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All Journal Medical Journal of Indonesia Indonesian Journal of Rheumatology The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia
Harry Isbagio
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Medicine & Pharmacology

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Comparison of urinary excretion of Deoxypiridinoline and value of serum Osteocalcin within the Knee Osteoarthritis grading Isbagio, Harry
Medical Journal of Indonesia Vol 13, No 2 (2004): April-June
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (85.993 KB) | DOI: 10.13181/mji.v13i2.135

Abstract

The identification of molecular markers, which reflects differences in disease progression rates in Osteoarthritis (OA), would greatly facilitate clinical studies. Urinary Deoxypyridinoline (UDPD) and serum osteocalcin (OC) had been widely used for marker of bone metabolism, but the use for molecular marker in OA was lack of data. Recent studies show that there were conflicted results between urinary excretion of DPD and serum OC value within knee OA grading. The aim of this study is to compare of urinary excretion of DPD and the level of serum OC as destructive parameter of cartilage within the knee OA grading. This cross sectional study comprise of 69 patients with OA of knee joints. Kellgren and Lawrence scale was use for grading of OA. Group of patients with knee OA grade 2 call as group of early OA and group of patients with knee OA grade 3 and 4 calls as group of late OA. DPD in urine was measured using Immuno-chemilunescence, serum osteocalcin was measured using Elisa method. The mean value of urinary concentrations of DPD in OA patients was higher than normal value (9.79 ± 7.28 nM DPD/mM Creatinin), and the mean value of serum OC within normal value (8.49 ± 4.68 ng/mL). There were no significant differences of age, body mass index (BMI), duration of illness, urinary excretion of UDPD and serum OC level between early and late OA. In conclusion, there is no significant difference of urinary excretion of DPD and serum OC level within knee OA grading. The use of urinary DPD and serum OC as molecular markers of progression of OA needed to be explored by other longitudinal study. (Med J Indones 2004; 13: 96-101) Keywords: Knee osteoarthritis, deoxypiridinoline, osteocalcin
Use of anti-citrullinated peptide (Anti –CCP) antibodies in distinguishing patients with systemic lupus erythematosus and rheumatoid arthritis Isbagio, Harry
Medical Journal of Indonesia Vol 13, No 4 (2004): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (230.912 KB) | DOI: 10.13181/mji.v13i4.157

Abstract

Diagnosis of Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) can be confused in their initial stages. The joints, especially the hands, are commonly affected in both disorders, many patients with SLE are initially misdiagnosed as having RA Given that the outcome for the two diseases is diverse, it would be helpful to have serological marker to distinguish between them at onset. Anti-citrullinated peptide antibodies (anti-CCP) have recently been described as highly specific for RA. The objective of this study is to confirm the specificity of anti-CCP antibodies and to determine whether they might distinguish patients with RA from those with SLE. This study is a cross sectional study on a group of patients with RA (n=27), SLE with arthritis (n=20), other autoimmune diseases (non-rheumatic diseases, n = 8), and healthy adults (n=20). Anti-CCP was determined by a commercial Elisa test and Rheumatoid factor (RF) was determined by the standard slide latex test. The sensitivity and specificity of anti-CCP for the diagnosis of RA was 63.0% and 97.9% respectively, comparing with RF for RA that was 40.7 % and 85.4 %. Only 1 healthy adult was anti-CCP+, no anti-CCP was detected from SLE and other autoimmune disease. The mean of titer anti CCP in normal healthy adult, other autoimmune diseases, SLE and RA was 1.35 ± 2.04, 0.63 ± 0.59, 0.75 ± 0.59, and 38.17± 44.22 RU/ml, respectively. There was a highly significant difference between the mean of titer anti CCP for RA with others diseases (p <0.001). We conclude that detection of anti-CCP is very useful for the diagnosis of RA and distinguishing RA from SLE. (Med J Indones 2004; 13: 227-31)Keywords: Rheumatoid Arthritis, Systemic Lupus Erythematosus, anti-CCP antibodies
Pathogenesis of atherosclerosis in rheumatoid arthritis Pambudi, Joko Rilo; Isbagio, Harry
Indonesian Journal of Rheumatology Vol 5, No 1 (2014)
Publisher : Indonesian Rheumatology Association

