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All Journal Indonesian Journal of Rheumatology Jurnal Penyakit Dalam Indonesia Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)
Sumariyono Sumariyono
Internal Medicine Department, Faculty of Medicine Universitas Indonesia/ Cipto Mangunkusumo Hospital, Jakarta
Health Professions Medicine & Pharmacology Public Health

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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.
Role of interleukin-17 in the pathogenesis of rheumatoid arthritis Ongkowijaya, Jeffrey A; Setiyohadi, Bambang; Sumariyono, Sumariyono; Kasjmir, Yoga I
Indonesian Journal of Rheumatology Vol 2, No 2 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Rheumatoid arthritis (RA) is a systemic autoimmune disorder with an unknown etiology. It typically affects the peripheral synovial joints symmetrically. The roles of T and B cells, macrophages, plasmocytes, host tissue cells (synoviocytes, chondrocytes), and osteoclastsin RA are more defi ned. In RA, cytokines secreted by cells implicated in adaptive and natural immunity have important roles in causing infl ammation, articular destruction, and other comorbid diseases related to RA. Other than the clear roles of interleukin (IL)-1 and tumor necrosis factor α, there are other cytokines that are suspected of having roles in the pathogenesis of RA, IL-17 for instance. Interleukin-17 is a proinfl ammatory cytokine,  produced by Th17 cells, and has pleiotropic effects on various cells contributing to the pathogenic condition of RA. Several studies showed that this cytokine maintains the infl ammation and causes more destruction of joint cartilage. Advances in the understanding of the role of IL-17 elicits the idea to modulate IL-17 and/or Th17 cells as the potential targetsof therapy in RA
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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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.
Septic arthritis caused by Salmonella sp Hambali, Wirawan; Sumariyono, Sumariyono; Chen, K
Indonesian Journal of Rheumatology Vol 2, No 1 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Septic arthritis is a rare joint disorder, and can be caused by various pathogenic microorganisms, including bacteria, virus, mycobacterium, and fungus. The incidence of this infection is between 2 to 10 cases per 100,000 populations annually andcan reach as high as 30 to 70 cases per 100,000 in immunodeficient population. This disorder is frequently unidentified in early phase of the disease due to its unspecific symptoms and signs.1 This joint infection can cause numerous problems to the patient ranging from joint damage, bone erosion, osteomyelitis, fibrosis, ankylosis, sepsis,or even death.1-5 The case-fatality rate for this disorder can reach up to 11%, comparable to the case fatality rate for other community infections such as pneumonia.2,6 Salmonella sp. is a Gram-negative bacillus bacterium with main invasion predilection in intestinal villi.7 This microorganism rarely causes septic arthritis although several cases have been reported before. Ortiz-Neu et al. demonstrated that septic arthritis caused by Salmonella sp. has high relapse incidence and a tendency to turnchronic, making the treatment more difficult and challenging
Predictor of joint damage in rheumatoid arthritis Sumariyono, Sumariyono; Isbagio, H
Indonesian Journal of Rheumatology Vol 2, No 2 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Objective: This study was implemented to determine the joint damage predictor in rheumatoid arthritis (RA).Methods: A cross-sectional study was conducted on outpatients of the rheumatology clinic at Cipto Mangunkusumo General Hospital who had suffered from RA for more than 2 years during the period from October 1, 1999 to June 30, 2000. During this period, we obtained 23 RA patients who fulfi lled the inclusion and exclusion criteria. We evaluated the patients’ medical data that included gender, education, age of onset, rheumatoid factor (RF), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Then we carriedout examinations and tests including X-ray of hand and wrist joints, RF, CRP, and ESR. The degree of joint damage was evaluated using the Larsen score.Results: Twenty three patients—all women, mean age of onset was 36.7 years, mean duration of disease was 62.8 months, educational level with high school degree or above were found in 19 cases (82.6%), and RF (+) at initial treatment were found in 10 cases (43.5%). The mean ESR at initial treatment was 77.9 mm/hr and CRP at initial treatment was between 0 and 768 mg/dL. The Larsen score ranged between 0 and 68 with a meanof 21.7. In bivariate analysis, the Larsen score was signifi cantly higher in the group with positive RF at initial treatment compared to that in the group with negative RF at initial treatment (p = 0.031). C-reactive protein and ESR at initial treatment and the age of onset did not have any signifi cant correlation with the Larsen score, but there was a signifi cant correlation of CRP and ESR during the study with the the Larsen score.Conclusion: RF level was the most signifi cant predictor in determining the degree of joint damage according to the Larsen score while initial positive RF had lower signifi cance level.
Correlation of serum level of interleukin-6 and disease activity with bone-resorption activity in premenopausal rheumatoid arthritis patients Akil, Natsir; Isbagio, H; Sumariyono, Sumariyono
Indonesian Journal of Rheumatology Vol 4, No 1 (2013)
Publisher : Indonesian Rheumatology Association

