4 JENIS SUNTIKAN MERAWAT RADANG SENDI DAN PERSEDIAAN SEBELUM PROSEDUR
oleh Dr. Sanjiv Rampal, Pakar Tulang, Kuala Lumpur. 

Knee pain is the 2nd most common musculoskeletal complaint among adult patients. Osteoarthritis is the most common cause of knee pain and stiffness for patients over 50 years old. Osteoarthritis occurs when the protective cartilage that cushions the ends of the bones wears down over time resulting in two adjacent bones constantly rubbing each other and causing damage to the bone structure.

Radang sendi sering-kali terjadi kepada individu yang berumur 50 tahun keatas, dan menyumbang kepada masalah membabitkan tulang lutut. Radang sendi / sakit lutut menyebabkan seseorang itu mengalami kesukaran dalam menjalani kehidupan seharian kerana kesakitan yang dialami, lalu, menghadkan pergerakan mereka. Punca radang sendi adalah disebabkan oleh faktor penuaan, yang mana tulang rawan yang bertindak sebagai pelindung antara dua tulang telah berkurangan lalu menyebabkan permukaan tulang haus dan rosak.

Symptoms include possibly

• Deep, achy joint pain exacerbated by extensive use – The disease’s primary symptom
• Reduced range of motion and presence of crepitus (clicking sound) when knee is manipulated– Frequently present
• Knee swelling is often mild
• Stiffness during rest – May develop, with morning joint stiffness usually lasting for less than 30 minutes

Gejala yang dialami pesakit adalah seperti

• Kesakitan yang perit selepas melakukan aktiviti yang membabitkan pergerakan yang banyak
• Pergerakan menjadi terhad dan kadang-kala terdapat bunyi semasa lutut digerakkan
• Lutut bengkak
• Lutut tidak boleh bergerak/kaku (lebih kurang dalam 30 minit) semasa dalam keadaan berehat dan kerap terjadi selepas bangun dari tidur

One common option of treatment at general practice clinics in the region would include injection into the knee with various medications, called intra-articular injection.

Salah satu kaedah untuk merawat gejala radang sendi adalah dengan cara suntikan ubat dalam sendi atau saintifiknya dipanggil ‘intra-articular’ yang bermaksud, ‘intra’=dalam, ‘articular’=sendi.

Various joint injections are available as below:

Terdapat pelbagai jenis ubat suntikan sendi seperti:

1.Corticosteroids / Ubat Kortikosteroid

2. Hyaluronic Acid Gel injection / Asid Hyaluronik

3. Plasma Rich Platelet Injection / Plasma darah

4. Stem Cell injection / Sel stem

5. Less effective and rarely given are other preparations sorbitol and short-acting painkillers / ubat yang jarang digunakan adalah sorbitol dan ubat tahan sakit jangka masa pendek.

The following are common questions asked in my clinical practice.

Berikut merupakan soalan lazim yang diajukan pesakit di klinik.

1. What is the gel injection into the knee? Is it harmful?

1. Apakah maksud suntikan gel, dan adakah ianya membahayakan?

Generally, this type of injection is gel preparation with synthetic molecules of varying concentrations believed to mimic normal knee fluid. It is usually in 3-10cc quantity and given in a clean clinical setting. This product, which has been gaining popularity, offers evidence of short-term pain relief effects but does not change the overall degenerative process of the body. It is generally safe to be given, especially at the initial stages of osteoarthritis and offers almost no effect in advanced knee osteoarthritis.

Secara umum, suntikan gel ini mempunyai kandungan yang sama seperti komposisi semulajadi bendalir yang ada pada sendi. Ianya dipercayai membantu merawat kesakitan dalam jangka masa terhad/pendek dan tidak memulihkan kerosakan sendi yang dialamai oleh pesakit. Suntikan ini kebiasaanya diberikan di klinik dan terbukti berkesan untuk penghidap yang berada di tahap permualaan penyakit radang sendi dan kurang berkesan bagi tahap kronik.

2. Is the injection painful? Can I drive back home after the procedure? How long do I have to keep the plaster dry?

2. Adakah suntikan pada sendi sakit, dan bolehkah saya memandu kereta selepas prosedur? Berapa lama saya perlu memastikan plaster yang ditampal itu kering selepas suntikan?

