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"ABSTRAKLatar Belakang: Obesitas merupakan faktor risiko utama osteoartritis (OA). Penelitian terdahulu mendapatkan bahwa faktor mekanik saja tidak cukup untuk menjelaskan hubungan kejadian OA dengan obesitas. Leptin diduga berperan dalam proses destruksi kartilago pada OA. Tujuan penelitian ini adalah untuk melihat adakah korelasi antara leptin serum dengan COMP dan dengan lebar celah sendi tibiofemoral medial.Metode: Penelitian ini merupakan studi potong lintang pada penderita OA yang berobat di poliklinik Reumatologi RSCM dalam periode Juni-Juli 2014. Pengambilan sampel dilakukan dengan metode consecutive sampling. Diagnosis OA lutut berdasarkan kriteria American College of Rheumatology (ACR) 1896. Dilakukan pemeriksaan leptin dan COMP serum dengan metode ELISA. Pemeriksaan radiologi kedua lutut dilakukan dengan posisi antero-posterior pada pasien yang berdiri tegak. Kemudian dilakukan pengukuran lebar celah sendi tibiofemoral medial oleh ahli radiologi, Analisa statistik bivariat digunakan mendapatkan korelasi antara leptin dengan COMP dan dengan lebar celah sendi tibiofemoral medial.Hasil: Sebanyak 51 subjek memenuhi kriteria inklusi penelitian, 45 orang (88,2%) adalah wanita. Rerata kadar leptin didapatkan 38119,45 ± 21076,09 pg/ml. Nilai median COMP adalah 805,3(144,1-2241)ng/ml dan rerata lebar celah sendi tibiofemoral medial 3,73 ± 1,58 mm. Pada analisa bivariat tidak ditemukan korelasi antara leptin dan COMP ( r = 0,043, p= 0,764) dan juga antara leptin dengan lebar celah sendi tibiofemoral medial( r = -0,135, p = 0,345). Pada subjek dengan lama sakit > 24 bulan didapatkan korelasi negatif kuat antara leptin dengan lebar celah sendi tibio femoral medial ( r = 0,614, p = 0,015).Simpulan: Tidak didapatkan korelasi antara leptin dan COMP pada penelitian ini. Penelitian ini juga tidak mendapatkan korelasi antara leptin dengan lebar celah sendi tibiofemoral medial pada pasien OA lutut dengan obesitas.

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ABSTRACTBackground: Obesity is a well-recognized risk factor for osteoarthritis. However, the relationship between obesity and OA may not simply due to mechanical factor. Increasing evidence support the role of leptin in OA cartilage destruction. The objective of this study was to examine the possible correlation between leptin serum with COMP and medial joint space width in knee OA with obesity. Methods: This study was a cross sectional study in OA patients visiting Rheumatology outpatient clinic in Cipto Mangunkusumo Hospital between June- July 2014. Samples were collected using consecutive sampling method. Knee OA was diagnosed from clinical and radiologic evaluation based on American College of Rheumatology 1986 criteria. Serum was collected from 51 knee OA patients, serum leptin and COMP were measured by ELISA. Antero-posterior radiographs of the knee have been taken in weight bearing position, and then the radiologist measured the minimum medial joint space width. The correlation between leptin and same variables, such as COMP and tibiofemoral medial minimum joint space width were analized by bivariate analysis.Results: Fifty one subjects met the inclusion criteria, with 45 (88,2%) are women. Mean of Leptin was 38119,45 (SD 21076,09). Median of COMP was 805,3(144,1-2241) and mean of minimum joint space width was 3,73 (SD1,58) mm. In bivariate analysis we found no correlation between leptin and COMP ( r = 0,043, p= 0,764) and also between leptin and medial joint space width ( r = - 0,135, p = 0,345).Cluster analysis for the subject with disease onset >24 month showed strong negative correlation between leptin and tibiofemoral medial minimum joint space width (r = 0,614, p = 0,015).Conclusion: There was no correlation between leptin and COMP in this study. This study also showed that there was no correlation between leptin and medial tibiofemoral joint space width in knee OA with obesity."

