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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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The Use of Tocilizumab in Combination with Methotrexate in Indonesian Rheumatoid Arthritis Patients (PICTURE INA Study) Setyohadi, Bambang; Isbagio, Harry; Wachjudi, Rachmat Gunadi; Soeroso, Joewono; Kalim, Handono; Achadiono, Deddy Nur Wachid
Indonesian Journal of Rheumatology Vol 10, No 1 (2018)
Publisher : Indonesian Rheumatology Association

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Abstract

Background Aim of this research is to assess the efficacy and safety of tocilizumab (TCZ) in combination with methotrexate (MTX) in Indonesian patients with moderate to severe active rheumatoid arthritis (RA) who have an inadequate response to non-biologic DMARDs.Methods This was a interventional, prospective, single arm, multicenter, study in  Indonesian male or female patients aged ≥ 18 years old, with a diagnosis of RA for > 6 months based on ACR 1987 revised criteria with moderate to severe disease activity (DAS28 score > 3.2) after ≥ 12 weeks of non-biologic DMARDs treatment. The treatment consisted of tocilizumab, 8 mg/kg, intravenous (IV), every 4 weeks for a total of 6 infusion in combination with oral MTX (10−25 mg) every week. Efficacy was assessed based on the percentage of patients achieving low disease activity state (DAS28 < 3.2), percentage of patients achieving reduction > 1.2 point of DAS28, percentage of patients achieving remission (DAS28 < 2.6), and percentage of patients with ACR20, ACR50, and ACR70 responses. Descriptive statistics will be used for presentation of results.Results 100% patients reached low disease activity (DAS28 ≤ 3.2) at last study visit (week 24) and clinically significant improvement (reduction at least 1.2 units) at every visit in DAS28, both for ITT or PP patients. Remission (DAS28 < 2.6) was observed in 82.1% (ITT patients) and 93.1 % (PP patients) on last study visit. ACR20, ACR50, and ACR70 were achieved in 20%, 34%, and 34% (ITT patients), and 7%, 24%, and 62% (PP patients) on week 24. There were 3 out of 39 patients (7.69%) with adverse events (AE) and serious adverse events (SAE) that resulted in discontinuation of TCZ treatment, consisting of 1 patient with SAE of sepsis ec acquired community pneumonia, 1 patient with SAE of pneumonia tuberculosis, and 1 patient with AE of candidiasis. Most common adverse events were hepatic dysfunction (30.7%), hypercholesterolemia (23.1%), followed by arthralgia (20.5%) Twelve percent of patients needed dose modification due to elevated liver enzyme (elevated ALT/SGPT level).Conclusion Tocilizumab seems to be efficacious and likely to have good safety profile in non- biologic DMARD nonresponsive RA patients of PICTURE INA study.   Keywords: Rheumatoid Arthritis, Tocilizumab, DMARD, DAS28
Proportion and Factors that Associate with Incidence of Hepatotoxicity in Rheumatoid Arthritis Patients Treated with Methotrexate in RSCM Year 2013−2015 Prathitasari, Rahma Anindya; Isbagio, Harry
Indonesian Journal of Rheumatology Vol 10, No 1 (2018)
Publisher : Indonesian Rheumatology Association

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Abstract

Background Rheumatoid arhtirtis (RA) is a chronic autoimmune disease that mainly attacks joints. It may causes joint deformities which leads to lower quality of life of RA patients. RA is treated with metothrexate (MTX) which inhibiting disease progression. MTX is known for its hepatotoxicity side effect, which is described by an elevation of aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) beyond the upper normal limit. Factors that may enhance hepatotoxicity are gender, age, cummulative dose of MTX, and duration therapy of MTX. Prevalence of hepatotoxicity caused by MTX therapy in RA patients in Indonesia is still unknown. The objective of this research is to know the proportion of hepatotoxicity and its associations with the factors that may enhance hepatotoxicity caused by MTX therapy in RA patients in RSCM.Method Data about gender, age, cummulative dose and duration therapy of MTX are obtained from 115 RA patients medical records.Result Proportion of hepatotoxicity in RA patients treated with MTX in RSCM is 42.60%. Gender, age, cummulative dose and duration therapy of MTX do not significantly enhance hepatotoxicity (p>0.05).Conclusion In conclusion gender, age, cummulative dose and duration therapy of MTX do not have association with hepatotoxicity in RA patients treated with MTX. Keywords: Rheumatoid Arthritis, Methotrexate, Hepatotoxicity
Characteristics of Patients with Autoimmune Rheumatic Disease in the Era of COVID-19 Pandemic in Indonesia Rudy Hidayat; Harry Isbagio; Anna Ariane; Faisal Parlindungan; Laniyati Hamijoyo; I Nyoman Suarjana; Dwi Budi Darmawati; Rakhma Yanti Hellmi; Gede Kambayana; IA Ratih Wulansari Manuaba; Awalia Awalia
Indonesian Journal of Rheumatology Vol. 12 No. 1 (2020): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v12i1.159

