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Kasjmir, Yoga I
Indonesian Rheumatology Association
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Risk factors for the development of knee osteoarthritis Kasjmir, Yoga I; Nasution, A R; Daud, Rizasyah
Indonesian Journal of Rheumatology Vol 1, No 1 (2009)
Publisher : Indonesian Rheumatology Association

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Abstract

Objective. This article presents case control study conducted at the Rheumatology Outpatient Unit, Department of Internal Medicine, Cipto Mangunkusumo Hospital. The aim of this study was to determine several risk factors for the development of knee osteoarthritis (OA) at Rheumatology out-patient unit Department of InternalMedicine, Cipto Mangunkusumo Hospital.Method. This study used a case control design. Subjects were divided into two groups, case group and control group. The case group included all patients who had kneecomplaints that fulfi lled the 1990 American College of Radiology criteria while the control group included patients randomly chosen from visitors of the RheumatologyOutpatient Unit of Cipto Mangunkusumo Hospital who did not complain of knee pain and had been proven of not suffering OA by physical and radiological examinations. A similar questionnaire was designed for both groups. After filling out the questionnaire, both groups were examined physically and radiologically. The risk factors were analyzed using logistic regression.Results. We included 127 patients in the case group and 102 in the control group. In the case group, there were 95 women (74.80 %) and 32 men (25.20%) while the control group consisted of 69 women (67.65%) and 33 men (32.35%). From the analysis of several risk factors, there were signifi cant differences between the case and control groups such as weight (p < 0.0001 df 3), prior history of overweight or obesity (x2 = 21.255, df 1, p < 0.0001), knee trauma (p = 0.0002), and kneel down activity (p < 0.0001). There was also a signifi cant difference of smoking habit between the case group and the control group (p < 0.0001). Duration of smoking cessation was also signifi cantly different between the case group and controlgroup (t = 2.315, df 45, p = 0.0252). From the multivariate analysis, it was found that age, kneel down activity, prior obesity condition, interval between knee trauma and onset of OA, smoking habit, and duration of smoking cessation had a signifi cant correlation with knee OA.Conclusion. Age, prior history of overweight or obesity, kneeling, and interval between knee trauma and onset of OA were risk factors of knee OA. Smoking was a negative risk factor for knee OA. The protective effect of smoking was infl uenced by the duration of smoking habit and the duration of smoking cessation.
Tophi which develop years before the first attack of acute gouty arthritis Hidayat, Rudy; Kasjmir, Yoga I
Indonesian Journal of Rheumatology Vol 1, No 1 (2009)
Publisher : Indonesian Rheumatology Association

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Abstract

Gout is a clinical disease associated with hyperuricemia and caused by the deposition ofmonosodium urate crystals in and around the tissue of joints. The course of classic gout passes through three distinct stages: asymptomatic hyperuricemia, acute intermittent gout, and advanced gout/chronic tophaceous gout.1,2 Tophi; described as accumulation of articular, osseus, soft tissue, and cartilaginous crystalline deposits; is one of clinical manifestation of chronic tophaceous gout stage, and usually developedafter 10 or more years of acute intermittent gout.1,2 Although patients have been reported with tophias their initial clinical manifestation
Atherosclerosis prevalence and the correlation between atherosclerosis risk factors and carotid intima-media thickness in below 40-year-old women with systemic lupus erythematosus Sari, R M; Kasjmir, Yoga I; Antono, D; Setiati, S
Indonesian Journal of Rheumatology Vol 2, No 2 (2010)
Publisher : Indonesian Rheumatology Association

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Objectives: To determine the prevalence of atherosclerosis in female systemic lupus erythematosus (SLE) patients aged below 40 years old and the factors correlated with carotid intima-media (CIM) thickening.Methods: A cross-sectional study was conducted on 80 female SLE respondents aged below 40 years old who were either in- or outpatient of Cipto Mangunkusumo General Hospital, Jakarta. History of disease and treatment was taken, and laboratory test and  ultrasonography of the carotid artery to evaluate CIM thickness were performed.Results: The prevalence of atherosclerosis was 40%, comprising of CIM thickening and/or presence of atherosclerotic plaque in the carotid artery. The median values of CIM thickness in the right common carotid artery, right carotid bulb, left common carotid artery, and left carotid bulb were 0.040 cm, 0.04535 cm, 0.0430 cm, and 0.047 cm, respectively. There was also a positive correlation reported of CIM thickness with increased age, the duration of SLE disease, and the duration of steroid treatment.Conclusions: We found a positive correlation of CIM thickness with age, the duration of SLE disease, and the duration of steroid treatment in female SLE patients aged below 40 years.
Correlation between serum leptin concentration and disease activity in normal body mass index premenopausal women with systemic lupus erythematosus Suarjana, I Nyoman; Kasjmir, Yoga I; Isbagio, Harry; Soegondo, S
Indonesian Journal of Rheumatology Vol 1, No 1 (2009)
Publisher : Indonesian Rheumatology Association