"Latar Belakang: Obesitas merupakan faktor risiko utama osteoartritis (OA). Penelitian terdahulu mendapatkan bahwa faktor mekanik saja tidak cukup untuk menjelaskan hubungan OA dengan obesitas. Saat ini faktor metabolik yang berkaitan dengan massa lemak tubuh dianggap memiliki peranan penting, tetapi lemak mana yang paling berperan masih kontroversial apakah lemak viseral atau lemak subkutan. Tujuan penelitian ini untuk mendapatkan korelasi antara distribusi lemak tubuh dengan lebar celah sendi tibiofemoral medial. Metode: Penelitian ini merupakan studi potong lintang pada penderita OA lutut dengan obesitas yang berobat di poliklinik Reumatologi, Geriatri dan Penyakit Dalam RSCM periode Januari-Maret 2016. Diagnosis OA lutut berdasarkan kriteria American College of Rheumatology (ACR) 1986. Pemeriksaan distribusi lemak tubuh menggunakan bioelectrical impedance analysis (BIA). Pemeriksaan radiologi lutut menggunakan radiologi konvensional (foto polos) untuk menilai lebar celah sendi tibiofemoral medial. Analisis statistik bivariat digunakan untuk mendapatkan korelasi antara distribusi lemak tubuh dengan lebar celah sendi tibiofemoral medial. Hasil: Sebanyak 56 orang pasien yang memenuhi kriteria inklusi dan bersedia ikut dalam penelitian, mayoritas subjek berjenis kelamin perempuan (73,2%). Median kadar lemak viseral adalah 12% (7.5-16,5) median lemak subkutan adalah 30,2% (16,5-37,9) dan median rasio lemak viseral/subkutan adalah 0,40 (0,26-0,80). Rerata lebar celah sendi tibiofemoral medial adalah 2,34 mm (SB 0,78). Korelasi antara lemak viseral dengan lebar celah sendi tibiofemoral medial (r: -0,474 p: < 0,001). Tidak didapatkan korelasi antara lemak subkutan dengan lebar celah sendi tibiofemoral medial (r: -0,187 p: 0,169) serta tidak didapatkan korelasi antara rasio lemak viseral/subkutan dengan lebar celah sendi tibiofemoral medial (r: -0,225 p: 0,09). Simpulan: Lemak viseral berkorelasi negatif sedang dengan lebar celah sendi tibiofemoral medial (r: -0,474 p: < 0,001). Tidak didapatkan korelasi antara lemak subkutan dan rasio lemak viseral/subkutan dengan lebar celah sendi tibiofemoral.

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Background: Obesity is a major risk factor for knee osteoarthritis. The relationship between obesity and OA may not simply due to mechanical factor. Evidence suggests that metabolic factors related to body fat play important roles, but the specific type of fat that contributes to OA is unclear. The objective of this study was to examine the possible correlation between body fat distributions with knee OA.

Method: This study was a cross sectional study in OA patients with obesity visiting Rheumatology, Geriatric, Internal Medicine clinics in Cipto Mangunkusumo Hospital between January-March 2016. Samples were collected using consecutive sampling method. Knee OA was diagnosed from clinical and radiologic evaluation based on American College of Rheumatology 1986 criteria. Body fat distribution was measured by bioelectrical impedance analysis (BIA). Radiographs of the knee was measured by conventional radiography to evaluate joint space narrowing (JSN). The correlation between body fat distributions with joint space width was analyzed by bivariate analysis.

Result: A total of 56 subjects were recruited, with majority of subjects were women (73,2%). Median of visceral fat was 12% (7.5-16,5), median of subcutaneous fat was 30,2% (16,5-37,9) and median of visceral to subcutaneous fat ratio was 0,40 (0,26-0,80). Mean of medial tibiofemoral joint space width was 2,34 mm (SB 0,78). In bivariate analysis we found correlation between visceral fat and medial tibiofemoral joint space width (r: -0,474 p: < 0,001). There is no correlation between subcutaneous fat and medial tibiofemoral joint space width (r: -0,187 p: 0,169) and also visceral to subcutaneous fat ratio and medial tibiofemoral joint space width (r: -0,225 p: 0,09).

Conclusion: Visceral fat is correlated with medial tibiofemoral joint space width (r: -0,474 p: < 0,001). There is no correlation between neither subcutaneous fat nor visceral to subcutaneous fat ratio and medial tibiofemoral joint space width."

