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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

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (577.723 KB)

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 Â Indonesian male or female patients aged â¥ 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 â¥ 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 (10â25 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 â¤ 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. Â Â Keywords: Rheumatoid Arthritis, Tocilizumab, DMARD, DAS28

Role of nuclear factor-κB (NF-κB) on mind body interventions (MBIs) in patients with systemic lupus erythematosus (SLE) Achadiono, Deddy Nur Wachid; Kertia, Nyoman; Asdie, Achmad Husain; Riyanto, Bambang Udji Djoko
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 52, No 3 (2020)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Mind body interventions (MBIs) are exercise that emphasizes the use of brain and body to assist the healing process and to manage symptoms in order to improve wellbeing. The MBIs are expected to be a supporting therapy for patients with autoimmune disease such as systemic lupus erythematosus (SLE), to improve patients’ activities, reduce fatigue, stress, and depression.One type of MBIs that could be potentially applied in Indonesia is latihan pasrah diri (LPD). Studies showed that MBIs can affect the expression of pro- and anti-inflammatory mediators. Nuclear factor-κB(NF-κB) is a transcription factor that controls gene expression related to many physiological responses including inflammation, proliferation, cell differentiation, and apoptosis. NF-κB can be activated through canonical and alternative pathway. This literature review aimed to identify the role of NF-κB as consequence of practicing MBIs in SLE patients. We searched for relevant publications in the MEDLINE/Pub Med and Google Scholar with no date restriction. This review revealed that abnormal NF-κB could mediate autoimmune condition in SLE pathogenesis. MBIs are expected to be a supportive treatment that can help to control NF-κB expression in SLE patients. LPD as an Indonesian original MBI is expected as a suitable techniques that can be applied in patients with SLE in Indonesia. Further studies on the effect of LPD on NF-κB expression in patients with SLE need to be further explored.

Relationship between the Degrees of Severity Sequelae after Treatment with Quality of Life in Patients of Pulmonary Tuberculosis Patients Deddy Nur Wachid Achadiono; Heni Retnowulan; Tiara Putri Utami
Acta Interna The Journal of Internal Medicine Vol 6, No 1 (2016): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: Tuberculosis remains a global health problem, especially for developing countries.Tuberculosis can cause permanent deformity of the lung parenchyma, airways, pleura, mediastinum,chest wall, and vascular. This deformity is residual symptoms or sequelae. Tuberculosis sequelae mayoccur in most patients although has completed treatment. These sequelae can affect lung functionand will ultimately influence patient’s quality of life.Objective: This study aims to determine the relationship between the severities of sequelae aftertuberculosis based index Willcox with patient’s quality of life.Methods: The study design was cross-sectional at patients of outpatient clinic BP4Yogyakarta from September 2013 until the samples are met. The relationship between theseverities of the degree of sequelae after treatment with the quality of life in patients with pulmonarytuberculosis will be analyzed using t test. Relationship is significant if p <0.05 with 95% confidenceintervals.Results: The total of the subjects are 37 consist of 24 patients (64.9%) males and 13 (35.1%) women.Subjects who met the criteria will be examined the thoracic x-ray poster anterior (PA). Severity of tuberculosis sequelae will be assessed according to the index Willcox. Subjects also completed a SGRQ questionnaire as a tool for assessing their quality of life. There is a significant correlationbetween the severity of tuberculosis sequelae with the quality of life in the activity (ρ = 0.031) and total (ρ = 0.037) domain.Conclusions: There is a relationship between the severities of the quality of life in patients with pulmonary tuberculosis sequelae.

The Relationship between 12MWD and Quality of Life in Tuberculosis Sequelae Patients Heni Retnowulan; Deddy Nur Wachid Achadiono; Andika Ilham Rahmatullah
Acta Interna The Journal of Internal Medicine Vol 6, No 1 (2016): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Background: The incidence of TB cases in Indonesia is very high. Although it was undergoing treatment and was declared cured the infection, but it does not mean that the infection does not leave sequelae.Patients TB sequelae decreased functional capacity and quality of life.Aim: The purpose of this study is to determine the relationship between functional capacity (12MWD) and quality of life (SGRQ) in tuberculosis sequelae patients.Method: Patients with TB sequelae aged 18-59 years without comorbid examined functional capacity with a 12-minute walking distance test and assessment of quality of life using the SGRQ questionnaires. Statistical analysis is using correlation and regression.Result: There were significant negative correlation (p<0.05) between the 12 minute walking distance and activity domain (r -.336). In other domains, there is a negative relationship but not significant at the totaldomain (r -.152), impacts (-.124), and symptoms (-.043).Conclusion: There is a significant negative relationship between the 12 minute walking distance and quality of life as assessed by questionnaire SGRQ in activity domain, in other domains there is also a negative correlation but was not statistically significant. The higher of functional capacity patients with tuberculosis sequelae, the quality of life also become higher.