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Abstract

Background. Leptin is recognized as a cytokine-like hormone with pleiotropic actions in modulating immune responses. The role of leptin in pathogenesis of systemiclupus erythematosus (SLE) was not fully understood yet. Previous study did not fi nd the correlation between serum leptin concentration and disease activity in patients with SLE, but selection of the subjects wasn’t based on the classifi cation of body mass index (BMI) and menopausal status.Objective. To determine correlation between serum leptin concentration and the disease activity in normal BMI premenopausal women with SLE.Methods. Serum leptin concentration was measured by enzyme-linked immunosorbent assay and disease activity was scored using Mexican SLE disease activity index (Mex-SLEDAI). Spearman’s correlation coeffi cient test was used for evaluating the strength of association between leptin level and Mex-SLEDAI score.Results. Seventy normal BMI premenopausal women with SLE were included in this study. The median of serum leptin concentration was 13.4 (0.6 – 45.9) ng/ml.The median serum leptin concentration in patients with active disease was 12.4 (0.6 – 41.6) ng/dl, whereas in patients with inactive disease was 15.2 (3.9 – 45.9) ng/dl.No signifi cant different was found between serum leptin concentration in active and inactive disease (p = 0.14). A weak negative correlation was observed between leptinconcentration and Mex-SLEDAI score, but not statistically signifi cant (r = -0.22; p = 0.07).Conclusion. No correlation was found between serum leptin concentration and disease activity in normal BMI premenopausal women with SLE. Prednisone doses anddisease duration might interfere.
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
Knee function measured by timed up-and-go test and stair-climbing test after isometric exercise of quadriceps femoris muscles in female patients with knee osteoarthritis Widjanantie, S C; Tulaar, A BM; Kasjmir, Yoga I; Prasetyo, S B
Indonesian Journal of Rheumatology Vol 3, No 1 (2011)
Publisher : Indonesian Rheumatology Association