"Obesitas telah menjadi salah satu masalah kesehatan yang besar di dunia. Di Indonesia, prevalensi obesitas dilaporkan meningkat dari tahun ke tahun. Pada penderita obesitas, penurunan berat badan dengan latihan fisik dapat memberikan banyak manfaat kesehatan. Akan tetapi, pada penderita obesitas dengan osteoartritis sendi lutut latihan disik harus dilakukan dengan hati-hati. Kombinasi latihan aerobik pada intensitas submaksimal dengan sepeda statis, disertai latihan keseimbangan dan kekuatan otot tungkai bawah yang disesuaikan dengan kapasitas fisik diberikan pada individu obesitas dengan osteoartritis lutut untuk menurunkan berat badam. Restriksi asupan kalori juga diberikan bersamaan. Penelitian ini bertujuan menentukan efektifitas kombinasi terapi di atas dalam menurunkan berat badan. Pada penelitian ini dilakukan analisis data sekunder yang diperoleh dari status pasien dari Klinik Obesitas di Rumah Sakit Cipto Mangunkusumo. 200 status pasien dari Januari 2009 sampai April 2012 dipilih secara acak oleh petugas ruang penyimpanan status. Dari 200 status tersebut, diambil 37 status yang dipilih berdasarkan tabel nomor acak.Semua dari 37 subjek adalah wanita, dengan rerata umur 59.41+5.91tahun. Rerata berat badan awal adalah 71.91+11kg. Rerata indeks masa tubuh adalah 31.18+5.15, dan semua subjek adalah penderita obesitas. Rerata lingkar pinggang adalah 96.4+9.51cm. Tiga subjek tidak mengalami perubahan berat badan, sedangkan 34 subjek mengalami penurunan berat badan. Didapatkan rerata perubahan berat badan -2.08 kg(95% CI: -1.48kg to 2.67kg, standar deviasi 1.789kg). Tidak ditemukan korelasi yang bermakna secara statistik antara pengukuran antropometri awal dan usia dengan jumlah penurunan berat badan.Penelitian ini membuktikan bahwa latihan fisik yang diberikan efektif dalam menurunkan berat badan pasien obesitas dengan osteoartritis lutut. Pengukuran antropometri awal dan usia tidak tampak berkorelasi dengan penurunan berat badan.

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Obesity has become a major health problem around the world. In Indonesia, the prevalence of obesity is increasing annually. Weight loss by physical exercise have been demonstrated to have a lot of benefit in people suffering from obesity. However, physical exercise have to be done carefully in patients with osteoarthritis. A delicate combination of aerobic exercise done in submaximal intensity with balance exercise and lower extremity strength which were individually tailored is given to obese patient who also suffer from knee osteoarthritis. Caloric restriction is also given along the physical exercise

This study tried to find out how effective is this regimen in inducing weight loss. Analysis of secondary data obtained from medical record of patients from Obesity Clinic in Cipto Mangunkusumo Hospital was done. 200 medical records from January 2009 up to April 2012 were taken randomly. From those 200, 37 was chosen randomly with the aid of random number table.

All of the 37 subjects were women with average age of 59.41+5.91year. The initial body weight averaged at 71.91+11kg. The BMI averaged at 31.18+5.15, and all of the subjects were obese. The average waist circumference was 96.4+9.51cm. Three subjects had stable weight and 34 subjects lost weight. The average change was -2.08 kg(95% CI: -1.48kg to 2.67kg, standard deviation 1.789kg). Age and all baseline anthropometric measurement does not correlate with the change in bodyweight.

The study have shown that the physical exercise given was effective in reducing body weight of obese patient‟s with knee osteoarthritis. The baseline age and anthropometric measurement does not appear to correlate with the degree of weight loss."

"Obesitas merupakan suatu trend yang semakin banyak di dunia. Hal ini terjadi karena banyak faktor seperti junk food, globalisasi, dan penurunan aktivitas fisik. Obesitas sendiri merupakan faktor terbesar terjadinya Osteoartritis (OA) lutut. Otot quadriceps adalah salah satu otot yang melindungi sendi lutut. Pasien OA lutut ditemukan memiliki kelemahan otot quadriceps. Hubungan antara obesitas dan OA lutut serta hubungan antara OA lutut dengan kekuatan otot quadriceps sudah banyak diteliti, namun hubungan antara IMT dan kekuatan otot quadriceps masih belum jelas. Penelitian ini diadakan dengan tujuan untuk mengetahui hubungan antara Indeks Massa Tubuh (IMT) dengan kekuatan otot quadriceps pada pasien obesitas dengan OA lutut. Penelitian ini menggunakan desain studi cross-sectional secara analitik. Populasi subjek penelitian merupakan pasien obesitas dengan OA lutut di poli Rehabilitasi Medik RSCM. Data subjek penelitian diambil dari rekam medis elektronik lalu diskrining menggunakan kriteria eligibilitas sehingga didapatkan 18 subjek penelitian berdasarkan jumlah minimum sampel. Analisis data digunakan korelasi spearman di software SPSS. Hubungan dinyatakan bermakna secara statistik apabila p<0.05. Proses analisis data dengan korelasi spearman pada variabel Indeks Massa Tubuh (IMT) dan kekuatan otot quadriceps menghasilkan nilai p<0.05 dengan nilai rho -0,498. Hasil dari analisis data menunjukkan bahwa terdapat inverse correlation antara Indeks Massa Tubuh (IMT) dan kekuatan otot quadriceps yang bermakna secara statistic, maka semakin besar IMT seseorang, semakin lemah kekuatan otot quadriceps subjek pada populasi pasien obesitas dengan OA lutut.