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Abstract

Background: Rheumatoid arthritis (RA) is a chronic, systemic disease characterized by inflammation and cellular proliferation in the synovial lining of joints that can ultimately result in cartilage and bone destruction.Patients with RA are at increased risk of osteoporotic fractures in both axial and appendicular bones. Several cytokines are involved in the pathogenesis of osteoporotic RA patients, including tumor necrosis factor α, interleukin (IL)-1, IL-6, and IL-17. Among these cytokines, IL-6 has a pivotal role in the pathogenesis of increased bone resorption in postmenopausal RA patients. There are currently scarce data concerning this process in premenopausal RA patients.Objective: To determine the correlation of serum level IL-6 and disease activity with bone-resorption activity in premenopausal RA patients. Methods: This is a cross-sectional study with consecutive sampling method conducted at the Division of Rheumatology, Cipto Mangunkusumo General Hospital from June until August 2010. Bone-resorption activity was quantified using serum C-terminal crosslinking telopeptide of type I collagen (CTx-I) level, while disease activity was assessed using the 28-joint disease activity (DAS28) score. Statistical analysis was performed to investigate the correlation of serum IL-6 level and disease activity with serum CTx-I level.Results: There were 38 patients enrolled in this study. Mean serum level of IL-6 was 10.99 pg/mL (SD 16.06). Mean serum level of CTx-I was 405.37 pg/mL (SD 199.32). There was no significant correlation (p = 0.252) between serum IL-6 level with serum CTx-I level;however, a significant correlation existed (r = 0.389, p = 0.033) among seropositive patients. There was no significant correlation (p = 0.257) between the DAS28score with serum CTx-I level.Conclusion: There were no significant correlation either of serum IL-6 level or disease activity with serum CTx-I level among patients in this study
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.
Correlation of matrix metalloproteinase-9 level, erythrocyte sedimentation rate, rheumatoid factor, and the duration of illness with radiological findings in rheumatoid arthritis patients Aji, G; Manuaba, Ida Ayu Ratih Wulansari; 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

Background: Rheumatoid arthritis (RA) is a common autoimmune disease of the joint indicated by chronic inflammation of synovium, cartilage destruction, and osteopenia. The end results of RA are joint deformity and disability that will decrease the quality of life ofthe patients. Until now there is not a specifi c marker to assess the process of joint and bone damage in RA. Available markers such as C-reactive protein and erythrocyte sedimentation rate (ESR) indicate more about the infl ammatory status of the patient. Thediscovery of matrix metalloproteinases (MMPs) enzyme overexpression in RA has brought a new hope for the discovery of more specifi c markers of joint damage.Objective: To study the correlation of MMP-9 level, ESR, rheumatoid factor (RF), and the duration of illness with joint damage in RA patients.Methods: A cross-sectional study was conducted on RA outpatients in rheumatology clinic at Cipto Mangunkusumo General Hospital, Jakarta from January to October 2009. From the patients who fulfilled the inclusion criteria and did not fulfi ll the exclusion criteria, blood sample was collected for MMP-9 level, RF, and ESR examinations; hand radiography (posterior-anterior view) was also taken. Results: From the study of 46 patients, we found a significant correlation between MMP-9 level and radiographic feature of bone erosion (r = 0.3, p = 0.02) and between the duration of illness and Sharp score (r = 0.36, p = 0.014). There was no correlation between ESR and radiological fi ndings nor between RF and radiological fi ndings. Linear regression analysis showed the duration of illness as the most infl uencing factor toradiological fi ndings in RA patients.Conclusion: We found a signifi cant correlation between MMP-9 level and radiographic feature of bone erosion, and between the duration of illness and radiological fi ndings in RA patients.
Korelasi Antara Kadar Matriks Metalloproteinase 9, Laju Endap Darah, Faktor Reumatoid, dan Lama Sakit dengan Gambaran Radiologis pada Pasien Artritis Reumatoid Aji, Giri; Sumariyono, Sumariyono; Kusumawidjaja, Kahar; Abdullah, Murdani
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 2
Publisher : UI Scholars Hub

