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All Journal Indonesian Journal of Rheumatology The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Bambang Setiyohadi
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Medicine & Pharmacology

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Avascular necrosis of the right femoral head in a systemic lupus erythematosus patient Manuaba, Ida Ayu Ratih Wulansari; Setiyohadi, Bambang
Indonesian Journal of Rheumatology Vol 1, No 1 (2009)
Publisher : Indonesian Rheumatology Association

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Abstract

According to the 1993 Association Research Circulation Osseous, idiopathic avascular necrosis of the femoral head is defined as the presence of disease or other causes that result in ischemic osteonecrosis of the femoral head without the presence of trauma or sepsis. Based on the above defi nition, idiopathic avascular necrosis(AVN) includes those that are the result of steroid administration, systemic lupus erythematosus, alcoholic consumption, etc. The pathogenesis of AVN is still obscure; however, it is basically caused by vascular circulation disorder, cell death and decreased capability of bone repair.1,2 Systemic lupus erythematosus (SLE) is characterized by the presence of systemic immune dysregulation, autoantibody formation, immune complex in the circulation, and activation of the systemic complement. The pathology during recurrence of SLE, among others, is the presenceof vascular lesion in the form of infl ammation, thrombosis, endothelial injury in which the three of them are predispositions for atherosclerosis. The vascular lesion will cause microcirculation damage which is a risk factor for the occurrence of AVN in activation of SLE. Besides being caused by vascular lesion during activation of SLE, AVN is also triggered by fat deposition in SLE patients as a result of long term steroid therapy that causes abnormal blood fat level.1,2 Patients with SLE who have undergone pharmacologic treatment with systemic steroid either in oral or injection form will have 10 to 40 times the risk of having idiopathic AVN. High dose of systemic steroid treatment of more than 4000 mg of prednisone administered for more than three months or low dose of oral steroid administered for seven days can become a risk factor for AVN. The mechanism of AVN caused by steroid treatmentis associated with hypercoagulation, fi brinolysis disorder, and thrombosis of the bone vein.1,2,3 We report a case of AVN of the right femoral head in an SLE patient.
Prevalence of anti–C-reactive protein autoantibody and its correlation with disease activity in systemic lupus erythematosus patients at Cipto Mangunkusumo General Hospital Lusiani, Lusiani; Setiyohadi, Bambang; Sukmana, N; Abdullah, M
Indonesian Journal of Rheumatology Vol 2, No 3 (2010)
Publisher : Indonesian Rheumatology Association