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Obesity is an increasing trend in today’s world. This happens because various factors such as increase in availability of junk food, globalization, and decrease in physical activity. Obesity is one of the biggest risk factor for knee OA. Quadriceps muscle is one of the muscle that protects the knee joint. There is a lot of findings of weakening in quadriceps muscle strength in knee OA patients. There is a lot of evidence for the correlation of obesity and knee OA, there is also a lot of evidence for the correlation of knee OA and quadriceps muscle strength, but there is very little evidence for the correlation between BMI and quadriceps muscle strength. This study is made to find the correlation between BMI and quadriceps muscle strength in obese patients with knee OA. This study has an analytic cross-sectional design. The population of this study’s subject is obese patients with knee OA in the Department of Medical Rehabilitation of dr. Cipto Mangunkusumo Hospital. Subject’s data is acquired through electronic medical records and then screened using a particular eligibility criteria. This study acquired 18 subjects according to the minimum study sample. Data was analysed using spearman correlation in SPSS software. The correlation is stated statistically significant if p<0,05. Data analysis using spearman correlation to search for the correlation between BMI variable and quadriceps muscle strength variable shows a result with p<0.05 and a rho of -0,498. Based on the results of data analysis, it can be concluded that there is an inverse correlation between BMI and quadriceps muscle strength that’s statistically significant. Therefore, in obese patients with knee OA, the higher the BMI means the lower the strength of quadriceps muscle is."

"Latar Belakang Osteoartritis (OA) merupakan kondisi degeneratif sendi kronis yang umum terjadi di seluruh dunia, termasuk Indonesia. Nyeri adalah gejala predominan OA yang memengaruhi kualitas hidup pasien. Penyebab OA bersifat multifaktorial dan berat badan berlebih ataupun obesitas merupakan faktor risiko OA yang dapat diubah dan paling berpengaruh. OA bersifat nonreversibel sehingga tata laksananya saat ini berfokus pada manajemen rasa nyeri yang ditimbulkan. Penelitian ini utamanya bertujuan untuk mengetahui hubungan indeks massa tubuh dengan nyeri lutut pada pasien obesitas dengan osteoartritis genu. Metode Penelitian ini dilakukan dengan desain studi potong lintang analitis. Populasi penelitian merupakan pasien obesitas dengan osteoartritis lutut di Indonesia. Data subjek penelitian didapatkan dari rekam medis pasien yang menjalani rehabilitasi di Poli Rehabilitasi Medik RSCM. Hasil data dianalisis dengan menggunakan uji Kolmogorov-Smirnov untuk uji normalitas data. Analisis hubungan variabel dilakukan dengan menggunakan uji Spearman. Hubungan dinyatakan bermakna apabila p<0.05. Hasil Hubungan indeks massa tubuh dengan nyeri lutut memiliki nilai p<0.001 dan nilai r=0.457. Kesimpulan Rerata indeks massa tubuh pasien obesitas dengan osteoartritis genu Poli Rehabilitasi Medik RSCM adalah 30.17 kg/m2. Rerata skor nyeri lutut yang dialami pasien adalah 3.9 dengan semua pasien mengalami nyeri. Terdapat hubungan bermakna antara indeks massa tubuh dan nyeri lutut pada pasien obesitas dengan osteoartritis genu.

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Introduction Osteoarthritis (OA) is a common chronic degenerative joint condition that occurs worldwide, including in Indonesia. Pain is the predominant symptom of OA that affects the quality of life of patients. The causes of OA are multifactorial, and excess body weight or obesity is a modifiable and influential risk factor for OA. OA is nonreversible, so current management focuses on addressing the pain it causes. The main aim of this study is to determine the relationship between body mass index and knee pain in obese patients with knee osteoarthritis. Method This research was conducted with an analytical cross-sectional study design. The study population consisted of obese patients with knee osteoarthritis in Indonesia. Subject data were obtained from the medical records of patients undergoing rehabilitation at the Medical Rehabilitation Clinic of RSCM. Data results were analyzed using the Kolmogorov-Smirnov test for data normality. Variable relationships were assessed using the Spearman test. The relationship was considered significant when p<0.05. Results The relationship between body mass index and knee pain has a p-value of <0.001 and an r-value of 0.457. Conclusion The mean body mass index of obese patients with knee osteoarthritis at the Medical Rehabilitation Clinic of RSCM is 30.17 kg/m2. The mean knee pain score experienced by patients is 3.9, with all patients experiencing pain. There is a significant relationship between body mass index and knee pain in obese patients with knee osteoarthritis."