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Abstract

Pendahuluan. Artritis Reumatoid (AR) merupakan penyakit autoimun dengan etiologi yang belum jelas, gejala utama dari AR adalah keradangan pada sendi yang ditandai dengan sinovitis simetris dan erosi tulang, walaupun perjalanan penyakit AR sulit diduga dengan sifat kronik-remisi-eksaserbasi namun secara umum hasil akhir dari AR adalah deformitas sendi. Penelitian terakhir pada AR menunjukkan adanya overekspresi dari sejumlah enzim matrix metallopeoteinases (MMPs) yang mempunyai kemampuan degradasi komponen kolagen dam matriks ekstraseluler tulang rawan Beberapa penelitian menemukan keterlibatan MMP-2, MMP-9, MMP-1 ,MMP-8 dan MMP-3 pada penyakit AR. Penelitian di Taiwan oleh Chang Yh menunjukkan peningkatan kadar aktivitas MMP-9 pada pasien AR di Taiwan dibandingkan pada populasi normal. Giannelli melaporkan peningkatan kadar MMP-2, MMP- 9, Tissue Inhibitor Matrix proteinase 1 dan Tissue Inhibitor Matrix proteinase 2 pada pasien dengan AR dan artritis psoriasis, Gruber juga melaporkan adanya peningkatan yang bermakna dari kadar MMP-9 atau gelatinase B pada serum pasien AR. Penelitian ini bertujuan untuk meningkatkan pemahaman mengenai peran MMP-9 atau gelatinase B pada serum pasien AR, serta mencari korelasi antara kadar MMP-9, laju endap darah (LED), faktor reumatoid dan lama sakit dengan gambaran radiologis pada pasien AR. Metode. Penelitian ini menggunakan studi potong lintang analitik dengan metode sampling konsekutif yang dilakukan di poliklinik Reumatologi/Ilmu Penyakit Dalam RSUPN Cipto Mangunkusumo. Sebagai variabel bebas adalah : kadar matriks metalloproteinase 9, laju endap darah (LED) , faktor reumatoid dan lama sakit sementara variabel tergantung adalah skor radiologis Sharp. Hasil. Dari 46 subjek penelitian didapatkan peningkatan kadar rerata MMP-9 yaitu sebesar 104,82 ng/ml, rerata LED 58,5 mm/jam, rerata kadar faktor reumatoid 57,13 IU/ml dan rerata lama sakit adalah 4,83 tahun. Korelasi antara kadar MMP-9 dengan skor erosi tulang secara radiologis adalah r=0,3 dengan p=0,02 (bermakna), sementara korelasi antara lama sakit dengan gambaran radiologis ( skor Sharp) r=0,36 dengan p=0,014 (bermakna). Korelasi antara LED, dan faktor reumatoid dengan gambaran radiologis adalah r=0,10,p=0,24;dan r=0,19,p=0,09. Simpulan. Didapatkan peningkatan kadar MMP-9 pada pasien AR, kadar MMP-9 berkorelasi dengan gambaran erosi tulang secara radiologis, lama sakit berkorelasi dengan gambaran radiologis (skor Sharp), Faktor reumatoid dan LED tidak berkorelasi dengan gambaran radiologis (skor Sharp).
Effects of Early Hospital-Based Palliative Care Consultation on Length of Stay and Costs of Care at Indonesian Tertiary Hospital Putranto, Rudi; Shatri, Hamzah; Rajabto, Wulyo; Sumariyono, Sumariyono; Faisal, Edward; Sihwastuti, Sihwastuti
Kesmas Vol. 18, No. 3
Publisher : UI Scholars Hub

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Despite the numerous benefits of palliative care for cancer patients, there have been few studies on palliative care services for terminal cancer patients, particularly near the end of life. This study aimed to evaluate whether there were differences in length of stay and cost of care associated with how early or late a patient received palliative care intervention. Another objective was to compare the length of stay and cost of care of those who received palliative care intervention and those who did not. This study used a cohort retrospective design at Hospital A, Jakarta, Indonesia, from January to December 2019. The diagnosis of terminal cancer was based on medical records. Data on length of stay and costs of care were based on medical records and finance billing. The hospitalized terminal cancer patients (392) were recruited by consecutive sampling. The length of stay and costs of care for patients with advanced cancer who received palliative care consultations were longer and higher than for patients who did not receive them. However, if palliative care consultation is provided early, the increase in length of stay and costs are less.
Co-Authors Aji, G Akil, Natsir Bambang Setiyohadi Chen, K E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Faisal, Edward Giri Aji, Giri Harry Isbagio Isbagio, H Kahar Kusumawidjaja, Kahar Kasjmir, Yoga I Murdani Abdullah Ongkowijaya, Jeffrey A Pramono, A Rudi Putranto Sihwastuti, Sihwastuti Wirawan Hambali, Wirawan Wulyo Rajabto