needle is inserted into the joint to withdraw a sample of fluid for testing.

The fluid is examined under a microscope to see if there are gout crystals or signs of a bacterial infection present. Sometimes other crystals can be found in the joint fluid, such as calcium pyrophosphate, which is caused by an entirely different condition called pseudogout ("like gout").

Gouty arthritis is sometimes diagnosed based on the typical clinical presentation without a joint aspiration.

Blood tests

Your doctor may obtain a blood sample to look at your cell counts, uric acid levels, kidney function, etc.

Unfortunately, the level of uric acid in your blood cannot be reliably used to make a diagnosis of gout. It is normal in approximately 10% of people during an acute attack of gouty arthritis. Moreover, uric acid levels are elevated in 5%-8% of the general population, so the presence of an elevated level does not necessarily mean that gout is the cause of an inflamed joint. Interestingly, the uric acid is typically lowered during a flare of inflammatory gouty arthritis. Therefore, the optimal time to measure the uric acid is after a flare has resolved when acute inflammation is not present.

Radiographs

X-rays are primarily used to assess underlying joint damage, especially in those who have had multiple episodes of gouty arthritis.

Gout Prognosis

The prognosis for gout is excellent if you are properly diagnosed and treated. Gout Prevention

If you are at risk for gout, you should do the following:

Eat a low-cholesterol, low-fat diet. People with gout have a higher risk for heart disease. This diet would not only lower your risk for gout but also your risk for heart disease. Control your cholesterol.

Avoid foods that are high in purines (the biochemical in foods that is metabolized into uric acid), including shellfish and red meats.

Slowly lose weight. This can lower your uric acid levels. Losing weight too rapidly can occasionally precipitate gout attacks.

Restrict your intake of alcohol, especially beer.

Stay hydrated.

Increase your intake of dairy products, such as nonfat milk and yogurt, because they can lower the frequency of gout attacks.

Avoid fructose, such as in corn syrup.

Talk to your doctor if you are taking thiazide diuretics (hydrochlorothiazide, HCTZ), low-dose aspirin, levodopa (Larodopa), cyclosporine (Gengraf, Neoral, Sandimmune), or nicotinic acid.

If you have had an attack of gouty arthritis, you should do all of the above and follow the regimen prescribed by your physician. The adequate prevention of gouty arthritis may involve lifelong medical therapy.

Gout Medications

While some medications are used to treat the hot, swollen joint, other medications are used to prevent further attacks of gout. With any of these medications, call your doctor if you think you are having problems from them or if they are not working.

Medicines used to treat acute gout and/or prevent further attacks are as follows:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Examples include indomethacin (Indocin), ibuprofen (Advil), and naproxen (Aleve). Newer drugs such as celecoxib (Celebrex) can also be used. Aspirin should not be used for this condition.

High doses of anti-inflammatory medications are needed to control the inflammation and can be tapered off within a couple of weeks.

Tell your doctor about your other health problems, particularly if you have a history of peptic ulcer disease or intestinal bleeding, if you are taking warfarin (Coumadin), or if you have problems with your kidney function.

The primary complications of these medications include upset stomach, bleeding ulcers, and decreased kidney function.

Colchicine (Colcrys)

This medication is given in two different ways, either to treat the acute attack of arthritis or to prevent recurring attacks.

To treat the hot, swollen joint, colchicine is given rapidly (generally, two tablets at once followed by another tablet an hour later).

To help prevent an attack from coming back, colchicine can be given once or twice a day. While the chronic use of colchicine can reduce the attacks of gout, it does not prevent the accumulation of uric acid that can lead to joint damage even without attacks of hot, swollen joints.

Tell your doctor if you have any problems with your kidney or liver function.

Corticosteroids

Corticosteroids such as prednisone (Meticorten, Sterapred, Sterapred DS) are generally given when your doctor feels this is a safer approach than using NSAIDs.

When given by mouth, high-dose corticosteroids are used initially and tapered off within a couple of weeks. It is important to take these medications as prescribed to avoid problems.

Some complications with the short-term use of corticosteroids include altered mood, elevated blood pressure, and problems with control of glucose in patients with diabetes.

Corticosteroids can also be injected into the swollen joint. Resting the joint temporarily, after it is injected with steroids, can be helpful.

Occasionally, corticosteroids or a related compound, corticotropin (ACTH), can also be injected into the muscle or given intravenously.