"Penelitian ini bertujuan untuk membuktikan apakah efek klinis lateral wedged insole (LWI) pada pasien osteoartritis lutut kompartemen medial dipengaruhi oleh postur kaki. Penelitian eksperimental nonblinded dilakukan untuk membandingkan efek klinis LWI pada 20 subjek kelompok postur kaki netral dan 17 subjek dengan postur kaki tidak netral. LWI dibuat custom molded dengan peninggian di lateral 7 mm disertai penyokong arkus medial. Subjek memakai LWI selama 4 minggu. Hasil keluaran penelitian ini adalah selisih penurunan derajat nyeri dengan menggunakan skala numeric rating scale (NRS) dan selisih penurunan waktu tempuh uji jalan 15 meter setelah pemakaian LWI. Hasil penelitian menunjukkan bahwa selisih penurunan derajat nyeri lutut kanan kelompok postur kaki netral didapatkan sebesar 3(0-4) dan kelompok postur kaki tidak netral sebesar 1(0-2). Ada perbedaan signifikan antar kedua kelompok (p<0.001). Selisih penurunan derajat nyeri lutut kiri kelompok postur kaki netral didapatkan sebesar 3,15 (±1,46) dan kelompok postur kaki tidak netral sebesar 0(0-2). Ada perbedaan signifikan antar kedua kelompok (p<0.001). Selisih penurunan waktu tempuh uji jalan 15 meter kelompok postur kaki netral sebesar 6,18 detik (±3,30) dan kelompok postur kaki tidak netral sebesar 2,76 detik (-3,2-15,37). Ada perbedaan yang signifikan antar dua kelompok dengan nilai p= 0,015. Penelitian ini menunjukkan bahwa kelompok postur kaki netral mendapatkan penurunan derajat nyeri dan penurunan waktu tempuh uji jalan 15 meter yang lebih baik dibandingkan kelompok postur kaki tidak netral. Temuan ini mengindikasikan bahwa melakukan asesmen yang baik terhadap postur kaki dapat meningkatkan efektivitas LWI pada pasien osteoartritis lutut kompartemen medial.

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The aim of this study was to prove whether the clinical effects of lateral wedged insoles (LWI) depend on individual foot posture. We conducted a non-blinded experimental study comparing clinical effect of LWI in two groups. There were 37 subjects with medial knee osteoarthritis, divided into normal foot groups (20 subjects) and abnormal foot groups (17 subjects). LWI was designed as custom molded insole with 7 mm lateral elevation accompanied by medial arch support. Subjects used LWI for 4 weeks. Data were obtained by measuring the pain level using numeric rating scale (NRS) and time duration in performing 15 meter walking test which represent functional capacity. Outcomes of this study were the difference in the decrease of pain level and the increase of functional capacity after the use of LWI. The difference of right knee pain level after the use of LWI was 3(0-4) in normal foot and was 1(0-2) in abnormal foot. The difference between groups was statistically significant (p < 0.001). The difference of left knee pain level after the use of LWI was 3.15 (± 1.46) whereas in the abnormal foot was 0 (0-2). The difference between groups was also statistically significant (p<0.001). The difference of time duration in performing 15 meter walking test after the use of LWI in the normal foot group was 6.18 second (± 3.30) and in the abnormal foot was 2.76 second (-3.2-15.37). The difference between groups was statistically significant with p = 0.015. The present study showed that normal foot group had a better outcomes in the decrease of pain level and the increase of functional capacity than that of the abnormal foot group after the use of LWI. These findings suggested that it is suggested to assess individual foot alignment to ensure adequate insole treatment for patients with medial knee osteoarthritis."

