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Relationship Between Systemic Lupus Activity Measurement (SLAM) Score and Mortality in Systemic Lupus Erytemathosus (SLE) Inpatients Paramaiswari, Ayu; Kertia, Nyoman; Achadiyono, Deddy Wachid
Acta Interna The JOurnal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
Publisher : Acta Interna The JOurnal of Internal Medicine

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ABSTRACTBackground: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder that can be severeand life threatening. Mortality in SLE may due to lupus activity or long-term sequel. Systemic Lupus ActivityMeasurement (SLAM) score is a tool that can count lupus disease activity inpatients.Aims: To analyze the relationship between SLAM score and mortality in lupus inpatients.Methods: Retrospective cohort study used for reaching objective of the study. Lupus inpatients was usedas research population. Medical record was used as study data collection over periods of 2006 until 2011.Independent variable was a SLAM score. The cut point of SLAM score was made based on the mean ofSLAM score (16.7 point score). Dependent variable was mortality.Results: There were differences between number of ACR criteria fi ndings, pneumonia, heart rate withSLAM score (p value 0.001; 0.001; 0.002 respectively).There was a difference of median survival between less and more than 16.7 point score, 45 and 28 respectively (p 0.034). There was a relationship betweenSLAM score (more than 16.7 point score) and mortality HR 2.78 (96% CI 1.01-7.53).There was a differenceof mortality incidence between more and less than 16.7 point score, 0.35 and 0.10 respectively. There wasa relationship between SLAM score (more than 16.7 point score) and mortality RR 3.5 (95% CI). Mortalityin lupus inpatients was 23%.Conclusion: There was a relationship between SLAM score and mortality on lupus inpatients.Keywords: SLE, SLAM, Mortality

Relationship Between Systemic Lupus Activity Measurement (SLAM) Score and Mortality in Systemic Lupus Erytemathosus (SLE) Inpatients Paramaiswari, Ayu; Kertia, Nyoman; Achadiyono, Deddy Wachid
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
Publisher : Acta Interna The Journal of Internal Medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (228.179 KB)

ABSTRACTBackground: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder that can be severe and life threatening. Mortality in SLE may due to lupus activity or long-term sequel. Systemic Lupus Activity Measurement (SLAM) score is a tool that can count lupus disease activity inpatients.Aims: To analyze the relationship between SLAM score and mortality in lupus inpatients.Methods: Retrospective cohort study used for reaching objective of the study. Lupus inpatients was used as research population. Medical record was used as study data collection over periods of 2006 until 2011. Independent variable was a SLAM score. The cut point of SLAM score was made based on the mean of SLAM score (16.7 point score). Dependent variable was mortality.Results: There were differences between number of ACR criteria fi ndings, pneumonia, heart rate with SLAM score (p value 0.001; 0.001; 0.002 respectively).There was a difference of median survival between less and more than 16.7 point score, 45 and 28 respectively (p 0.034). There was a relationship between SLAM score (more than 16.7 point score) and mortality HR 2.78 (96% CI 1.01-7.53). There was a difference of mortality incidence between more and less than 16.7 point score, 0.35 and 0.10 respectively. There was a relationship between SLAM score (more than 16.7 point score) and mortality RR 3.5 (95% CI). Mortality in lupus inpatients was 23%.Conclusion: There was a relationship between SLAM score and mortality on lupus inpatients.Keywords: SLE, SLAM, Mortality

ANTI-INFLAMMATORY ACTIVITIES OF TEMULAWAK, GINGER, SOYBEAN AND SHRIMP SHELL EXTRACTS IN COMBINATION COMPARED TO DICLOFENAC SODIUM Kertia, Nyoman; Akhadiono, Deddy Nur Wachid; Paramaiswari, Ayu; Fadlilah, Arina Syarifa; Harinawantara, Hangga
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Acta Interna The Journal of Internal Medicine