The relationship between six minutes walking distance and quality of life in pulmonary tuberculosis sequelae patients Heni Retnowulan; Deddy Nur Wachid Achadiono; Anggraeni Ayu Rengganis
Acta Interna The Journal of Internal Medicine Vol 6, No 2 (2016): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: Tuberculosis is an infectious disease that affects the lung and has high incidence. It could leave sequelae in the patient that has been declared cured. Tuberculosis sequelae results in changes of lung function that could lead to deteriorating of functional capacity and quality of life.Aim: The study aim to determine the relationship between functional capacity (6MWD) and quality of life (SGRQ) within pulmonary tuberculosis sequelae patients.Method: This study used cross sectional design and performed on pulmonary tuberculosis sequelae patient in pulmonary clinic of Dr. Sardjito General Hospital and BP4 Yogyakarta. Functional capacity was assessed with six minutes walking distance and assessment of quality of life using SGRQ questionnaire. Distribution of data was tested using the Shapiro-Wilk statistical test. Spearman correlation test and regression test was used to analyze the correlation between 6-minute walking distance test and assessment of quality of life using the SGRQ questionnaire.Result: The 6 minutes walking distance was 257.02±64.56 m. There were significant negative correlation between 6 minutes walking distance and SGRQ score activity domain (r=-.333, p<0.05). The others domains in SGRQ, there were no significant negative correlation at domain symptoms (r-.062), impacts (-.114), and total (-.135).Conclusion: There were negative correlation between the 6 minutes walking distance (6MWD) and SGRQ score. There was significant negative correlation between 6 minutes walking distance (6MWD) and activity domain in the SGRQ score.Keywords: tuberculosis sequelae, functional capacity, 6MWD, quality of life, SGRQ.

Relationship between Degrees of Dyspnea with Functional Capacity in Pulmonary Tuberculosis Sequelae Patients Deddy Nur Wachid Achadiono; Heni Retnowulan; Eko Nugroho
Acta Interna The Journal of Internal Medicine Vol 6, No 2 (2016): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACT Background: TB disease is still a serious health problem. Due to the changes that occur because of TB infection, appears sequelae in patients with pulmonary tuberculosis. TB sequelae will have an impact on the patient’s life, especially to do with the degree of dyspnea and functional capacity.Objective: To know the relationship between degree of dyspnea with functional capacity in pulmonary tuberculosis sequelae patients.Method: The design of this study is cross-sectional observational study. Subjects were patients with TB who have had at least 6 months of therapy that has been declared cured by leaving sequelae in Dr. Sardjito Hospital and BP4 Yogyakarta in September 2013. The sample was selected based on the selection criteria. Statistical analysis is using One-Way ANOVA.Results: From the 42 patients, there were 78.6% of patients with MRC scale 0, 11.9% of patients with MRC scale 1, and 4.8% respectively of patients with MRC scale 2 and 3. The mean of 6-minute walk test distance is 257.02±64.56 meters. There is a significant relationship on comparison of the mean of 6-minute walk test distance on each MRC scale (p = 0.028).Conclusion: There is a relationship between degrees of dyspnea with functional capacity in pulmonary tuberculosis sequelae patients. Keywords: tuberculosis sequelae, degrees of dyspnea, functional capacity