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Abstract

Increased morbidity and mortality in patients with rheumatoid arthritis (RA) is largely associated with cardiovascular disease. In this case, the factors that play a role is chronic inflammation. A chronic inflammatory associated with condition which accelerate atherosclerosis and increased cardiovascular morbidity and mortality. Inflammatory and atherogenic mediators have a role in pathogenesis of RA and atherosclerosis. Atherogenesis in RA start when cytokines from the inflamed synovial tissue are released into the systemic circulation. Circulating cytokines affects the function of other tissues such as adipose tissue, skeletal muscle, liver and vascular endothelium that would lead to proatherogenic transformation process such as insulin resistance, prothrombotic effects, pro-oxidative stress and endothelial dysfunction. Size, weight and durationof systemic inflammatory response in RA are the most important factor causing damage. IMT (Intima Media Thickness) measurement on common carotid arteries byB-mode ultrasound is a rapid non-invasive examination of the structural anatomy, reproducible and relatively low risks that are advantageous for assessing therisk of cardiovascular disease and monitoring disease progression.
Reliability and validity of European Quality of Life 5 Dimension (EQ-5D) for measuring health-related quality of life in knee osteoarthritis patients at Cipto Mangunkusumo General Hospital Pramono, A; Sumariyono, Sumariyono; Isbagio, Harry
Indonesian Journal of Rheumatology Vol 2, No 3 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Background: Quality of life is very important to knee osteoarthritis (OA) patients. The term quality of life denotes one that is health-related. One of the questionnaires most frequently used to measure the quality of life is the European Quality of Life 5-Dimension (EQ-5D) questionnaire. At Cipto Mangunkusumo General Hospital, until today there has not been any instrument for measuring the health-related quality of life in knee OA patients that has been tested for its reliability and validity.Objective: To prove the reliability and validity of EQ-5D as a measurement tool in  determining the healthrelated quality of life in knee OA patients at Cipto Mangunkusumo General Hospital.Methods: This is a validity study in which all patients were asked to complete both the EQ-5D form and 36- item short form (SF-36) on their fi rst visit. They were subsequently asked again to complete only the EQ-5Dform one week after their fi rst visit.Results: Data were obtained from 86 respondents.The value of the intraclass correlation coeffi cient of each EQ-5D dimension, EQ-5D index, and visual analogue scale (VAS) was excellent (>0.75). Cronbach’s α value for internal consistency reliability in this study was0.6772 (<0.7). The external validity of EQ-5D compared to SF-36 was analyzed with the Pearson’s correlation test and revealed a signifi cant correlation (p<0.01) of all EQ-5D dimensions, EQ-5D index, and EQ-5D VAS with total score of SF-36 except for the dimensions of self-care, pain, and anxiety/depression. The construct validity of EQ-5D showed that all of the dimensions were signifi cantly correlated with the EQ-5D index (p<0.01) except for self-care dimension.Conclusion: EQ-5D is a valid and reliable measurement tool. It is thus recommended for measuring the healthrelated quality of life in knee OA patients at CiptoMangunkusumo General Hospital.
Predictor Factors of Atherosclerosis and Atherosclerosis Plaque in Rheumatoid Arthritis Patients Pambudi, Joko Rilo; Isbagio, Harry; Mulyadi, Rahmad; Abdullah, Murdani
Indonesian Journal of Rheumatology Vol 8, No 2 (2016)
Publisher : Indonesian Rheumatology Association