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ABSTRACT Background: The prevalence of osteoarthritis (OA) in the community is high. This disease is the second most common cause of physical disability worldwide. Pain in OA is caused by several factors, such as inflammation. Non steroidal anti-inflammatory drugs (NSAIDs) were the most common drugs given worldwide to reduce pain in OA. NSAIDs were also associated with a high incidence of gastrointestinal side effects. An alternative to manage this problem is by using the combination of Curcuma xantorrhyza Roxb. (commonly known as temulawak) extract, ginger (Zingiber officinale) extract, soybean (Glycine max), and shrimp shell. Curcuma xantorrhyza contains curcumin which has anti-inflammatory effect by suppressing cyclo-oxygenase (COX-2) enzyme activity, suppressing lipo-oxygenase enzyme activity, and play a role as a free radical scavenger. Ginger can inhibit COX-2 activity in PGE-2 production. Shrimps shell contains glucosamine and chondroitin which can increase proteoglycan in articular chondrocytes and inhibit COX-2 synthesis. Isoflavone in soybean can inhibit articular cartilage degradation and COX-2 synthesis.Study Aims: The purpose of this study is to compare the effect of the combination to diclofenac sodium in reducing synovial fluid leukocyte count and joint pain in patients with osteoarthritis.Study Method:This study was a prospective randomized open end blinded evaluation (PROBE). Twenty one patients with knee osteoarthritis diagnosed by American College of Rheumatology criteria were included in this study. Patients were randomized into two groups to receive either diclofenac sodium 25 mg (control group) or the combination of Curcuma xantorrhyza extract 50 mg, ginger extract 100 mg, shrimp shell 100 mg, and soy bean flour 50 mg (treatment group) three times daily for 14 days. Independent t-tests and Mann-Whitney-Wilcoxon tests were used to evaluate changes between prior and post intervention.Results: Â There were significantly reduction of synovial fluid leukocyte count in both control group (p=0.017) and treatment group (p=0.008) respectively. Â The reduction of synovial fluid leukocyte count was not significantly different between control group and treatment group (p=0.929).Â There were significant improvement of joint pain (VAS score) in both control group (p=0.012) and treatment group (p<0.001). Â The reduction of VAS score was not significantly different between diclofenac group and treatment group (p=0.607).Conclution: These results indicate that the evicacy of this combiation was not significantly different with diclofenac sodium in reducing the synovial fluid leukocyte count and joint pain in patients with osteoarthritis.Keywords: osteoarthritis, Synovial fluid leukocyte count, Pain, VAS, Diclofenac sodium,Combinaion of curcuma, ginger, shrimp shell and soybean.

ANTI-INFLAMMATORY ACTIVITIES OF TEMULAWAK, GINGER, SOYBEAN AND SHRIMP SHELL EXTRACTS IN COMBINATION COMPARED TO DICLOFENAC SODIUM Nyoman Kertia; Deddy Nur Wachid Akhadiono; Ayu Paramaiswari; Arina Syarifa Fadlilah; Hangga Harinawantara
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACT Background: The prevalence of osteoarthritis (OA) in the community is high. This disease is the second most common cause of physical disability worldwide. Pain in OA is caused by several factors, such as inflammation. Non steroidal anti-inflammatory drugs (NSAIDs) were the most common drugs given worldwide to reduce pain in OA. NSAIDs were also associated with a high incidence of gastrointestinal side effects. An alternative to manage this problem is by using the combination of Curcuma xantorrhyza Roxb. (commonly known as temulawak) extract, ginger (Zingiber officinale) extract, soybean (Glycine max), and shrimp shell. Curcuma xantorrhyza contains curcumin which has anti-inflammatory effect by suppressing cyclo-oxygenase (COX-2) enzyme activity, suppressing lipo-oxygenase enzyme activity, and play a role as a free radical scavenger. Ginger can inhibit COX-2 activity in PGE-2 production. Shrimps shell contains glucosamine and chondroitin which can increase proteoglycan in articular chondrocytes and inhibit COX-2 synthesis. Isoflavone in soybean can inhibit articular cartilage degradation and COX-2 synthesis.Study Aims: The purpose of this study is to compare the effect of the combination to diclofenac sodium in reducing synovial fluid leukocyte count and joint pain in patients with osteoarthritis.Study Method:This study was a prospective randomized open end blinded evaluation (PROBE). Twenty one patients with knee osteoarthritis diagnosed by American College of Rheumatology criteria were included in this study. Patients were randomized into two groups to receive either diclofenac sodium 25 mg (control group) or the combination of Curcuma xantorrhyza extract 50 mg, ginger extract 100 mg, shrimp shell 100 mg, and soy bean flour 50 mg (treatment group) three times daily for 14 days. Independent t-tests and Mann-Whitney-Wilcoxon tests were used to evaluate changes between prior and post intervention.Results: There were significantly reduction of synovial fluid leukocyte count in both control group (p=0.017) and treatment group (p=0.008) respectively. The reduction of synovial fluid leukocyte count was not significantly different between control group and treatment group (p=0.929). There were significant improvement of joint pain (VAS score) in both control group (p=0.012) and treatment group (p<0.001). The reduction of VAS score was not significantly different between diclofenac group and treatment group (p=0.607).Conclution: These results indicate that the evicacy of this combiation was not significantly different with diclofenac sodium in reducing the synovial fluid leukocyte count and joint pain in patients with osteoarthritis.Keywords: osteoarthritis, Synovial fluid leukocyte count, Pain, VAS, Diclofenac sodium,Combinaion of curcuma, ginger, shrimp shell and soybean.