ASSOCIATION BETWEEN NUTRITIOUS STATUS AND LIFE QUALITY OF ELDER PEOPLE VISITING GERIATRIC CLINIC AT DR. SARDJITO HOSPITAL Muhipah Muhipah; I Dewa Putu Pramantara; Deddy Nur Wachid Achadiono
Acta Interna The Journal of Internal Medicine Vol 6, No 2 (2016): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground. Successful development in health sector cause shift in world population to older age. Yogyakarta Special Territory reveals highest percentage in amount of elderly people in Indonesia (13.7%). Prevalence of decrease in nutritional status rise along with age. Individual with low nutritional status is vulnerable to some diseases such as depression, cognitive disturbance and dementia progressivity. Nutritional status on elderly people is subject ignored in clinical practice. Prevention and early intervention is the best approach to obtain optimal nutrition.Objective. To identify association between nutritional statuses measured using MNA score and life quality measured with WHOQOL-BREF at elderly patient visiting geriatric clinic in Dr. Sardjito Hospital.Method. This research used cross-sectional design on elderly population in Dr. Sardjito Hospital. The research was conducted in October 2014. It includes elderly persons meeting inclusion and exclusion criteria, nutritional status assessed with MNA score and measurement of life quality with QHOQOL-BREF including four domains: physical aspect, psychological aspect, social relationship and environment.Result: There is significant correlation with p<0.001 between MNA and domain 1 (physical aspect) where Pearson correlation of 0.546 indicates positive correlation with weak correlation. Association of MNA and domain 2 (physical aspect) indicates significant correlation with p =0.006 with Pearson correlation of 0.435 indicating positive correlation with moderate correlation. There is significant correlation between MNA and domain 3 (social aspect) with p=0.005 and Pearson correlation of 0.437 indicating weak correlation. Association of MNA and domain four (environment aspect) indicate significant correlation with p=0.007 and Pearson correlations core of 0.426 indicating positive correlation with moderate correlation.Conclusion. The results indicate significant association between nutritional status (MNA) and life quality based on WHOQOL viewed from physical aspect (domain 1), psychological aspect (domain 2), social aspect (domain 30 and environmental aspect (domain 4) on elderly person.Keywords: Geriatrics, MNA, quality of life

Association between Serum Vitamin D Level and Clinical Manifestations of Systemic Lupus Erythematous Patients in Dr. Sardjito General Hospital Anggi Wahyu Nugroho; Ayu Paramaiswari; Deddy Nur Wachid Achadiono
Acta Interna The Journal of Internal Medicine Vol 10, No 2 (2020): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.62844

Background. Vitamin D played a role in the pathogenesis of systemic lupus erythematosus (SLE). Vitamin D made dendritic cells more tolerogenic to autoantigens and inhibited B cells from producing autoantibodies. Vitamin D deficiency would make dendritic cells intolerant, increased production of interferons, and B cells produce excessive autoantibodies. These excessive autoantibodies and interferons would have caused severe clinical manifestations in SLE patients.Aims. This study was to find out vitamin D deficiency would increase the proportion of severe clinical manifestations in SLE patients in the Dr. Sardjito General Hospital. Methods. We conducted a cross-sectional study. Data was taken from medical records of SLE patients who went to Dr. Sardjito General Hospital in 2018. The independent variable was serum 25(OH) D levels, which were divided into deficiency (≤12 ng/ml) and not deficiency (>12ng/ml). The dependent variable was the clinical manifestations of SLE patients, which were divided into mild-moderate and severe. Association between two variables was analyzed using Chi-Square.Results. Vitamin D deficiency was observed in 19(54%) and not deficiency in 16(46%) subjects. SLE patients who underwent vitamin D deficiency more often experienced severe clinical manifestations than those without (52.6% versus 12.5%), prevalence ratio 4.2 CI 1.1-16.5 p=0.015. SLE patients who underwent vitamin D deficiency were more likely to suffer mucocutan, musculoskeletal, and kidney disorders. Also more likely to suffer more than 2 organ disorders than those without (57.9% versus 12.5%), prevalenceratio 4.6 CI 1.2-17.9 p=0.007.Conclusions. Vitamin D deficiency increased the proportion of severe clinical manifestations in SLE patients at Dr. Sardjito General Hospital. It also increased the proportion of mucocutan disorder, musculoskeletal disorder, and kidney disorder. Also, it increased the proportion of occurrence of more than 2 organ disorders in SLE patients at Dr. Sardjito General Hospital.

Maxillary Reconstruction Timing in Severe Systemic Lupus Erythematous (SLE) Patient with Bone Destruction due to Invasive Aspergillosis: Case Report Yulyani Werdhiningsih; Ayu Paramaiswari; Deddy Nur Wachid Achadiono; Nyoman Kertia
Acta Interna The Journal of Internal Medicine Vol 10, No 2 (2020): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.62845

Severe Systemic Lupus Erythematosus patient was in the third of 28-days-cycle cyclophosphamide chemotherapy when the early symptoms of aspergillus infection occurred. This developed into extensive cranial bone damage. It was planned to get a biopsy and debridement for bone and soft tissue to diagnose and therapy palate osteonecrosis, followed by reconstruction surgery. This case report aimed to report the successful management of a severe patient on chemotherapy undergoing several operations so that the SLE aspergillosis is optimally managed.

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

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 Â Indonesian male or female patients aged â‰¥ 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 â‰¥ 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 (10âˆ’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 â‰¤ 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. Â Â Keywords: Rheumatoid Arthritis, Tocilizumab, DMARD, DAS28

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