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Abstract

Background: Atherosclerosis and cardiovascular diseases have been known as the cause of increasing mortality among rheumatoid arthritis (RA) patients. Carotid intima media thickness (CIMT) measurement by ultrasound has been used as surrogate marker of atherosclerosis and cardiovascular disease.Methods: A cross sectional study of 86 RA patients fulfills EULAR/ACR 2010 critera for RA was conducted to study proportion and predictor factors of atherosclerosis and atherosclerosis plaque in rheumatoid arthritis patients.Results: Atherosclerosis and plaque was found in 47,7% and 29 % of patients. Age ≥ 40 yo, hypertension and duration of illness ≥ 24 mo were associated with atherosclerosis in multivariate logistic regression analysis with OR 10.70 (95% CI: 2.93-39.10), 4.99 (95% CI: 1.15-21.61) and 3.66 (95% CI: 1.11-11.99) respectively. Whereas hypertension, presence of antiCCP antibody and age ≥ 40 yo, were associated with plaque formation with OR 3.96 (95% CI: 1.15-13.57), 3.20 (95% CI: 1.11-9.24) and 3.61 (95% CI: 1.03-12.63) respectively.Conclusions: Age ≥ 40 yo, hypertension and duration of illness ≥ 24 mo was the predictors ofatherosclerosis, while hypertension, presence of antiCCP antibody and age ≥ 40 yo was the predictors of atherosclerosis plaque.Key words: atherosclerosis, intima media thickness, predictor, rheumatoid arthritis, ultrasonography.
Correlation between serum leptin concentration and disease activity in normal body mass index premenopausal women with systemic lupus erythematosus Suarjana, I Nyoman; Kasjmir, Yoga I; Isbagio, Harry; Soegondo, S
Indonesian Journal of Rheumatology Vol 1, No 1 (2009)
Publisher : Indonesian Rheumatology Association

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Abstract

Background. Leptin is recognized as a cytokine-like hormone with pleiotropic actions in modulating immune responses. The role of leptin in pathogenesis of systemiclupus erythematosus (SLE) was not fully understood yet. Previous study did not fi nd the correlation between serum leptin concentration and disease activity in patients with SLE, but selection of the subjects wasn’t based on the classifi cation of body mass index (BMI) and menopausal status.Objective. To determine correlation between serum leptin concentration and the disease activity in normal BMI premenopausal women with SLE.Methods. Serum leptin concentration was measured by enzyme-linked immunosorbent assay and disease activity was scored using Mexican SLE disease activity index (Mex-SLEDAI). Spearman’s correlation coeffi cient test was used for evaluating the strength of association between leptin level and Mex-SLEDAI score.Results. Seventy normal BMI premenopausal women with SLE were included in this study. The median of serum leptin concentration was 13.4 (0.6 – 45.9) ng/ml.The median serum leptin concentration in patients with active disease was 12.4 (0.6 – 41.6) ng/dl, whereas in patients with inactive disease was 15.2 (3.9 – 45.9) ng/dl.No signifi cant different was found between serum leptin concentration in active and inactive disease (p = 0.14). A weak negative correlation was observed between leptinconcentration and Mex-SLEDAI score, but not statistically signifi cant (r = -0.22; p = 0.07).Conclusion. No correlation was found between serum leptin concentration and disease activity in normal BMI premenopausal women with SLE. Prednisone doses anddisease duration might interfere.
Association Between Adiponectin Levels with Markers of Atherosclerosis In Patients with Rheumatoid Arthritis Meriza, Tanggo; Isbagio, Harry; Mulyadi, Rahmad; Abdullah, Murdani
Indonesian Journal of Rheumatology Vol 5, No 1 (2014)
Publisher : Indonesian Rheumatology Association