"Pasen dan cara kerja : 30 pasen OA lutut (15 pria, 15 wanita) dengan peningkatan sudut Q (> 15°) yang memenuhi kriteria inklusi dan ekslusi kemudian dicatat derajat nyeri (Nilai VAS; Visual Analogue Scale), derajat OA (Klasifikasi Kellgreen & Lawrence) dan IMT. Selanjuinya dilakukan pemeriksaan pola ajakan otot vastus medialis dan vastus lateralis dengan EMG. Ditentukan awal ajakan otot vastus lateralis dibandingkan dengan otot vastus medialis. Grafik EMG dinilai pada tugas berdiri berjinjit dan berdiri dengan tumit. Hasil pemeriksaan kemudian dianalisa secara stalistik lalu dilihat hubungan antar variabel secara statistik.Hasil : Terjadi perubahan pola ajakan otot vastus lateralis dan vastus medialis pada seluruh naracoba penderita OA baik laki-laki dan perempuan dengan kenaikan sudut Q (>l5°). Terdapat hubungan signifikan berupa korelasi negatif (R = -0,663; p = 0,007) antara kenaikan sudut Q dan perubahan pola ajakan pada kelompok laki-laki dengan cara pemeriksaan berdiri berjinjit. Terdapat hubungan signifikan berupa korelasi negatif (R = -0,508; p = 0,002) antara pembahan pola ajakan dan derajat OA lutut pada nilai total (Gabungan kelompok pria dan wanita, n = 30) dengan cara pemeriksaan berdiri berjinjit. Terdapat hubungan signifikan berupa korelasi negatif (R = -0,692; p = 0,04) antara perubahan pola ajakan dan derajat OA lutut pada nilai kelompok Iaki-laki dengan cara pemeriksaan berdiri berjinjit.Kesimpulan : Walaupun seluruh naracoba penderita OA lutut dengan peningkatan sudut Q mengalami perubahan pola ajakan, namun hubungan yang terjadi tidak sesuai dengan teori dasar. Terdapat hasil pemeriksaan perubahan pola ajakan yang tidak terdistribusi normal, baik berdiri berjiniit maupun berdiri dengan tumit. Hal ini, diduga sebagai penyebab timbulnya hasil-hasil yang tidak menunjang hipotesis. Penyebabnya mungkin akibat adanya faktor-faktor lain yang tidak termasuk dalam kriteria inklusi dan elslusi seperti kekakuan(rightness) jaringan lunak bagian lateral, kekendoran (laxity) jaringan lunak bagian medial, displasia tulang dan posisi abnormal patella.

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Subject and Interventions : 30 pts knee OA (15 men, 15 women) with increased Q - angle (>15°) and passes exclusion and inclusion criteria, have been registered entering the EMG study on medial and lateral vastus recruitment pattern atter noted on the pain scale, knee OA grade, and BMI. The starting point of recruitment is determined using the EMG on muscle activity visualization Comparison of medial and lateral vastus recruitment starting point, concluded as the altered recruitment pattern. The EMG examination is conduct in the rock on toe and heel test. All of data was analyzed using statistic software, to determine the correlation between all variables.Results : All of the patients with increased Q-angle shows altered recruitment pattern. There is a significant negative correlation between increased Q-angle and altered recruitment pattern in male group with rock on toe test (R = -0,663; p = 0,007). The significant negative correlation occurs between altered recruitment pattern and the knee OA grade in the total value (male+female group, n=30) with rock on toe test (R = -0,508; p = 0,002). Significant negative correlation also occurs between altered recruitment pattern and the knee OA grade in the male group with rock on toe test (R = -0,692; p = 0,04).Conclusion : Even all of the knee OA patients with increased Q-angle shows altered recnritment pattern, the correlation occurs in different way with the theory. The results have not been support the hypothesis owing to the fact that the recruitment pattern data is not nomtally distributed and another factors which are not include in the exclusion criteria may affect the pain and knee OA grade. Those factors are lateral solt tissue tightness, medial soft tissue laxity, dysplastic bone and patella position abnomarlity."

