3 Jenis Radang Sendi Lutut.

Disediakan oleh Dr. Sanjiv Rampal, Pakar Tulang, Orthopaedic, Kuala Lumpur.

The presence of knee pain in the advanced ages in life is relatively common. Reports from western data prove more than 1/3 of the elderly population will complain of some form of knee pain in people above the age of 45 years old. This is probably due to the location and the mere size of the joint, which is the largest joint in the body. It single-handedly bears much of the body weight when moving, walking and running. Knee pain in the elderly is commonly seen with acute bouts of mild to moderate pain or more common chronic knee pain (lasting for more than 3 months).

Radang sendi lutut kebiasanya terjadi kepada individu yang telah meningkat usia dan laporan data dari negara-negara barat menunjukkan lebih 1/3 daripada mereka berusia 45 dan ke-atas. Berkemungkinan hal ini berpunca kerana saiz sendi lutut yang paling besar di antara sendi yang lain, dan lokasi lutut yang banyak menampung berat badan dan daya hentakan semasa bergerak seperti berjalan atau berlari. Kesakitan radang sendi lutut selalunya datang secara ringan atau sederhana sakit, dalam masa yang singkat atau lama (kronik) yang mana sakit berterusan selama 3 bulan.

Malaysian population is heading towards ageing society. Public health information regarding healthcare is becoming very relevant and important in embracing 2023 and beyond. Local Malaysian statistics shows that knee pain is 2nd most common musculoskeletal symptom complain among adults in outpatient clinics set ups.

Penduduk Malaysia kebanyakkan menghampiri populasi ke arah penuaan dan kesedaran mengenai penjagaan kesihatan adalah sangat penting. Statistik Malaysia menunjukkan radang sendi lutut merupakan kedua tertinggi aduan berkaitan tulang sendi di klinik-klinik kesihatan.

If you are experiencing knee pain in your 60s, do not worry as it’s relatively common.

Sekiranya anda mengalami masalah sakit sendi lutut pada usia 60-an, anda tidak perlu bimbang kerana ini merupakan masalah yang biasa bagi golongan seperti anda.

The three main causes of chronic knee pain in elderly are

Tiga penyakit yang selalu mengakibatkan radang sendi ialah:

1. Knee Osteoarthritis

2. Rheumatoid arthritis

3. Gouty Arthritis (Gout)

1.Knee osteoarthritis

Degenerative knee disease is a common, multifaceted condition that can occur secondary to advanced age, injury, inflammation, and infection. The most common form of degenerative knee pathology is osteoarthritis (OA), which affects close to one in every 3 elderly people age 65 years and above locally.

End-stage arthritis presents pain, stiffness, reduction of quality of life and limitations in function. Treatment of knee osteoarthritis would depend heavily on symptoms chronicity, pain affecting ambulation and activities of normal daily living. Management of knee osteoarthritis consists of nonsurgical options that include painkillers, thermotherapy, and physical therapy and for more complicated arthritis a surgical option of knee replacement is a safe and viable option.

Tahap akhir radang lutut sendi akan mengakibatkan kesakitan seterusnya sendi menjadi kaku atau tidak boleh berjalan/bergerak. Rata-rata penghidap menjadi sukar untuk menjalani kehidupan seharian yang normal. Kaedah rawatan adalah berdasarkan simtom yang dihadapi oleh pesakit seperti pengambilan ubat tahan sakit dan terapi fisio atau tuaman di bahagian yang sakit. Jika rawatan dari klinik tidak berhasil, pembedahan penggatian tulang lutut atau implan lutut merupakan kaedah yang selamat dan mempuyai peratusan keberkesanan yang tinggi untuk melegakan kesakitan.

2.Rheumatoid Arthritis of the knee

Rheumatoid Arthritis (RA) is an auto immune disease where your immune system attacks healthy tissues in your joints. It is relatively the second most common arthritis cause of knee pain

Penyakit kedua tertinggi yang menyumbang kepada masalah sakit sendi lutut ialah Rheumatoid Arthritis (RA) yang berpunca daripada sel immunisasi (sel darah putih) merosakkan sel tisu di sendi lutut.