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Abstract

Background: Several studies have shown that atherosclerosis underlying processes of Cardiovascular disease (CVD), increased in rheumatoid arthritis (RA) and occurred early (premature). The cause of accelerated atherosclerosis in RA are still unknown.Adipokines have known that the adipokines play a role in the pathophysiology of RA and CVD. Accumulation of visceral fat associated with dysregulation of adipokinesthat influence the development of the atherosclerotic and disruption plaque. Obesity and pathological changes in fat mass and fat dysfunction as well as a change inthe pattern of secretion of proinflammatory adipokines, may have a correlation between heart disease and rheumatic diseases. Adiponectin is one of the mostwidely-studied adipokines. In RA, adiponectin is involved in the pathophysiology of RA that produces of various proinflammatory and prodestructive molecules. So far, adiponectin has been known to provide antiatherosclerotic effects in patients with non-RA. But, several recent studies in RA patients get opposite results in which increased levels of adiponectin are associated with increased prevalence of atherosclerosis. The effect of adiponectin on atherosclerosis in patient with RA is still unknown.Objective: to determine the relationship of adiponectin with atherosclerosis in patients with rheumatoid arthritis. Methods: This is a cross-sectional study conducted on outpatients of the  rheumatology clinic at Cipto Mangunkusumo General Hospital from January untilApril, 2013. Subjects consisted of 50 patients were diagnosed based on ACR 1987/EULAR 2010 criteria. The collection of data obtained by consecutive sampling and evaluated the patients’ medical data that included age, long-suffering of RA, body mass index (BMI), lipid profile, rheumatoid factor levels, levels of anti-cyclic citrullinated peptide (anti-CCP), C-reactive protein (CRP), erythrocyte sedimentation rates (ESR), blood pressure, fasting blood glucose, 2 hour post prandial blood glucose, ECG, examination of serum adiponectin levels and bilateral carotid ultrasound to measure the carotid artery intima media thickness.Results: From the results of the 50 patients studied, obtained 28 (56%) of patients had increased levels of adiponectin. Atherosclerosis was found in 13 (26%) subjects. The median value was 9.46 μg / ml with the lowest levels of 4 μg/ml and the highestlevels of 24μg/ml. The Spearman’s test showed no significant correlation between adiponectin serum and atherosclerosis in patients with RA (p = 0706 and r = 0.055). The analysis results of the correlation of adiponectin with atherosclerosis based on age, disease duration, ESR, rheumatoid factor, DAS 28, CRP, BMI, dyslipidemia showed no significant correlation.Conclusion : From this study, researchers found no statistically significant correlation between adiponectin levels with marker of atherosclerosis (CIMT) in patients with rheumatoid arthritisKeywords : Adiponectin, Atherosclerosis
Correlation Of Clinical Disease Activity Index And Disease Activity Score-28 in Indonesian Rheumatoid Arthritis Patients Pasha, Mochamad; Isbagio, Harry; Albar, Zuljasri; Rumende, Cleopas Martin
Indonesian Journal of Rheumatology Vol 9, No 1 (2017)
Publisher : Indonesian Rheumatology Association

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Abstract

Background:Clinical Disease Activity Index (CDAI) stands out amongst other methods in measuring disease activity of rheumatoid arthritis (RA) patient. CDAI is considered to be more practical and cost-effective in daily practice because it requires no laboratoryexamination. Previous studies conducted overseas revealed that CDAI has good correlation compared to other scoring index in measuring RA disease activity. However, those studies only included pure RA patients without any comorbidity diseases. Indonesian RA patients have distinct clinical profile, in terms of comorbidity conditions, and genetic predisposition which affect the fenotype of the disease.Objectives: Analyze correlation between CDAI compared to Disease Activity Score 28 CRP (DAS28- CRP) in measuring RA disease activity of RA patients in Indonesia.Methods: We conducted a cross sectional study to RA patients who visited rheumatology clinic at Cipto Mangunkusumo general hospital from April to May 2016. Data collected included history of illness, physical examination, and recent laboratory results. All data were documented in reseach’s form. Both CDAI and DAS28- CRP were measured in each patient by two observers. Correlation analysis between two numeric datas fromCDAI and DAS28-CRP were measured with Spearman’s Rho. Overall performance was analyzed as additional results using R2 index.Result: A total of 119 subjects were included in this study. All subjects were RA patients with comorbidities and were representing quite numbers of Indonesian races characteristic profile. Spearman’s Rho = 0,918 and R2 index =0,831 (83,1%).Conclusion: There is positive correlation result between outcome of CDAI and outcome of DAS28-CRP in assesing disease activity of Indonesian RA patients.Key Word: rheumatoid arthritis, Indonesia, correlation,Clinical Disease Activity Index.
Correlation of autoantibodies with the Disease Activity Score 28 and radiographic hand joint damage in rheumatoid arthritis patients Manuaba, Ida Ayu Ratih Wulansari; Sumariyono, Sumariyono; Isbagio, Harry
Indonesian Journal of Rheumatology Vol 2, No 2 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Background: Rheumatoid arthritis (RA) is a systemic chronic infl ammatory disease of the joint that causes deformity or disability leading to a decreased function in RA patients. According to the 1987 American College of Rheumatology, rheumatoid factor (RF) is used as one of the diagnostic criteria because until today it is still considered as the primary autoantibody in RA although it has a lower specifi city than that of anticyclic citrullinated peptide (anti-CCP). Besides RF and anti-CCP, anti-RA33 is another autoantibody found. Thepresence of the three autoantibodies in RA patient serum is important because it is the starting point of the pathogenesis of the autoimmune process in RA.Methods: This is a cross-sectional study using consecutive sampling. Forty six subjects, all suffering from RA, were recruited for this study. All of them were tested for RF, anti-CCP, anti-RA33 titers using enzymelinked immunosorbent assay (ELISA) method and hadtheir hand radiograph taken to obtain the Sharp score to evaluate joint damage. During this study, 28-joint Disease Activity Score (DAS28) (4 parameters) was also evaluated using erythrocyte sedimentation rate as one of the parameters.Results: The study found that the correlation between the three antibodies and DAS28 was not statistically signifi cant: RF (r = 0.200, p = 0.091), anti-CCP (r =0.117, p = 0.220), and anti-RA33 (r = 0.126, p = 0.202). There was a signifi cant correlation between antiCCP and the Sharp score (r = 0.300, p = 0.021). The correlation between the other two autoantibodies and the Sharp score was not statistically significant:RF (r = 0.194, p = 0.098), anti-RA33 (r = 0.156, p = 0.150).Conclusion: There was a signifi cant correlation between anti-CCP autoantibody and  radiographic hand joint damage in RA patients so that it could be used as an indicator for occurrence of an erosive or a more severe RA.
The Correlation between Body Fat Distribution and Medial Tibiofemoral Joint Space Width in Obese Knee Osteoarthritis Patients Herikurniawan, Herikurniawan; Isbagio, Harry; Soewondo, Pradana; Diana, Nyimas; Setiati, Siti
Indonesian Journal of Rheumatology Vol 9, No 1 (2017)
Publisher : Indonesian Rheumatology Association