"Latar Belakang : Otot Kuadrisep pada penderita Osteoarthritis lutut disekitar sendi lutut sering mengalami atrofi, penurunan kekuatan serta fungsi sebagai stabilitas sendi terutama sendi penumpu berat badan. Terapi latihan merupakan salah satu bentuk rehabilitasi untuk peningkatan kekuatan otot sekitar sendi, yang mengalami kelemahan karena nyeri dan tidak digunakan. Volume latihan yang tinggi dapat menyebabkan kerusakan struktural otot skeletal. Secara struktural latihan yang menyebabkan kelemahan sarkomer akibat dari robeknya membran dan rendahnya kadar protein intraseluler (Kreatin Kinase) karena masuk ke dalam aliran darah. Semakin tinggi intensitas latihan penguatan otot semakin tinggi pula terjadinya risiko kerusakan otot, akan tetapi semakin rendah intensitas penguatan otot semakin kurang efektivitas pencapaian penguatan otot. Tujuan : Untuk mengetahui efektivitas latihan penguatan otot intensitas rendah dan sedang untuk mencapai kekuatan otot Kuadrisep dan fungsi yang optimal pada penderita OA lutut serta tidak menyebabkan kerusakan otot yang bermakna. Populasi dan Sampel : Semua pasien OA lutut usia 50-65 tahun di poliklinik Muskuloskeletal Departemen Rehabilitasi Medik RSCM dengan nyeri lutut VAS < 4 dan klinis (kriteria ACR) serta memenuhi kriteria penerimaan. Metode : Dilakukan pengukuran kekuatan otot Kuadrisep dengan dinamometer jinjing, kecepatan jalan 15 meter (detik), dan kadar serum enzim Kreatin Kinase sebelum dan setelah latihan. Responden dibagi menjadi 2 kelompok intensitas ringan (40% dari 10 RM) dan sedang (60% dari 10 RM) dilakukan latihan penguatan otot Kuadrisep isotonik dengan menggunakan NK table 3 set 10 repetisi, frekuensi 3 x/minggu selama 8 minggu dengan kenaikan beban bertahap setiap minggu. Hasil : Terdapat perbedaaan bermakna peningkatan sebesar 27,2 % kekuatan otot Kuadrisep setelah diberikan latihan intensitas ringan (p=0,001) dan sebesar 27,94 % (p <0,001) latihan intensitas sedang. Didapatkan penurunan waktu jalan 15 meter sebesar 39,9 % pada intensitas ringan (p=0,03) dan penurunan sebesar 47,37% pada intensitas sedang (p=0,007). Kedua kelompok tidak menunjukkan perbedaan bermakna pada kekuatan otot, kecepatan jalan, dan kadar enzim Kreatin Kinase. Kesimpulan : Latihan kekuatan otot Kuadrisep intensitas ringan dan sedang efektif mencapai kekuatan otot dan fungsi yang optimal tanpa menyebabkan kerusakan otot yang bermakna.

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Background : Osteoarthritits is rheumatoid disease mostly occurs in knee joint. Quadricep muscle around joint frequently athrophy, reduce strengthening, and functioning as stability joint especially as a role weight bearing joint so that occur deformity and worsen disease. Therapeutic exercise is one of rehabilitation treatment to enhance muscle strengthening around joint that become weakness due to pain and inactivity. Therefore it is important to make exersie prescription to achieve optimal result. High intensity exercise may cause structural damage skeletal muscle. This damage may lead muscle soarness, edema, and weakness. In structural, exercise can lead fraility of sarcomer consequence disruption of membrane and reduction level of protein intraceluller (Creatine Kinase) into bloodstream. Higher intensity of exercise will cause high risk of injury, however lower of intensity of muscle strengthening increasing less effective achievement of muscle strength. Ideally training given to the patient is an effective muscle-strengthening exercises to achieve optimal muscle strength and functional improvement achieved in the absence of muscle damage.

Objective : to find effetctivity of strengthening exercises low and moderate intensity to achieve Quadriceps muscle strength and optimal functional in patient with knee OA without causes significantly muscle damage.

Subject : All of knee OA patient at Inpatient of Musculoskeletal Rehabilitation Departement-Medical Faculty of Indonesia - Cipto Mangunkusumo Hospital, age 50-65 years with knee pain VAS < 4, clinical according American College of Rheumatology, and require inclusion criteria.

Method : Pre and Post Experimental, measurement of Quadriceps muscle strengthening with Hand held Dynamometer before and after exercise, time of walking speed on 15 metre (second), and creatine Kinase enzyme in blood serum. Subject divide to be 2 group, low intensuty (40% of 10 RM) and moderate (60% of 10 RM). Isotonic Quadricep strengthening exercise with NK table, 3 set 10 repetion 3 times in week during 8 week that intensity gradually increase each week.

Result : The study found that significantly increase of 27,2 % muscular strength Quadricep that having given a low intensity exercise ( p = 0,001 ) and significantly increase of muscular strength 27,94 % ( p < 0,001 ) in moderate intensity exercise . Decline significantly time of walking speed on 15 meters of 39,9 % in group low intensity (p = 0.03) and 47,37 % in moderate intensity (p = 0,007). Both of groups did not show the difference activity of Creatine Kinase.This study indicated no difference significantly exercise of muscular strengthen in both groups low and moderate intensity (p = 0,410 ).There was not significantly difference time walking speed both of group (p = 0,514). There were no significantly differences levels of enzyme Creatine kinase in both groups.

Conclusion: Quadriceps muscle exercise low and moderate intensity effective achieve muscle’s strength and functional optimal without causes significantly muscle damage."

