Kadar Tumor Necrosis Factor-Alfa yang disekresikan monosit cairan sendi dan derajat nyeri pada Osteoartritis Lutut :: Tinjauan pustaka dan laporan penelitian

SESON, 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). Saat ini sudah banyak bukti bahwa OA merupakan penyakit inflamasi. Penelitian secara imunohistokimia pada OA membuktikan adanya infiltrasi sel mononuklear yang menghasilkan sitokin proinflamasi seperti Tumor necrosing factor-α (TNF-α) dan Interleukin-1(IL-1). Kedua sitokin tersebut berperan dalam mengaktifkan enzim-enzim degradasi seperti metalloproteinase, collagenase, gelatinase dan aggrecinase yang dapat menimbulkan destruksi kartilago dan proses inflamasi. Tumor Necrosing Factor-α dan IL-1β telah ditemukan meningkat dalam cairan sinovia dan kartilago pasien OA. Nyeri dinilai berdasarkan Visual Analogue Scale (VAS). Tujuan: Mengetahui hubungan antara kadar TNF-α yang disekresikan sel monosit cairan sendi dengan derajat nyeri pada pasien OA lutut. Metode dan Subyek Penelitian: Penelitian ini dilakukan pada pasien OA lutut yang berobat di poliklinik Rematologi RSUP Dr. Sardjito dan poli Penyakit Dalam RSU Wirosaban Yogyakarta yang memenuhi kriteria dan bersedia ikut dalam penelitian antara bulan Januari sampai dengan Juli 2007. Subyek menjalani wash out selama satu minggu. Pada saat penelitian dilakukan pengisian VAS dan pengambilan cairan sendi. Pemeriksaan kadar TNF-α yang disekresikan sel monosit dengan metode ELIZA.. Hubungan rerata kadar TNF-α yang disekresikan sel monosit dengan rerata nilai VAS dianalisis dengan uji korelasi Pearson bila syarat terpenuhi. Hasil: Sebanyak 45 subyek (66,2%) dari 68 subyek yang ikut penelitian adalah perempuan. Rerata usia subyek penelitian 64,50±9,28 (62,25-66,75) tahun. Rerata kadar TNF-α yang disekresikan oleh sel monosit cairan sendi adalah 31,50±59,45 (17,11-45,89) pg/ml dan rerata nyeri berdasarkan VAS adalah 51,618±23,26 (45,98 – 57,24) mm. Hasil analisis didapatkan kadar TNF-α yang disekresikan sel monosit cairan sendi berhubungan positif sangat lemah dengan nyeri(r=0,027), namun tidak bermakna secara statistik (p=0,830). Simpulan: Didapatkan hubungan tidak bermakna antara kadar TNF α yang disekresikan sel monosit cairan sendi dengan derajat nyeri pada pasien OA lutut.

Background. Pain is the most frequent chief complaint encountered by osteoarthritis (OA) patients. Recently it has been many evidence that OA is an inflammation disease. Immunohistochemically study on OA found infiltration mononuclear cell with resulted cytokines inflammation such as TNF-α and IL-1. Both the cytokines play role in activated degradation enzymes such as metalloproteinase, collagenase, gelatinase, and aggrenicase which can result cartilage damage and inflammation process. Tumor necrosing factor-α and IL-1β have been found increase in sinovial fluid and cartilage on OA patients. Pain is measured by Visual Analogue Scale (VAS) Objective. To know association between level of TNF-α secreted by monocyte sinovial fluid with pain in knee OA patients. Subjects and Methods. This is a study on knee OA patient who seek medication in Rheumatologic outpatient department of Dr. Sardjito and Internal Medicine outpatient department of Wirosaban Hospital Yogyakarta, who fulfilled eligibility criteria and signed informed consent. Subjects performed a wash out period for one week. This study begin from January until July 2007. Subjects filled in VAS questionnaire and sinovial fluid was taken. Level of TNF-α secreted by monocyte cells was assay by ELIZA. The association between mean of TNF-α and mean of VAS score will be analyzed using Pearson Correlation test if the prerequisite is fulfill. Results. There were 68 subjects, 45 (66.2%) were females. Mean of age was 64.50±9.28 (62,25-66,75) years old. Mean of level TNF-α secreted by monocyte sinovial fluid was 31.50±59.45 (17,11-45,89) pg/ml and mean of pain score by VAS was 51,618±23,26 (45,98 – 57,24) mm. The result of analysis showed that there was a very weak positive association level of TNF-α secreted by monocyte sinovial fluid with pain score, but this association was not significant (r=0,027; p=0,830). Conclusion. There was no significant association between level of TNF-α secreted by monocyte sinovial fluid with pain score in knee OA patients.

Kata Kunci : Osteoartritis Lutut, yeri, Kadar TNF,Alfa, Knee Osteoarthritis-Pain- TNF alpha-Monocyte-VAS