Medicines in addition to low-dose colchicine used to prevent further attacks of gout and lower the level of uric acid in the blood include the following.

Probenecid (Benemid)

This medication helps the body eliminate excess uric acid through the kidneys and into the urine.

You should drink at least 2 liters of fluid a day while taking this medication (to help prevent uric acid kidney stones from forming).

Advise your doctor if you have kidney problems or a history of kidney stones or if you are taking aspirin. You may need to take allopurinol (see below) instead.

There are a number of drug interactions with probenecid, so you should advise your doctor of your other medications. If you are prescribed a new medication, let your doctor know that you are taking probenecid.

Allopurinol

This medication decreases the formation of uric acid by the body and is a very reliable way to lower the blood uric acid level. Allopurinol is currently the gold standard of maintenance therapy.

Advise your doctor if you have kidney problems. Allopurinol can be still used, but the dose may need to be adjusted.

Common side effects include stomach pain, headache, diarrhea, and rash.

Discontinue allopurinol if you develop a rash or a fever, and call your doctor.

A very rare risk of allopurinol hypersensitivity exists. This problem can cause a severe skin rash, fever, kidney failure, liver failure, bone marrow failure, and can be fatal.

Advise your doctor if you are taking azathioprine (Azasan, Imuran), 6-mercaptopurine, or cyclophosphamide (Cytoxan, Cytoxan Lyophilized, Neosar); dose adjustments of allopurinol may be needed.

Ampicillin (Principen) is more likely to cause a rash if you are taking allopurinol.

Febuxostat (Uloric)

Febuxostat is first new medication developed specifically for the control of gout in over 40 years.

Febuxostat decreases the formation of uric acid by the body and is a very reliable way to lower the blood uric acid level.

Febuxostat can be used in patients with mild to moderate kidney impairment.

Febuxostat should not be taken with 6-mercaptopurine (6-MP), or azathioprine.

It is important to understand that these maintenance medications are used to lower the uric acid well below normal to prevent recurrent gouty arthritis attacks. Generally, doctors want the blood uric acid level to be below 6.0 mg/dL. This level of uric acid is referred to as the "target level" or "goal" of therapy.

Range of Movement (ROM)

Plane and Axis

Movement is defined by reference to a plane and/or axis.

The Three Planes

Sagittal Plane - a vertical plane which passes from front to rear dividing the body into right and left sections

Frontal or lateral Plane - which passes from side to side at right angles to the sagittal plane which divide the body into a front and back section

Transverse or horizontal Plane - a horizontal plane which divides the body into an upper and lower section

The Three Axis

Frontal Axis - passes from side to side at right angles to the sagittal plane

Sagittal or Transverse Axis - passes horizontally from front to rear lying at right angles to the frontal plane

Longitudinal or Vertical Axis - passes from head to foot at right angles to the transverse plane

Joint Actions

Spinal Column

The vertebral column has the following normal ranges of movement: Flexion, Extension, Lateral Flexion and Rotation.

Shoulder Girdle

The shoulder girdle has the following normal ranges of movement: Elevation, Depression, Adduction and Abduction.

Shoulder Joint

The shoulder joint has the following normal ranges of movement: Flexion, Extension, Adduction, Abduction and Medial Rotation.

Elbow Joint

The elbow joint has the following normal ranges of movement: Flexion, Extension, Pronation and Supination.

Wrist Joint

The wrist joint has the following normal ranges of movement: Flexion, Extension, Adduction, Abduction and Circumduction.

Hip Joint

The hip joint has the following normal ranges of movement: Flexion, Extension, Adduction, Abduction, Medial Rotation and Lateral Rotation.

Knee Joint

The knee joint has the following normal ranges of movement: Flexion and Extension

Ankle Joint

The ankle joint has the following normal ranges of movement: Plantar Flexion, Dorsi Flexion, Inversion and Eversion.

Page Reference

The reference for this page is:

MACKENZIE, B. (2004) Range of Movement (ROM) [WWW] Available from: http://www.brianmac.co.uk/musrom.htm [Accessed 18/9/2012]

Dari sekian banyak persendian yang terdapat pada tubuh manusia ada beberapa persendianyang cukup tinggi mobilitasnya sehingga kemungkinan untuk mengalami cedera jugasemakin besar. Contohnya adalah persendian pada daerah siku dan lutut.