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Background: Systemic lupus erythematosus (SLE) is a complex autoimmune disease with various underlying mechanisms characterized by autoantibody overproduction. It has been known that mortality and morbidity of SLE was higher in Asian patients compared with white patients. Several studies had showed that C-reactive protein (CRP) has the ability to suspend the progression of SLE through regulatory and clearance pathway, and low level of CRP and high level of anti-CRP antibody has been detected in SLE patients. A question raise whether mortality and morbidity in Asian SLE patients are associated with anti-CRP antibody.Objective: To study the prevalence of anti-CRP antibody and its relationship with disease activity in SLE patients at Cipto Mangunkusumo General Hospital,Jakarta.Methods: This is a cross-sectional study conducted at Cipto Mangunkusumo General Hospital from December 2009 until May 2010. Subjects were SLE patients whowere diagnosed based on the 1982 American College of Rheumatology criteria. Disease activity was measured using the Mexican SLE Disease Activity Index scoringsystem. Anti-CRP antibody assay was performed using the Western blot analysis. Correlation between the presence of anti-CRP antibody and disease activitywas evaluated using the T-test and multivariate logistic regression analysis.Result: Forty SLE patients with a mean age of 31.65 (SD 8.84) were enrolled in the study, 33 of which (82.5%) had positive autoantibody to CRP pentamer. The anti-CRP antibody was signifi cantly correlated (p = 0.024) with disease activity. Conclusions: There was a relatively large proportion of patients with positive anti-CRP antibody among SLE patients in Cipto Mangunkusumo General Hospital. Therewas also a signifi cant correlation between anti-CRP antibody and the disease activity.
Complete manifestations of Behçet’s disease Umami, V; Setiyohadi, Bambang
Indonesian Journal of Rheumatology Vol 2, No 2 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Behçet’s disease (BD) is a chronic, relapsing, inflammatory disease characterized by recurrent oral aphthae and any of several systemic manifestations that include genital aphthae, ocular disease, skin lesions, neurologic disease, vascular disease, or arthritis. Hippocrates may had described BD in the fifth century B.C.; however, the first official description of the syndrome was attributed to the Turkish dermatologist Hulusi Behçet in 1924. In 1930, the Greek physician Adamantiades reported a patient with inflammatory arthritis, oral and genital ulcers, phlebitis, and iritis.1 Since then, the syndrome has been referred to as BD.1,2 The manifestations of BD are thought to be caused by an underlying vasculitis. Although this disease is recognized worldwide, the prevalence is highest in the eastern Mediterranean, the Middle Eastern, and East Asian countries, thus the nickname Silk Road disease. The disease tends to be more severe in areas where it is more common. Prevalence rates all over the world are increasing, probably because of improved recognition and reporting. Behçet’s disease occurs primarily in young adults. The mean age at onset is between 25 and 30 years. The incidence of disease in males and females is approximately equal along the Silk Road, but in Japan, Korea, and Western countries the disease occurs more frequently in women. Caseconfirmation can be challenging because many patients labeled as having BD have oral ulcers as the primary or sole manifestation.3
Knee arthritis in an HIV positive patient - not associated with antiretroviral therapy Suarjana, I Nyoman; Kasjmir, Yoga I; Setiyohadi, Bambang
Indonesian Journal of Rheumatology Vol 1, No 1 (2009)
Publisher : Indonesian Rheumatology Association

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Abstract

Human immunodefi ciency virus (HIV)-associated arthritis is an oligoarthritis which predominantly affect the knees and ankles. It tends to be selflimited and to last less than six weeks. However, some patients with HIV-associated arthritis have been reported to have a disease course of more than six weeks with joint destruction. Synovial fl uid cultures are typically sterile and radiographs of the affected joints are usually normal except in those rare patients with a prolonged duration of symptoms in whom joint-space narrowing can occur.1,2 The pathophysiology of HIV specific arthritis types is not fully understood but drugs of the highly active antiretroviral therapy, in particular indinavir, are supposed to cause arthritis or rheumatological complaints.3 However,recently both human T-lymphotropic virus (HTLV) type I and HTLV-II have been suggested to induce infl ammatory or autoimmune reactions which can increase signifi cantly the incidence of arthritis.4 We report a patient with HIV infection presenting as knee arthritis which was apparently not associated with antiretroviral therapy.
Invasive aspergillosis in a systemic lupus erythematosus patient Setiyohadi, Bambang; Azizi, M S; Yuliani, Ika Wulan; Sukmana, N; Suhendro, Suhendro; Simadibrata, M; Rumende, C Matin; Sulaiman, A S; Wahyuningsih, R; Lisnawati, Lisnawati; Yudharto, M A; Anggraini, N; Oktaviana, F; Sandra, R
Indonesian Journal of Rheumatology Vol 2, No 3 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disease with a broad clinicalmanifestation characterized by production of antibodies against cellular nuclear components. The prevalence of SLE among many countries is variable, ranging from 2.9 to 400 per 100,000. In Cipto Mangunkusumo General Hospital, the incidence of SLE between 1990 and 1998 is 37.3 per 10,000 hospitalization.1 Patients with autoimmune disease have at least twofold risk of acquiring infections compared with healthy individuals. This may be due to the immunosuppresant therapy but could also caused by the primary immune dysregulation that was the basis for the pathogenesis of their disease, or other autoimmune disease manifestations such as lymphopenia.2 Infection is the main factor increasing the mortality and morbidity of SLE patients. A study in New York conducted between 1966 and 1976 involving 223 SLE patients reported 150 cases of infection, of which 23 were opportunistic infection: 12 were candidiasis while 11 others were deep fungal infection. The use of corticosteroids in SLE is the main factor that predispose patients to infection, particularly fungal infection.3 Aspergillosis is the term used to denote all disease caused by any one of the pathogenic and allergenic species of Aspergillus. The annual incidence of aspergillosis in the United States is reported to be 1–2 per 100,000.4 Aspergillus fumigatus is the cause of most cases of invasive aspergillosis, almost all cases of chronic aspergillosis, and most allergic syndromes. The mortality rate of invasive aspergillosis is 50% when properly diagnosed and treated; otherwise it could be as high as 100%
Risk factors of osteoarthritis that reduce the Steinbrocker’s functional capacity of patients with osteoarthritis of the knee Setiyohadi, Bambang; Nasution, A R; Isbagio, H
Indonesian Journal of Rheumatology Vol 1, No 1 (2009)
Publisher : Indonesian Rheumatology Association

