Hubungan antara derajat nyeri yang dinilai dengan indeks Western Ontario and McMaster Universities (WOMAC) dan sekresi Reactive Oxygen Internediate (ROI) sel monosit cairan sendi pada osteoartritis lutut

ARDYASIH, dr. Nyoman Kertia, SpPD-KR

2007 | Tesis | PPDS I Ilmu Penyakit Dalam

Latar belakang: Nyeri merupakan keluhan utama dan paling sering disampaikan oleh penderita osteoartritis (OA). Pada OA nyeri terutama diakibatkan oleh inflamasi. Degradasi matriks kartilago pada OA yang dilepaskan ke cairan sinovial difagositosis oleh monosit. Monosit menghasilkan reactive oxygen intermediate (ROI) pada saat awal fagositosis. ROI dapat memicu siklooksigenase-2 (COX-2) melalui nuclear factor kB (NF-kB), akhirnya menghasilkan prostaglandin-2 (PGE-2) yang menyebabkan nyeri. Nyeri dinilai dengan indeks WOMAC. Tujuan: Mengetahui hubungan nyeri OA lutut dengan sekresi ROI oleh sel monosit cairan sendi. Metode dan Subyek Penelitian: Penelitian ini dilakukan secara potong lintang, pada bulan Januari sampai dengan Mei 2007. Subyek penelitian adalah penderita OA lutut yang berobat di Poliklinik Rematologi RSUP Dr. Sardjito dan RSU Wirosaban Yogyakarta yang memenuhi kriteria dan bersedia ikut dalam penelitian. Subyek menjalani wash out satu minggu. Pada saat penelitian dilakukan pengisian kuesioner indeks WOMAC dan dilakukan pengambilan cairan sendi di ruang uji klinik Farmakologi FK UGM Yogyakarta. Pemeriksaan ROI dilakukan di Bagian Parasitologi FK UGM Yogyakarta. Hasil analisis dilakukan dengan uji korelasi Pearson. Hasil: Sebanyak 20 subyek penelitian (66,7%) adalah perempuan. Rerata usia subyek penelitian 68,067±8,854 tahun, dan semua subyek diatas 50 tahun. Rerata nilai nyeri indeks WOMAC adalah 10,433±3,318 dan rerata nilai sekresi ROI monosit cairan sendi adalah 2,104±0,460. Dilakukan analisis korelasi Pearson, sekresi ROI oleh sel monosit cairan sendi berhubungan positif lemah dengan nyeri yang dinilai dengan indeks WOMAC, namun tidak bermakna (r=0,349; p=0,059). Kesimpulan: nyeri yang dinilai dengan indeks WOMAC pda penderita OA lutut mempunyai hubungan yang positif dengan sekresi ROI oleh sel monosit cairan sendi.

Background. Pain is the main complaint and mostly occurs in Osteoarthritis (OA) patients. This pain particularly due to inflammation. Degradation of cartilage matrix in OA released to synovial fluid was phagocyted by monocyte. It results in reactive oxygen intermediate (ROI) in initial phase phagocytosis. ROI can trigger cyclooxygenase-2 (COX-2) by nuclear factor kB (NF-kB), it finally results in prostaglandin-2 (PGE-2) that leads to pain. Pain was measured with WOMAC index. Objective. To know relationship between pain of knee OA patients and secretion of ROI by monocytes in joint fluid. Methods and Subjects. This is a cross-sectional study. We performed since January to May 2007. Subjects were knee OA patients visited to Rheumatologic Outpatient Department of Dr. Sardjito and Wirosaban Hospital Yogyakarta, who fulfilled eligibility criteria and signed informed consent. Subjects performed wash out period for one week. Subjects filled WOMAC index questionnaire and joint fluid taking in clinical study unit in Pharmacology Department, Gadjah Mada University. ROI examination was performed in Parasitology department of GMU. We analyzed results by Pearson correlation test. Results. There were 20 subjects, 66.7% were females. Mean age was 68.07±8.854 years old, all subjects were more than 50 y.o. Mean of WOMAC index value was 10.433±3.318 and mean value of ROI monocyte joint fluid was 2.104±0.460. We performed Pearson correlation test, ROI secretion by joint fluid monocyte has weak positive correlation and pain grade assessed by index WOMAC, but not significant (r=0.349; p=0.059). Conclusion. There was weak positive correlation between pain grade assessed by index WOMAC in knee OA patients and ROI secretion released by joint fluid monocyte.

Kata Kunci : Osteoartritis Lutut,Derajat Nyeri,Indeks WOMAC dan Sekresi ROI, Knee osteoarthritis-pain- ROI secretion-WOMAC index