Relationship Between Systemic Lupus Activity Measurement (SLAM) Score and Mortality in Systemic Lupus Erytemathosus (SLE) Inpatients Ayu Paramaiswari; Nyoman Kertia; Deddy Wachid Achadiyono
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder that can be severe and life threatening. Mortality in SLE may due to lupus activity or long-term sequel. Systemic Lupus Activity Measurement (SLAM) score is a tool that can count lupus disease activity inpatients.Aims: To analyze the relationship between SLAM score and mortality in lupus inpatients.Methods: Retrospective cohort study used for reaching objective of the study. Lupus inpatients was used as research population. Medical record was used as study data collection over periods of 2006 until 2011. Independent variable was a SLAM score. The cut point of SLAM score was made based on the mean of SLAM score (16.7 point score). Dependent variable was mortality.Results: There were differences between number of ACR criteria fi ndings, pneumonia, heart rate with SLAM score (p value 0.001; 0.001; 0.002 respectively).There was a difference of median survival between less and more than 16.7 point score, 45 and 28 respectively (p 0.034). There was a relationship between SLAM score (more than 16.7 point score) and mortality HR 2.78 (96% CI 1.01-7.53). There was a difference of mortality incidence between more and less than 16.7 point score, 0.35 and 0.10 respectively. There was a relationship between SLAM score (more than 16.7 point score) and mortality RR 3.5 (95% CI). Mortality in lupus inpatients was 23%.Conclusion: There was a relationship between SLAM score and mortality on lupus inpatients.Keywords: SLE, SLAM, Mortality

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.

The Relationship between the Number of Major Organ Involvement and Therapeutic Response of Pulse Dose Methylprednisolone in Systemic Lupus Erythematosus Patients Kartyanto, Adhita; Paramaiswari, Ayu; Kertia, Nyoman
Acta Interna The Journal of Internal Medicine Vol 12, No 1 (2023): 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.98165

Background. Systemic Lupus Erythematosus (SLE) requires comprehensive and integrated treatment because it can manifest in various organ systems, both non-major and major organs. Pulse doses Methylprednisolone used as induction therapy, it provides dramatic improvement in prognosis in severe lupus through its nongenomic effects. Not all SLE patients who received pulse dose methylprednisolone therapy gives complete response, several factors may influence the therapeutic response, one of which is thought to influence the difference in therapeutic response is the number of major organ involvement.Objectives. To determine the relationship between the number of major organ involvement and therapeutic response of pulse dose methylprednisolone therapy in SLE patients at Dr. Sardjito Hospital Yogyakarta.Methods. This study used a retrospective cross-sectional study. The subjects of this study were adult patients with SLE treated in the internal medicine ward at Dr. Sardjito Hospital Yogyakarta and met the inclusion and exclusion criteria from January 1, 2016 to December 31, 2019. The data on the characteristics of the research subjects were taken from the patient's medical records and laboratory data before giving pulse methylprednisolone.Results. A total of 88 research subjects were taken from medical records. Patients with major organ involvement 1 experienced more complete response (53.8%), major organ involvement 2 mostly partial response (66.7%), major organ involvement 3 (48.6%) and major organ involvement 4 (53.8%) no response, and major organ involvement 5 (75%) partial response. There is a significant relationship with the number of major organ involvement with therapeutic response p<0.001. The correlation coefficient r=0.382 means that the more major organ involvement the less therapeutic response. The results of multivariate analysis showed that only the number of major organ involvement had a dominant effect on the therapeutic response, p=0.001. Regression coefficient 0.797.Conclusion. The number of major organ involvement significantly affects the success of pulse dose methylprednisolone therapy in SLE patients.