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Abstract

Objective. This study was implemented to determine the risk factors of osteoarthrosis which potentially could reduce the Steinbrocker’s functional capacity (SFC) of patients with osteoarthrosis of the knee.Method. In this cross sectional study, the cases were taken consecutively from the ambulatory patient with the osteoarthrosis of the knee who visited the rheumatologyclinic, Cipto Mangunkusumo Hospital. Subjects was interviewed to record the existing and severity risk factors using a structured questionnaire regarding their age, gender, duration of the illness pattern of smoking history of diabetes mellitus, menopause, body mass index (BMI), knee joint deformity, 15 meters walking time and KellgrenLawrence radiologic index.Results. One hundred thirteen cases of osteoarthrosis of the knee were assigned to the study between July to December 1992, 24 patients were male and 89 werefemale. Eighteen patients were designated to SFC I, 77 patients to SFC II, 14 patients to SFC III and 4 patients to SFC IV. With the logistic regression analysis, it was found that the signifi cant risk factors of developing SFC II, III and IV from patients of SFC I were being female and smoking. In the second logistic regression analysis we found that the signifi cant risk factors for developing SFC III and IV from patients of SFC I and II were age and BMI.Conclusion. In this study we have found that age, smoking, female genders, and BMI were the risk factors which potentially could reduce the SFC of patients withosteoarthrosis of the knee.
Septic arthritis in malignancy Setiyohadi, Bambang; Santosa, D; Titis, Titis; Abdullah, A A
Indonesian Journal of Rheumatology Vol 3, No 1 (2011)
Publisher : Indonesian Rheumatology Association

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Abstract

Septic arthritis is an infection of a joint, which canbe caused by bacteria, viruses, fungi, or parasites. The infection may happen in distant sites of the body, which then spread hematogenously, or it could also result from open wounds, surgery, or unsterile injections.1 Septic arthritis is a serious condition that, if left undiagnosed and untreated, can cause joint destruction and an irreversible loss of joint function.2,3 Based on epidemiological data, the incidence of septic arthritis in general population is 2–10 cases in 100,000 people annually and is increased in those who have risk factors for septic arthritis, such as rheumatoid arthritis (RA) and joint prosthesis. In those with RA, the incidence of septic arthritis rises up to 30–70 cases in 100,000 people annually, and in those with prosthesis the figure is around 40–68 cases in 100,000 people annually.4,5 Septic arthritis can affect all age groups, but it is more prevalence in the elderly and in children under 5 years old, in which the prevalence is 8.4 and 5 cases, respectively, in 100,000 people annually.5 Septic arthritis is usually monoarticular, whereas polyarticular involvement occurs in only 10–15% of cases. The knee is involved in around 50% of cases.Septic arthritis is still a challenge for cliniciansince there has not been a significant decline in both morbidity and mortality in the last two decades.2 Late recognition and therapy can cause permanent joint dysfunction and even death; thus, early diagnosis and prompt therapy is expected to decrease the morbidity and mortality rate in septic arthritis.6 In this case report we would like to present a case of a woman suffering from septic arthritis with an underlying immunocompromised condition of malignancy
Erosive osteoarthritis Ongkowijaya, Jeffrey A; Setiyohadi, Bambang; Sumariyono, Sumariyono
Indonesian Journal of Rheumatology Vol 2, No 2 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Osteoarthritis (OA) is a degenerative joint disease characterized by the erosion of cartilage joints, hypertrophy of the marginal bone, subchondral sclerosis, and the morphological and biochemical changes of synovial membrane and joint capsule.This clinical syndrome is characterized by joint pain caused by degeneration of the joints. It is the most common joint disease to afflict the elderly and it occurs more often with age.1–3 Erosive osteoarthritis is a subset of OA in which there is a destruction of the joints as a result of inflammation.3,4 Changes mainly occur on the distal interphalangeal (DIP) joints, proximal interphalangeal (PIP) joints, carpometacarpal (CMC) joints, and very rarely occur on other joints of hand or of other body parts.3–5 The diagnosis is in accordance with the criteria of American College of Rheumatology (ACR) for OA and is supported by the existence of bone erosion on the radiological image. The management of this disease is merely for palliative purpose.
Systemic sclerosis in two generations family: a mother and offspring Nilasari, D; Hamijoyo, Laniyati; Kasjmir, Yoga I; Setiyohadi, Bambang
Indonesian Journal of Rheumatology Vol 1, No 1 (2009)
Publisher : Indonesian Rheumatology Association