Abstract

Background Coronavirus Disease 2019 (COVID-19) could be fatal in high-risk patient including autoimmune rheumatic patients. Nowadays, the management of these patients becomes dilemma because the use of steroids and disease-modifying anti-rheumatic drugs could suppress the immune system however, poor control of the underlying disease increases the infection risk. Understanding the characteristics of these patients in the COVID-19 pandemic is essentials to establish management guidelines and identify patients who are more susceptible to COVID-19. This study aimed to determine the characteristics of autoimmune rheumatic patients in the era of COVID-19 pandemic in Indonesia. MethodA descriptive study using national scale survey method was conducted. The subjects were autoimmune rheumatic patients in Indonesia and recruited using consecutive sampling. The variables evaluated in this study were demographic data, history of disease, current medications taken, daily activities in the COVID-19 pandemic, and also data related to COVID-19. The surveys distributed in online form to patients with autoimmune rheumatic disease in Indonesia. ResultTotal participants in this study were 570 patients, mostly women (93.9%), aged <60 years old (97.2%), and diagnosed with systemic lupus erythematosus (62.8%). Glucocorticoid (70.2%) especially low dose glucocorticoid (52.6%) is the most medication taken by patients. A 30.5% of patients is taking hydroxychloroquine/chloroquine and 88.1% of them have good compliance. During COVID-19 pandemic, 76.5% respondents still do normal activities/work and only 53.2% use personal protective equipment. Eleven of 541 respondents had positive PCR test and confirmed to COVID-19. The risk of COVID-19 infection based on British Society of Rheumatology (BSR) scoring system showed that 57.9%, 28.6%, and 13.5% patients in high, moderate and low risk, respectively. ConclusionPatients with autoimmune rheumatic diseases might be more susceptible to COVID-19 than the general population. Interplay of aging, therapies and disease-specific factors, comorbidities and the proper use of personal protective equipment seem to contribute. Keywords :autoimmune rheumatic disease, characteristic, COVID-19, Indonesia
The Relationship between Gastric Mucosa Mucous Thickness and Gastroscopic Findings in Patients Receiving Non-Steroidal Anti-Inflammatory Drugs Dono Antono; Chudahman Manan; Harry Isbagio; Vera D. Joewono
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 3, NUMBER 1, April 2002
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/3120021-8

Abstract

Non-steroid anti-inflammatory drugs (NSAID) can cause gastropathy and gastric mucosa, especially the mucous may play an important prevention role. This cross-sectional, single group study was conducted to know the difference in mucous thickness in antrum or corpus mucosa and the correlation of gastric mucous thickness to gastropathy. Patients who received NSAID from the rheumatology clinic were studied. Healthy subjects of 14 – 65 years old who never received NSAID were included as normal controls. Piroxicam 20 mg daily was given to the patients for 7 days, then gastroscopy and gastric mucosa biopsy with frozen section were performed. Specimens were stained with haematoxyline eosin and thickness of the mucous layer was measured using ocular micrometer. Thirty-two out of 70 patients participated in the study. All cases had hyperemia on gastroscopy with erosions and ulcer in 32 and 9 cases, respectively. The mean thickness of mucosa in distal antrum, proximal antrum and corpus was 28.5 ± 9, 37.4 ± 13.1 and 43.3 ± 13.1 microns, respectively. There was significant relationship between gastric mucosa mucous thickness with gastroscopic findings. In conclusion, this study confirmed that thickness of gastric mucosa mucous has an important role in  preventing NSAID gastropathy and dyspeptic complaints in this kind of patients does not suggest abnormalities of gastric mucosa.    Key Words: Gastric mucosa mucous thickness, NSAID, gastroscopy
Correlation between Disease Duration, Disease Activity Scoreand Disability Score with Diastolic Dysfunction in RheumatoidArthritis Women in Dr. Cipto Mangunkusumo Hospital Antono, Dono; Dhaki, Bernard Agus Sakti; Isbagio, Harry; Shatri, Hamzah
Jurnal Penyakit Dalam Indonesia Vol. 4, No. 2
Publisher : UI Scholars Hub