Knee presentations are usually slowly progressing, presenting with knock knee type of deformity over long periods of time if left untreated. RA patients often complain of pain over both knee, with stiffness, significantly more swelling and difficulty in bending and maintaining stability.

Sendi Rheumotoid jika tidak dirawat akan menyebabkan bentuk kaki berubah, yang mana lutut akan berdekatan antara satu sama lain dipanggil ‘knock knee’. Lama-kelamaan kaki akan menjadi kaku dan bengkak, menyebabkan kesukaran untuk membengkokkan kaki dan mengimbangi berat badan.

Treatment regimens would include treating underlying RA with modern anti rheumatic medication, physical and physiotherapy, maintenance of normal daily activity, use of non-steroidal anti-inflammatory drugs and surgical referral if all measures unsuccessful.
Over the years the need for total knee replacement surgery has reduced as more cases have been picked up at screening at earlier age and disease modification drugs are able to prevent or slow down the progress of joint damage.

Rawatan ubat anti-rhuemotid akan diberikan untuk mengawal kondisi ini beserta ubat tahan sakit. Selain itu, pesakit disarankan supaya melakukan terapi fisio. Sekiranya rawatan ubat dan fisio tidak berkesan, implan lutut boleh mengatasi masalah sakit sendi rheumatoid. Sejak beberapa tahun kebelakangan ini, implan lutut bagi kondisi rheumotid telah berkurangan kerana kesedaran penduduk Malaysia menjalani rawatan awal.

3.Gouty Arthritis

Gouty arthritis of the knee is a relatively common and complex form of arthritis that can affect almost anyone. Gout occurs when urate crystals accumulate in your joint, causing inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood.It then may aggregate into masses and called tophi’s may form in the joints or surrounding soft tissues. Tophi are white, chalky deposits that create visible skin lumps.

Sendi gout sering terjadi kepada mereka yang mempunyai kandungan asid urik yang tinggi di dalam badan. Asid akan berkumpul dan membentuk kristal urate berwarna keputihan pada sendi. Kristal akan berkumpul pada sendi-sendi dipanggil ‘tophi’ dan menjadikan sendi bengkak dan selalunya pesakit akan mengalami kesakitan yang perit yang dipanggil serangan gout.

If your knee stiffness is accompanied by a burning pain and is warm to touch, you may have a gout flare in the knee. It’s characterized by sudden, severe attacks of pain, swelling, redness, warm sensation around the joint and tenderness in one or more joints, most often associated with pain in the big toe.

Sekiranya lutut tidak boleh bergerak dan mengalami kesakitan yang perit datang secara tiba-tiba, dan berasa panas, kemerahan dan sakit apabila dipegang, kemungkinan serangan gout berlaku pada sendi. Selain daripada sendi lutut, sendi yang lain-lain boleh terjadi gout dan selalunya pada sendi ibu jari kaki.

Gout symptoms are usually intermittent and usually self-resolving in less than 2 weeks in most cases. It normally takes several years for chronic gout to develop. The condition can cause deformity, continuous pain, and permanent joint or soft tissue damage.

Gout datang secara tiba-tiba dan beransur pulih selama 2 minggu. Serangan boleh terjadi beberapa kali dan jika dibiarkan terlalu lama, tisu lutut akan mengalami kerosakan dan kesakitan akan lebih berpanjangan.

Management of gout usually entails reduction of diet rich in purines, a course of anti-gout medication e.g. allopurinol, colchicine, over-the-counter accessible oral anti-inflammatory , prescribed NSAIDS non-steroidal anti-inflammatory drugs and rarely corticosteroid administration via orally or into the knee injection. Surgical total knee replacement is often advised when chronic gouty arthritis has caused permanent joint damage and severe knee deformities.

Rawatan gout merangkumi pengambilan makanan yang kurang purin, ubat anti gout seperti allopurinol dan colchicine, beserta ubat tahan sakit. Suntikan ubat tahan sakit pada lutut juga boleh membantu mengurangkan kesakitan. Pembedahan implan lutut disarankan sekiranya lutut sendi mengalami kerosakan yang teruk.