LUTUT

Sendi lutut merupakan persendian yang sangat penting dalam tubuh, karena selain berfungsi sebagai alat gerak yang cukup tinggi mobilitasnya, juga sebagai penopang berattubuh saat berdiri. Hal ini meningkatkan kemungkinan untuk terjadinya cedera pada daerahtersebut saat beraktifitas.Cedera pada persendian lututdapat disebabkan oleh trauma(benturan), arthritis, atauaktivitas sehari-hari yang berlebihan, oleh sebab itunyeri pada lutut menjadikeluhan yang paling banyak dirasakan oleh setiap orang.Keluhan yang dirasakandapat berbeda-beda, mulaidari keluhan ringan sampai berat, tergantung dari beratnya cedera yang terjadi.Faktor yang dapat menyebabkan cedera lutut, yaitu• Obesitas dapat meningkatkan penekanan pada sendi lutut, sehingga meningkatkan risikoterjadinya osteoarthritis.• Aktivitas lutut yang berlebihan menyebabkan ketegangan otot yang dapat memicureaksiperadangan pada sendi lutut.• Usia• Olahraga yang berlebihan, terutama atletik • Kelainan bentuk, seperti panjang kaki kanan dan kiri yang tidak simetris.

penanganan / perawatan awal cedera lutut, yaitu1.

Menggunakan penahan atau penyangga

untuk menjaga kestabilan sendi lutut danmembatasi gerakan sendi lutut.2.

Istirahat selama beberapa har

i tergantung berat ringannya cedera.3.

Menggunakan es

untuk mengurangi nyeri atau peradangan sementara waktu.4.

Mengangkat kaki

.5.

Melakukan penekanan (kompresi) pada daerah sekitar cedera lutut

, untuk mencegah penumpukkan cairan akibat radang.6.

Menggunakan obat-obatan medis

.Seseorang yang mengalami cedera lutut memerlukan perawatan medis, bila :1. Terdapat bengkak di lutut,2. Terdapat kelainan pada lutut atau kaki,3. Merasakan nyeri yang hebat atau berkepanjangan,4. Terjadi infeksi pada daerah cedera,5. Sulit untuk mengurangi beban pada lutut,6. Mengalami kekakuan sehingga sulit untuk menekuk atau meluruskan sendi lutut.Setelah kita memahami fungsi dan kemungkinan cedera yang dapat terjadi pada persendianlutut, maka kita juga

harus mengetahui cara mencegah terjadinya cedera pada persendianlutut.Beberapa cara untuk mencegah cedera pada lutut menurut

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

:• Pemanasan yang cukup sebelum berolah raga. Jalan dan peregangan otot, terutama otot paha merupakan cara yang baik untuk mencegah cedera lutut saat berolah raga.• Memperkuat otot-otot kaki dengan melakukan beberapa latihan fisik, seperti berjalanmenaiki tangga, latihan sepeda statis.• Mengurangi berat badan yang berlebihan dan menjaga berat badan ideal.• Meningkatkan kekuatan dan durasi saat berolahraga secara bertahap.Beberapa macam olah raga yang sangat baik untuk membantu mengatasi arthritis menurut National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) :

• Olah raga dengan gerakan yang cukup luas untuk meningkatkan kelenturan otot danmengurangi ketegangan otot.• Olah raga yang memperkuat otot di sekitar lutut, sehingga dapat melindungi persendian.• Latihan

aerobic

untuk meningkatkan dan mempertahankan fungsi jantung. Selain itu

aerobic

sangat baik untuk menjaga berat badan.Gangguan pada sendi1) Dislokasi: tergesernya sendi dari tempat semula karena ligamen sobek diikuti dengan uraisendi.2) Ankilosis: persendian yang tidak dapat digerakkan karena menyatu.3) Terkilir: tertariknya ligamen disertai pembengkakan.4) Artitris (peradangan sendi)Macam-macamnya:a) Artitris gould: peradangan sendi karena timbunan asam urat. b) Artitris eksudaktif: peradangan sendi karena rongga sendi terisi dengan getah radang.c) Artritis sika: berkurangnya cairan sinovial5) Osteoartristis: penyakit kemunduran sendi yaitu terjadi penipisan selaput pelindung tulangrawan sehingga terjadi pembentukan tulang pada sendi