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Indonesian Journal of Rheumatology

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Published by Indonesian Rheumatology Association

ISSN : 20861435 EISSN : 25811142 DOI : -

Core Subject : Health,

Medicine & Pharmacology

Indonesian Journal of Rheumatology is a peer-reviewed open access journal on rheumatic diseases and connective tissue disorders. This is an official journal of Indonesian Rheumatology Associantion (IRA) and published twice a year since 2009. Our mission is to encourage the development of scientific and medical practice in rheumatic diseases and connective tissue disorders. This journal is self-focused on rheumatic disease and connective tissue disorders in the form of original article (extended and/or concise reports), review articles, editorial letters, leaders, lesson from memorable cases, book reviews, and matter arising. Both in clinical and laboratory including animal studies.

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Articles 252 Documents

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

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.

Correlation between serum leptin concentration and disease activity in normal body mass index premenopausal women with systemic lupus erythematosus I Nyoman Suarjana; Yoga I Kasjmir; Harry Isbagio; S Soegondo
Indonesian Journal of Rheumatology Vol. 1 No. 1 (2009): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

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 wasnâ€™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). Spearmanâ€™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 â€“ 45.9) ng/ml.The median serum leptin concentration in patients with active disease was 12.4 (0.6 â€“ 41.6) ng/dl, whereas in patients with inactive disease was 15.2 (3.9 â€“ 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.

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

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.

Knee arthritis in an HIV positive patient - not associated with antiretroviral therapy I Nyoman Suarjana; Yoga I Kasjmir; Bambang Setiyohadi
Indonesian Journal of Rheumatology Vol. 1 No. 1 (2009): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

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.

Systemic sclerosis in two generations family: a mother and offspring D Nilasari; Laniyati Hamijoyo; Yoga I Kasjmir; Bambang Setiyohadi
Indonesian Journal of Rheumatology Vol. 1 No. 1 (2009): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

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, andÂ 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.

Tophi which develop years before the first attack of acute gouty arthritis Rudy Hidayat; Yoga I Kasjmir
Indonesian Journal of Rheumatology Vol. 1 No. 1 (2009): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

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

Vitamin D and inflammation Zuljasri Albar
Indonesian Journal of Rheumatology Vol. 1 No. 2 (2009): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

The discovery that most body cells and tissues have vitamin D receptors and that some of them have the enzymatic machinery to convert the circulating form of vitamin D (25-hydroxyvitamin D) into the active form (1,25- dihydroxyvitamin D/1,25(OH)2D3 ) gave a new insight about the function of this vitamin. In the course of time, more and more evidences showed that a low vitamin D level leads to the occurrence or recurrenceof cardiovascular diseases, type II diabetes mellitus (DM), cell dedifferentiation (oncogenesis), and immune derangement (autoimmune diseases such as lupus, typeI DM, rheumatoid arthritis, and multiple sclerosis). Most researchers have agreed that a minimum 25(OH)D3 serum level of about 30 ng/ml or more is necessary for favorable calcium absorption and good health. Until proven otherwise, the balance of the research clearly indicates that oral supplementation in the range of 1,000 IU/day for infants, 2,000 IU/day for children, and 4,000 IU/day for adults is safe and reasonable to meetphysiologic requirements, to promote optimal health, and to reduce the risk of several serious diseases.

Hyperuricemia and Pro Inflammatory Cytokine (IL-1Î², IL-6, and TNF-Î±) Suyanto Hadi; D Sudarsono; Bantar Suntoko
Indonesian Journal of Rheumatology Vol. 1 No. 2 (2009): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Background. Rugerio et al 2006 reported that there were a positive correlation between the level of hyperuricemia and the level of IL-1Î², IL-6, and TNF-Î± pro infl ammatory cytokines value. On the other hand, Choi et al reported a negative correlation between hyperuricemia and the level of pro infl ammatory cytokine in the late phase of hyperuricemia.Methods. Venous blood samples were collected and stored at a temperature of - 80oC from in- and outpatients with hyperuricemia with age of more than 17years old at Dr. Kariadi Hospital, Semarang. The level of uric acids (mg/dl) were examined with enzymatic colorimetric technique (Roche Diagnostics) whereasthe levels of IL-1Î², IL-6, and TNF-Î± pro infl ammatory cytokines (pg/ml) were examined with enzyme linked immunosorbent assay (ELISA) technique using ultrasensitive commercial kit (Human ultra sensitive, Biosource International Inc Europe), and ELX 800, 2002 machine. The normality of the data was tested withOne-Sample Kolmogorov-Smirnov technique and the correlation was tested with Spearman correlation (data with abnormal distribution) or Pearson correlation (datawith normal distribution).Results. There was a weak positive correlation between the level of hyperuricemia and the level of IL-1 Î² cytokine in Spearman correlation test with r value = 0.246 and p value > 0.05 in Spearman correlation test. On the other hand, there was a weak negative correlation between the level of hyperuricemia and the level of TNF-Î± cytokine with r value = - 0.096 and p value > 0.05. There was also weak negative correlation between the level of hyperuricemia and the level of IL-6 cytokine with r value = - 0.072 and p value > 0.05 in Pearson correlation test.Conclusion. There was a weak positive correlation but not sifnificant between the level of hyperuricemia and the level of IL-1Î².

Correlation between anti-cyclic citrullinated peptide antibodies and the severity of clinical manifestation, laboratory manifestation, and radiological joint destruction in rheumatoid arthritis patients Mat Suwito; Kusworini Handono; Bagus Putu Putra Suryana; Handono Kalim; Cesarius Singgih Wahono
Indonesian Journal of Rheumatology Vol. 1 No. 2 (2009): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Background. The second generation anti-cyclic citrullinated peptide test (CCP2) displays sensitivity comparable to that of rheumatoid factor (RF) (approximately 80%) but with superior specificity (98%) . Several observations have indicated that early rheumatoid arthritis (RA) patients with positive anti-CCP may develop a more erosive disease than those without anti-CCP.Objective. The purpose of this cross-sectional study was to investigate the correlation between anti-CCP antibodies and clinical and laboratory parameters and radiological joint destruction in RA patients.Methods. We studied 31 patients with RA fulfilling the 1987 revised criteria of American College of Rheumatology in Rheumatology Clinic of Saiful Anwar General Hospital, Malang, Indonesia. Clinical parameters were collected such as age, sex, visual analog scale,disease duration and diseases activity score (DAS28-3(CRP)). Laboratory parameters were WBC, hemoglobin, platelet count, erythrocyte sedimentation rate, and Creactive protein. Analyzed autoantibody profiles were RF and anti-CCP (ELISA methode). Radiological jointdestruction was evaluated from bilateral postero-anterior manus x ray (Sharp score).Results. Anti-CCP antibodies were detected in 48.4% of RA patients with mean antibody concentration was 291.24Â±143.67 (range 16-523.8) units. Anti CCP level was significantly correlated with duration of RA (month) (p=0.04, r=0.371), RF level (p=0.002, r=0.542) andSharp score (p=0.048, r=0.358), but was not significantly correlated with other clinical and laboratory parameters.Conclusion. Anti-CCP level was correlated with duration of disease, RF, and Sharp score.

Profile of osteophyte location in different grades of functional status in patients with knee osteoarthritis O Mesanti; BAMBANG SETIYOHADI; Yoga I Kasjmir; U Budihusodo; M Oemardi
Indonesian Journal of Rheumatology Vol. 1 No. 2 (2009): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

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.Â 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.Â 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 2Â 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.

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