"Latar Belakang : Obesitas diketahui terkait dengan berbagai gangguan kesehatan di antaranya sistem muskuloskeletal, yaitu Osteoarthritis OA lutut yang menyebabkan nyeri sehingga terjadi penurunan aktivitas dan berdampak pada penurunan kekuatan otot lutut yang pada akhirnya menurunkan kapasitas fungsional seseorang. Penatalaksanaan meliputi edukasi dan terapi latihan merupakan hal penting namun terkadang ada kendala untuk melakukan latihan di darat. Penelitian ini bertujuan untuk membandingkan pengaruh latihan di air dan di darat pada penderita obesitas dengan Osteoarthritis OA lutut terhadap penurunan intensitas nyeri dan peningkatan kekuatan otot lututMetode : Quasi experimental terhadap subjek obesitas dan OA lutut usia 40 ndash; 80 tahun dengan sedentary lifestyle PAL

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Background: Obesity is well known to be associated with various health problems, some of which includes musculoskeletal system, such as knee osteoarthritis OA that causes pain, and thus resulting in decreased activity. These would cause an impact to decrease the knee muscle strength, which ultimately lowers the functional capacity of an individual. Management that includes education and exercise therapy are deemed to be important, however often there are obstacles in doing exercises on land. This study aims to compare the effects of water versus land based exercise for obese patients with knee osteoarthritis OA to reduce pain intensity and improve knee muscle strength.Methods Quasi experimental on obesity and knee OA subjects, age ranging from 40 80 years with sedentary lifestyle PAL "

"Latar Belakang: Obesitas merupakan faktor resiko terjadinya osteoartritis (OA). Penelitian terdahulu bahwa faktor mekanik belum cukup untuk menjelaskan hubungan OA dengan obesitas. Faktor resiko ini dapat menurunkan fungsi dan aktifitas fisik pasien OA. Lemak viseral tempat ditemukan White Adipose Tissue (WAT), dapat mengeluarkan hormon leptin, dan leptin dapat mensekresi sitokin proinflamasi yang berdampak pada degradasi kartilago sendi, yang diduga berhubungan dengan kejadian OATujuan: Mendapatkan gambaran leptin serum dan kadar IL-1β cairan sendi pasien OA lutut wanita dengan obesitas sentral.Metode: Studi potong lintang pada pasien OA lutut wanita yang berobat di poliklinik Rheumatologi RSCM dalam kurun waktu Maret–Juli 2017. Pengambilan sampel dilakukan secara berturutan. Diagnosis OA lutut berdasarkan kriteria ACR 1986. Dilakukan pemeriksaan lemak viseral dengan menggunakan alat BIA Karada Scan .HBF 375. Pemeriksaan leptin serum dan IL-1ß cairan sendi dengan metode ELISA.Hasil: Didapatkan 22 subjek wanita yang memenuhi kriteria penelitian. Nilai median lemak viseral 12,5 (5 – 27,5 ) %, nilai median leptin serum 19735,5 (2998–81782) pg/ml, dan nilaimedian IL-1ß 1,23 (0,76 – 6,11).Simpulan: Didapatkan kadar rerata leptin serum 19735,5 (2998-81782) pg/ml dan rerata kadar IL-1β cairan sendi 1,23 ( 0,76 – 6,11).

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Background: Obesity is a well recognized risk faktor for osteoarthritis. However, the relationship between obesity and OA may not simply due to mechanical factor, may be a risk factor for declining function and physical activity. Viseral fat is that founded white adipocite tissue is product quantities of leptin. It's to secrete higher levels of proinflammatory cytokine and implicated in cartilage degradation.

The aim: of this study was to examine Profile of serum leptin and IL-1β synovial fluid in central obecity with knee osteoarthritis woman patients

Methods: This study was cross sectional study in OA patients visiting Rheumatology outpatients clinic in Cipto Mangunkusumo Hospital during March – July 2017. Sample were collcted using consecutive sampling methood. Knee OA diagnosed according to the 1986 American College of Rheumatology criteria. Viseral fat were measred by BIA Karada Scan HBF 375. Blood serum and synovial fluid was collected from 22 knee OA patients, serum leptin and synovial fluid were measured by ELISA,

Results : Of twenty two subjects met the inclution criteria, median of viseral fat was 12,5 (5 – 27,5) % and median of serum leptin was 19735,5 ( 2998 – 81782) pg/ml and median of IL-1 β was 1,23 ( 0,76 - 6,11) pg/ml.

Conclusion: :Serum leptin was 19735,5 (2998 – 81782) pg/ml and median of IL-1 β was 1,23 ( 0,76 - 6,11) pg/ml."