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Background: Osteoarthritis (OA), the most common form of joint disease, can result in long-term disability. Limitation of activity in OA patients may result in a decline in the strength of quadriceps femoris muscles and thus further reduce mobility. Isometric exercise has been known to increase muscle strength, decrease pain, and improve knee function.Objective: To evaluate knee function measured by timed up-and-go test (TUGT) and stair-climbing test (SCT) as well as muscle strength in the fourth and sixth week after isometric exercise of quadriceps femoris muscles and the correlation between these variables.Methods: Female patients with OA underwent isometric exercise of quadriceps femoris muscles 3 times a week for 6 weeks. Muscle strength (measured by tensiometer cable) and knee function (measured by TUGT and SCT) were evaluated before and at week 4and 6 of the exercise.Results: Thirty fi ve female patients were recruited in this study. The majority of the patients (45.7%) were between 60 to 65 years old. Obesity was found in 62.86% of the patients. At week 6, there was significant decrease in mean TUGT and SCT (by 39.0% and 45.6%, respectively; p<0.001), and signifi cant increase in mean right and left quadriceps muscles strength (by 47.9% and 36.7%, respectively; p<0.001). There was a weaknegative correlation (nonsignifi cant) of the increased strength of quadriceps muscles with the increase of knee function according to TUGT (right leg: r = -0.172, p = 0.323; left leg: -0.303, p = 0.077) and SCT (right leg: r = -0.031, p = 0.860); left leg: r = -0.058, p = 0.742).Conclusion: In female patients in this study, significant improvement was found in the strength of quadriceps muscles, TUGT, and SCT after 6 weeks of isometric exercise. There was no signifi cant correlation between muscle strength and knee function according to TUGT and SCT.
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.
Role of diacerein in pain intensity and functional status in patients with knee osteoarthritis Kasjmir, Yoga I; Imelda, F; Erawati, L
Indonesian Journal of Rheumatology Vol 2, No 3 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Background: Infl ammation is an important mechanism in the pathogenesis of osteoarthritis (OA). Proinfl ammatory mediators, especially interleukin-1β (IL-1β), play a signifi cant role in the occurrence of joint infl ammation, which lead to pain and limitation of daily activities. As an anti–IL-1β, diacerein is therefore have potency to reduce pain and improve functional status of OA patients.Objective: To evaluate the role of diacerein in pain intensity and functional status of knee OA patients. Methods: This is a pre-post study without control group using consecutive sampling conducted at rheumatology outpatient clinic at the Cipto Mangunkusumo General Hospital, Jakarta from January until May 2006. At the fi rst visit, all patients underwentassessment of pain intensity (using visual analog scale (VAS)) and functional status (Lequesne algofunctional index) to obtain baseline data. We also performed kneeradiograph examination to evaluate joint damage basedon the Kellgren-Lawrence classifi cation. Measurement of IL-1β level in synovial fl uid was performed using enzyme-linked immunosorbent assay, with a minimum detectable value of 3.9 pg/mL. Diacerein wasadministered with a dose of 50 mg, given orally twice a day for 2 months. Follow-ups were done in the fi rst, second, and eighth week after the administration of diacerein. In the eighth week we repeated the measurement of IL-1β level.Results: Thirty three patients were enrolled in this study, most (78.8%) of them were female. The majority (81.8%) belong to the 50- to 70-year-old age group. More than half of the patients (54.5%) had detectable IL-1β level. The median baseline VAS score was 65.00 (range 25–100) while the median baseline Lequesne score was 11.00 (range 1.5–21.0). The statistical analysis showed a signifi cant decrease in VAS at the fi rst (p = 0.000), second(p = 0.000), and eighth week (p = 0.000). Lequesne index score was also decrease signifi cantly at the fi rst (p =0.000), second (p = 0.000), and eighth week (p = 0.000)of treatment. We found no signifi cant correlation of IL-1β level with VAS and Lequesne algofunctional index scores.Conclusions: Among the patients in this study, there were signifi cant decrease in pain intensity and disabilityafter the administration of diacerein.
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.
Profile of osteophyte location in different grades of functional status in patients with knee osteoarthritis Mesanti, O; SETIYOHADI, BAMBANG; Kasjmir, Yoga I; Budihusodo, U; Oemardi, M
Indonesian Journal of Rheumatology Vol 2, No 1 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Background. Osteophyte is a reparative response to cartilage breakdown in osteoarthritis (OA) and osteophyte formation is a knee stabilizing factor. Disability could be found in patients with knee OA. Objective. To identify the profile of osteophyte formation (location, size, and direction) based on knee radiograph and functional status examination in knee OA patients who presented to the Rheumatology Clinic, Cipto Mangunkusumo Central National General Hospital.Methods. Samples were taken by consecutive approach. Knee radiographs (weight bearing anteroposterior and30 degrees flexion skyline views) and functional status examinations were performed on 100 patients with knee OA (90 females and 10 males with ages ranging from 51 to 74 years old). A radiologist assessed films for osteophyte profile such as location, size, and direction according to standard atlas. One knee with the severe radiological assessment based on OA grade was selected from one patient to be the profile. LequesneAlgofunctional Index was also taken from the patients. Results. The site of osteophyte in patients with knee OA was mostly found at lateral femur (85/100 subjects). Based on specific location, grade 2 osteophyte at lateral femur was the most frequent size (49/100 subjects) and osteophyte extending toward the lower middle atlateral patella (65/100 subjects) was the most frequent direction of osteophyte. The most frequent profile for size and direction of osteophyte at specific location was the grade 2 osteophyte extending toward the lower middle at lateral patella (35/100 subjects). Severe functional status impairment was found in 53% of the patients. The most frequent functional status found according to specific location of osteophyte was severe functionalstatus impairment in patients with oste ophyte at lateral femur (46/100 subjects). The most frequent functional status of OA patients based on the size and direction of osteophyte at specific location was the severe functional impairment in the patients with grade 2  osteophyte at lateral femur (27/100 subjects) and the patients with osteophyte extending towards the lower middle at lateral patella (37/100 subjects) respectively.Conclusions. Osteophyte at lateral femur, osteophyte at lateral tibiofemoral compartment, grade 2 osteophyte at lateral femur, and osteophyte extending toward the lower middle at lateral patella were the profiles of osteophyte which mostly showed severe functional status impairment in patients with knee OA.
Co-Authors Antono, D Bambang Setiyohadi Budihusodo, U Daud, Rizasyah Erawati, L Harry Isbagio Imelda, F Laniyati Hamijoyo, Laniyati Mesanti, O Nasution, A R Nilasari, D Nyoman Suarjana Oemardi, M Ongkowijaya, Jeffrey A Prasetyo, S B Rudy Hidayat Sari, R M Setiati, S Soegondo, S Sumariyono Sumariyono Tulaar, A BM Widjanantie, S C