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Abstract

Systemic sclerosis (SSc) is uncommon connective tissue disease characterized by a pathological thickening and tethering of the skin and involvement of internal organ (i.e gastrointestinal tract, heart, lungs, and kidneys). Systemic sclerosis seems to result from a multifactorial process (alteration of the immune system, genetic, and  environmental factors) but its pathogenesis remains unclear. A familial history of SSc represents an important risk factor for developing the disease.1 We describe two generations family who developed SSc.
Tuberculous osteomyelitis in an immunocompetent patient with miliary tuberculosis Gunawan, Gunawan; Harahap, A; Setiyohadi, Bambang; Rumende, Cleopas Martin
Indonesian Journal of Rheumatology Vol 2, No 3 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Osteomyelitis is an infection of the bone, which may be caused by direct pathogen inoculation following trauma of surgery, contiguous spread from adjacent soft tissue or joint, or hematogenous spread from a focus of infection. Hematogenous osteomyelitis accounts for 20% of all cases of osteomyelitis.1 This type of osteomyelitis most often affect the long bones and vertebrae, although it could also affect other sites such as pelvic bones or clavicle.1 Mycobacterium tuberculosis is one of the causes of hematogenous osteomyelitis,comprising of 10 to 35 percent of extrapulmonary tuberculosis, or 2% of all tuberculosis cases.2,3 Joint involvement, when occur, is usually monoarticular, and mainly affect the weight-bearing joints such as hip or knee. Polyarticular cases occur in 10– 15% of extrapulmonary tuberculosis cases in developing countries.4 Tuberculous osteomyelitiscases are reported to be decreasing in number, probably because of earlier diagnosis and promptmanagement. In this article we report a case oftuberculous osteomyelitis in a patient with miliary tuberculosis
Co-Authors A Harahap, A Abd. Rasyid Syamsuri Abdullah, A A Abdullah, M Aji, G Akil, Natsir Anggraini, N Aru W. Sudoyo Aru W. Sudoyo Aziza, L Azizi, M S Budihusodo, U Budiman Budiman Cleopas Martin Rumende David R.S. Samosir Dewi, Sumartini Djoerban, Z Fawziah, A Gunawan Gunawan Isbagio, H Kasjmir, Yoga I L. A. Lesmana L. A. Lesmana Laniyati Hamijoyo, Laniyati Loli Simanjuntak Lubis, A MT Lusiani Lusiani, Lusiani Marcellus Simandibrata Mesanti, O Mokoagow, M I Nasution, A R Nilasari, D Nufus, H Nyoman Suarjana Oemardi, M Oktaviana, F Ongkowijaya, Jeffrey A Pangestu, Y Rudy Hidayat Rumende, C Matin S Effendy, S Sandra, R Santosa, D Setiati, S Simadibrata, M Sinaga, A Sinto, R Sitorus, F Suhendro Suhendro Sukmana, N Sulaiman, A S Sumariyono Sumariyono Titis, Titis Umami, V Utari, A P Wahyuningsih, R Wardoyo, A Wijaya, Linda K Yudharto, M A Yuliani, Ika Wulan Zuljasri Albar