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Abstract

Introduction. There are only few studies about correlation between non traditional risk factor and diastolic dysfunction in RA patients. This study aims to determinate the correlation between non traditional risk factors, including disease duration, disease activity and disability score with the diastolic dysfunction of women with RA. Methods. A cross-sectional, consecutive sampling study was conducted to 52 RA women without any previous cardiovascular disease history. All participants underwent an echocardiography to assess diastolic dysfunction and other findings associated. Duration of disease was assesed by direct interview, while the disease activity by calculating DAS28 and disability score by HAQ-DI. Results. Diastolic dysfunction was found in 30.8 % of study participants (13.5 % for each low and moderate grade, while severe was 3.8% ). Median duration of disease was 26.5 months (range 2-240), mean DAS28-CRP score was 2.69±1.11 while median DAS28-ESR score was 3.65 (range 1.13-7.5), and median HAQ-DI score was 0.29 (range 0-2.38). LV hypertrophy was found in 34.61% participants. Mean EF was 66.7±5.76%. Valve abnormality was found in 34.6% study participants. Correlation between duration of disease, DAS28-CRP, DAS28-ESR and HAQ-DI score with E/A in sequence was r= -0.065 (p=0.89), r=0.393 (p=0.38), r=0.357 (p=0.43), r=0.630 (p=0.12); while with E/E’ in sequence was r=0.136 (p=0.77), r= - 0.536 (p=0.21), r= - 0.393 (p=0.38), r=0.374 (p=0.41). Conclusions. Duration of the disease, disease activity score, and disability score in rheumatoid arthritis women had no correlation with diastolic dysfunction.
Korelasi Trigliserida Pascaprandial dengan Penanda Biologis Aktivasi Endotel pada Artritis Reumatoid Utari, Amanda Pitarini; Isbagio, Harry; Darmowidjojo, Budiman; Effendi, Shuffrie
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 2
Publisher : UI Scholars Hub

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Abstract

Pendahuluan. Terdapat peningkatan mortalitas akibat penyakit kardiovaskular (PKV) sebesar 50% pada pasien artritis reumatoid (AR). Trigliserida pascaprandial (TGPP) saat ini dikaitkan dengan risiko penyakit jantung iskemik, infark miokard, stroke iskemik, kematian, serta peningkatan kadar molekul adhesi. Kadar molekul adhesi yang meningkat merupakan tanda terjadinya aktivasi endotel, proses awal pada terbentuknya lesi aterosklerosis. Belum ada penelitian tentang peran TGPP dalam risiko kardiovaskular pada pasien AR. Penelitian ini ingin mengetahui hubungan antara TGPP dengan penanda biologis aktivasi endotel. Metode. Penelitian ini adalah studi potong lintang, yang menggunakan analisis korelasi dengan analisis multivariat. Sampel diambil dengan metode consecutive sampling. Pada subjek penelitian dilakukan pemeriksaan profil lipid dan penanda aktivasi endotel. Sebagai penanda biologis aktivasi endotel digunakan sICAM-1 dan sE-selectin. Dilakukan uji korelasi antara TGPP dengan sE-selectin dan sICAM-1. Hasil. Tidak terdapat korelasi antara TGPP dengan kadar sE-selectin dan sICAM-1 pada analisis multivariat. HDL mempengaruhi kadar sICAM-1 (R2=0,087). Sementara itu kadar sE-selectin dipengaruhi oleh DAS-28 (R2=0,174), indeks massa tubuh (R2=0,125), dan gula darah pascaprandial (R2=0,138). Simpulan. Tidak ditemukan kaitan antara TGPP dengan kadar sE-selectin dan sICAM-1 pada pasien AR.
Perbedaan Serotonin Plasma dan Kortisol Saliva terhadap Gejala Depresi pada Pasien Pasca Sindrom Koroner Akut Firmansyah, Irman; Shatri, Hamzah; Putranto, Rudi; Ardani, Yanuar; Ginanjar, Eka; koesnoe, sukamto; Rizka, Aulia; Isbagio, Harry; Yunir, Em
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
Publisher : UI Scholars Hub

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Abstract

Introduction. Psychological disorders are closely associated with hormonal factors, including cortisol and serotonin. In patients with acute coronary syndrome (ACS), autonomic dysfunction and dysregulation of the hypothalamic-pituitaryadrenal (HPA) axis can occur, leading to an increase in cortisol levels that may worsen the prognosis of ACS patients. Therefore, it is important to understand the hormonal impact, namely cortisol and serotonin levels, on depressive symptoms, which will be examined in this study. Methods. This was a cross-sectional study to determine the impact of cortisol and serotonin in the incidence of depression in post-treatment ACS patients at the ICCU RSUPN dr. Cipto Mangunkusumo, Jakarta. Data collection from patients meeting the inclusion criteria was carried out 10-14 days post-treatment through interviews, HADS questionnaire completion, physical examinations, and laboratory tests. The Mann-Whitney test was used to examine the differences between serotonin and salivary cortisol levels in patients with and without depression. Results. Among the 73 ACS patients included in this study, the average age was 57.53 (9.97) years, with 68.5% was male. Posttreatment depression was observed in 15.1% of subjects. The median serotonin levels were lower in patients with depression [175 (147 – 227.64) ng/mL vs. 189.31 (152.87-235.44) ng/mL], while cortisol levels were higher in patients with depression [3.09 (1.46-6.26) ng/mL vs. 2.15 (0.92-3.91) ng/mL]. However, the statistical analysis showed no significant differences between plasma serotonin and depression (p=0.482) or saliva cortisol and depression (p=0.275). Conclusions. There were no significant differences in cortisol and serotonin levels concerning depressive symptoms among post-acute coronary syndrome patients. Nevertheless, this study holds clinical importance due to the observed lower plasma serotonin levels and higher saliva cortisol levels in ACS patients with depression.
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