Usual intraarticular injections are almost painless, there may be a slight sting at initiation but usually will be masked by local anaesthesia given prior. The whole procedure would take less than 3 minutes to be done. Plaster of less than 3 cm will be applied and it is encouraged to keep the dressing dry for 3 days.
Post-procedure I advise patients not to exert themselves for 2 days and generally safe to drive as tolerated.

Pada kebiasaanya, suntikan bius lokal akan diberikan sebelum prosedur suntikan sendi, oleh itu, pesakit hanya akan dapat merasa suntikan jarum pada awalnya sahaja. Prosedur mengambil masa selama lebih kurang 3 minit dan plaster berukuran 3 cm akan ditampal selepas suntikan. Pesakit dinasihati tidak melakukan aktiviti yang lasak dalam masa 2 hari dan boleh memandu kereta pada waktu tersebut.

3. Doctor Sanjiv, do I need to keep dressing even on day 2 post-procedure? How do you generally keep dressing dry post-procedure at home and while bathing?

3. Doktor Sanjiv, bolehkah saya membuang tampalan plaster pada hari kedua dan bagaimana untuk memastikan plaster itu kering?

I would advise the patient to keep dressing for a duration of roughly 48 hours. It is vital to keep dressing dry post-procedure and example of a common example of such action is using common food plastic wrapper while showering like below

Pesakit dinasihati untuk memastikan plaster tampalan kering sekurang-kurangnya 48 jam selepas suntikan, dan dicadangkan supaya membalut tampalan plaster menggunakan pembalut plastik makanan seperti gambar yang ditunjukkan di bawah.

4. Which is the most effective intra-articular injection? How often can it last?

4. Suntikan ubat mana yang paling berkesan dan berapa lama ianya boleh bertahan?

The most effective form intra articular knee injections would depend on the stage of knee osteoarthritis. Generally the more early in the stage of osteoarthritis, the more chance that the injection would give some pain relief. The effectiveness and how long would the medication last would depend again on clinical symptoms and the stage of the disease. If administered at the right stage of arthritis, the effects of knee injection can extend to 1-2 months.

Keberkesanan ubat bergantung kepada tahap radang sendi yang dialami oleh pesakit. Secara umum, suntikan akan menunjukkan hasil yang memberangsangkan sekiranya diberikan pada peringkat awal. Tempoh masa ubat memberikan kelegaan juga bergantung kepada tahap kerosakan lutut pesakit dan sekiranya diberikan pada waktu yang sesuai, suntikan dalam sendi akan bertahan selama 1-2 bulan.

5. How often can corticosteroids be repeated safely?

5. Berapa kerap suntikan kortikosteroid dapat diberikan?

Corticosteroids are usually relied upon when the patient is in a severe arthritic stage or the surgical operation needs to be delayed for medical or logistical reasons. In usual settings, the injections are rarely repeated more than twice in each knee and at least should be 6 weeks to 3 months apart.

Ubat kortikosteroid kebiasaanya diberikan kepada pesakit yang mengalami kesakitan yang teruk atau pembedahan lutut terpaksa ditangguhkan atas sebab faktor masalah kesihatan atau sebagainya. Ubat ini diberikan tidak melebihi 2 kali pada satu-satu lutut yang mengalami gejala, dan suntikan perlu di jarakkan selama 6 minggu ke 3 bulan.

6. Do these knee injections allow the knee to heal and solve this problem of knee osteoarthritis?

6. Adakah ubat suntikan akan membantu memulihkan kerosakan lutut dan menyelesaikan masalah lutut yang saya alami?

Knee injections are often part of knee osteoarthritis treatment. It does not solve or heal the medical problem of knee osteoarthritis. It offers an option to reduce the need for long term painkillers tablets and short-term pain relief.

Suntikan sendi merupakan rawatan yang kerap diberikan bagi pesakit yang menghidapi gejala radang sendi. Suntikan tersebut tidak dapat memberikan pemulihan kepada struktur tulang yang telah rosak, tetapi ianya membantu mengurangkan kesakitan yang dialami pesakit, dan pesakit tidak perlu untuk memakan ubat tahan sakit dalam tempoh masa tertentu.

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