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Abstract

Background: Obesity is a major risk factor for knee osteoarthritis. The relationship between obesity and OA may not be simply due to a mechanical factor. Evidences suggest 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 distribution with knee OA.Methods: This study was a cross sectional study of OA patients with obesity visiting the Rheumatology and Geriatric-Internal Medicine clinics at Cipto Mangunkusumo Hospital between January-March 2016. Data was collected by consecutive sampling. 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). Conventional radiography of the knee was used to evaluate jointspace narrowing (JSN). The correlation between body fat distribution and joint space width was analyzed by bivariate analysisResult: A total of 56 subjects were recruited, majority were women (73.2%). Median visceral fat was 12% (7.5-16.5), median subcutaneous fat was 30.2% (16.5-37.9), and median visceral to subcutaneous fat ratio was 0,40 (0,26-0,80). The mean medial tibiofemoral joint space width was 2.34 mm (SD 0.78). Bivariate analysis revealed a 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 visceral to subcutaneous fat ratio and medialtibiofemoral 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 subcutaneous fat, and visceral to subcutaneous fat ratio, with medial tibiofemoral joint space width.Keywords: Osteoarthritis, obesity, visceral fat, subcutaneous fat, visceral to subcutaneous fat ratio, medial tibiofemoral joint space width
Co-Authors Amanda Pitarini Utari Anna Ariane Ardani, Yanuar Aulia Rizka, Aulia Awalia Awalia Bambang Setyohadi Bernard Agus Sakti Dhaki, Bernard Agus Sakti Budiman Darmowidjojo, Budiman Chudahman Manan Chudahman Manan Cleopas Martin Rumende Deddy Nur Wachid Achadiono Diana, Nyimas Dono Antono Dwi Budi Darmawati E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Eka Ginanjar Em Yunir, Em Faisal Parlindungan Gede Kambayana Handono Kalim Herikurniawan, Herikurniawan I Nyoman Suarjana Irman Firmansyah Joewono Soeroso Kasjmir, Yoga I Laniyati Hamijoyo, Laniyati Meriza, Tanggo Murdani Abdullah Nyoman Suarjana Pambudi, Joko Rilo Pasha, Mochamad Pradana Soewondo Pramono, A Prathitasari, Rahma Anindya Rachmat Gunadi Wachjudi Rahmad Mulyadi, Rahmad Rakhma Yanti Hellmi Rudi Putranto Rudy Hidayat Rudy Hidayat Shuffrie Effendi, Shuffrie Siti Setiati Soegondo, S Sukamto Koesnoe Sumariyono Sumariyono Vera D. Joewono Zuljasri Albar