The Impact of Starting Urate-Lowering Therapy (ULT) During A Gout Flare on The Ongoing Episode: A Systematic Review of Randomized Controlled Trials Yogiswara, Komang Satvika; Widhiarta, Putu Raka; Wiwekananda, Ketut Shri Satya; Paramaiswari, Ayu; Achadiono, Dedy Nurwachid; Kambayana, Gede; Kertia, Nyoman
Acta Interna The Journal of Internal Medicine Vol 13, No 1 (2024): 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.101289

Background. Gout is a prevalent form of arthritis caused by the accumulation of monosodium urate (MSU) crystals. Urate-lowering therapy (ULT) may be started once an acute flare has subsided to prevent the present episode from lasting longer. Nevertheless, ULT may be commenced during an acute flare-up in order to decrease the frequency of outpatient appointments and enhance patient adherence. The objective of this study was to conduct whether the commencement of urate-lowering therapy (ULT) during an acute gout flare is effective. Method. We performed a systematic review of articles published in MEDLINE, PubMed, Cochrane library, and EMBASE databases from 2018 to 2023. The search was limited to articles published in English, and RCTs in patients older than 18 years.Results and Discussions. Among 242 recorded studies, only four with 323 patients were eligible for this research. The treatment with Allopurinol began with a daily dose of 100 mg for the initial 14 days, followed by an increase to a daily dose of 200 mg for the subsequent 14 days. The reported time to resolution was 15.4 days for the group receiving allopurinol and 13.4 days for the group receiving the placebo. According to this review, the start of ULT (uric acid-lowering therapy) should be determined by sufficient anti-inflammatory measures. Commencing ULT during a gout flare has no impact on the intensity, duration, or likelihood of recurrence of the flare within the following 28 to 30 days.Conclusions. This study demonstrated that the commencement of urate-lowering therapy (ULT) during an acute gout flare did not result in a longer duration of the flare. Nevertheless, it is necessary to conduct a clinical studies with a bigger sample size in order to validate this review.

Predictors of persistent high disease activity after methotrexate treatment in rheumatoid arthritis patients Paramaiswari, Ayu; Kertia, Nyoman; Achadiono, Deddy; Sinarta, Armin; Nugroho, Dhite
Universa Medicina Vol. 44 No. 2 (2025)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2025.v44.141-151

Background Methotrexate (MTX) is the firstline therapy for rheumatoid arthritis (RA). However, 30–40% of RA patients exhibit poor response. Identifying early factors associated with persistent disease activity is critical to guide treatment. This study aimed to identify predictors of persistent high disease activity (DAS28-ESR >3.2) after six months of MTX therapy in RA patients. Methods A retrospective cohort study was conducted involving 204 RA patients who had completed six months of MTX therapy. The primary outcome was DAS28-ESR score at six months. Independent variables included baseline erythrocyte sedimentation rate (ESR), cumulative doses of MTX and low-dose methylprednisolone (LDM), and rheumatoid factor (RF) status. Simple and multiple logistic regression was used to analyze the data. Results Significant differences in ESR and cumulative MTX dose were observed between low and high disease activity groups. Multivariate analysis identified four independent predictors of persistent high disease activity (DAS28-ESR >3.2) after six months of MTX therapy: disease duration >11 months (AOR =0.45; 95% CI 0.23–0.89; p=0.025); age at onset >50 years (AOR 0.48; 95% CI 0.24–0.94; p=0.038); cumulative MTX dose >85 mg (AOR 4.75; 95% CI 1.55–14.64; p=0.006); ESR >66 mm/hr (AOR 2.32; 95% CI 1.11–4.89; p=0.026). Conclusion Greater cumulative methotrexate dose (>85 mg) was the most influential predictor of persistent high disease activity (DAS28-ESR >3.2) after six months of MTX therapy in RA patients. These findings may assist clinicians in identifying patients at risk for poor MTX response and support timely therapeutic adjustments.

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