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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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Diabetes insipidus in neuropsychiatric-systemic lupus erythematosus patient Y Pangestu; A Wardoyo; Linda K Wijaya; BAMBANG SETIYOHADI; Zuljasri Albar; N Sukmana; Budiman Budiman; Z Djoerban; S Effendy; L Aziza; F Sitorus
Indonesian Journal of Rheumatology Vol. 1 No. 2 (2009): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Systemic lupus erythematosus (SLE) is an idiopathic autoimmune chronic inflammatorydisease that is unique in its diversity of clinical manifestations, variability of diseaseâ€™s progression, and prognosis. The disease is characterized by the remission and multiple flare-ups in between the chronic phase that may affect many organ systems.The prevalence of SLE in the US population is 1:1000 with a woman to man ratio of about 9-14:1. At Cipto Mangunkusumo Hospital, Jakarta in 2002, there was 1.4% cases of SLE of the total number of patients at the Rheumatology Clinic. Neuropsychiatric manifestations of SLE (NP-SLE) have a high mortality and morbidity rates. The incidence of NP-SLE ranges 18-61%. Diagnosis of NP-SLE is difficult because there is no specific laboratory examination. Accordingly, in all SLE patients with central nervous system (CNS) dysfunction, additional tests will be necessary to confirm an NP-SLE diagnosis and exclude other causes.Â Similar to diabetes insipidus, SLE is a systemic disease which affects many organ systems, one being the endocrine system. No data has specified the occurrence rate of diabetes insipidus in SLE patients. This disease arises from a number of factors able to interfere with the mechanism of neurohypophyseal renal reflex resulting in the bodyâ€™s failure to convert water.3 There are three general forms of the disease, a polydipsicpolyuric syndrome caused by partial/complete vasopressin deficiency (central-diabetes-insipidus/CDI), vasopressin resistance of the kidney tubules (nephrogenic-diabetes-insipidus/NDI), and primary polydipsia. CDI occurs in about 1 in 25,000 persons

Osteoarticular tuberculosis of the right foot: a diagnostic delayed Natsir Akil; Bambang Setiyohadi; A MT Lubis; A Fawziah
Indonesian Journal of Rheumatology Vol. 1 No. 2 (2009): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Extrapulmonary tuberculosis (TB) involving the musculoskeletal system occurs in approximately 1% to 3% of patients with extrapulmonary TB. Concurrent pulmonary or intrathoracic TB is present in less than 50% of cases.1 Spine is the most frequent site of osseous tuberculous involvement. Other affected sites include the hip, knee, foot, elbow, hand, and bursal sheaths.2 Tuberculosis of the foot and ankle remains anuncommon site of the infection, present in 8% to 10% of osteoarticular infection. The diagnosis of osteoarticular tuberculosis is often delayed due to a lack of familiarity with the disease.3 We describe a patient with foot pain and swelling without any respiratory symptom as initial presentation of pulmonary and osteoarticular tuberculosis

Septic arthritis caused by Salmonella sp Wirawan Hambali; Sumariyono Sumariyono; K Chen
Indonesian Journal of Rheumatology Vol. 1 No. 2 (2009): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

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

Chronic polyarthritis mimicking rheumatoid arthritis in a patient with leprosy A S Haribowo; Bagus Putu Putra Suryana; Kusworini Handono
Indonesian Journal of Rheumatology Vol. 1 No. 2 (2009): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Currently leprosy is now still a global threat in the world even after the introduction of multidrug therapy (MDT), including in Indonesia.1 World Health Organization (WHO) data revealed that in 2002 there were 597,000 cases worldwide and the prevalence is only less than 1 every 10,000 populations.2 Nevertheless, the latest data showedthat 83% of leprosy cases concentrated in only 6 countries: Indonesia, India, Brazil, Madagascar, Myanmar, and Nepal.3 The most common manifestations of leprosyare cutaneous and neuritic manifestation. Rheumatologic manifestation is another common manifestation of leprosy.4-7 Prevalence of rheumatologic manifestation of leprosy is range from 1% to 77% of all leprosy patients.4-11 Study conducted by Mandal et al in India revealed that the prevalence of rheumatologic manifestation was 5.9%, in Brazil,6 another study by Pereira revealed the prevalence of 9.1%.5 Hadi, in Indonesia,showed the prevalence of arthritic manifestation was 7.5%.8 RheumatologicÂ manifestations that can be found in leprosy are polyarthritis or oligoarthritis, soft tissue rheumatism, noninflammatory arthritis, and also enthesitis.4-7 We report a patient presenting with polyarthritis as the primary manifestation of leprosy.

Calcinosis and myocarditis in systemic lupus erythematosus patient Sumartini Dewi; Rachmat Gunadi Wachjudi
Indonesian Journal of Rheumatology Vol. 1 No. 2 (2009): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Systemic lupus erythematosus (SLE) patients have multi-organ involvement related to their chronic inflammatory, autoimmune disease. Calcinosis can be clinical manifestations of SLE. Tissue calcinosis is reported in approximately 17% patients and myocarditis in 20-55% patients. Thus, both manifestations are not unusual in SLE. Tachypnea, tachycardia, pericardial effusion, and wheezing are often present and can be misleading in SLE patient.1,2 Calcinosis is less common in SLE, sometimesit is found as an incidental radiological finding. Calcification in SLE maybe periarticular, within joints or muscles, or in the subcutis (calcinosis universalis).1 Calcinosis is classified into four subsets: dystrophic, metastatic, idiopathic, or calciphylaxis/iatrogenic. When calcinosis cutis is isolated to a small area in extremities and joints, it is called calcinosis circumscripta; whereas its diffuse form, refers to calcinosis universalis, affects subcutaneous and fibrous structures of muscles and tendons. The pathophysiology of this condition is unknown and no effective therapy is currently available.3,4,5 Systemic lupus erythematosus can involve the myocardium, pericardium, cardiac valves,and coronary arteries. Myocarditis in SLE is not likely to produce major regional wall motion abnormalities but may contribute to global left ventricular dysfunction.7,8We report a young woman with SLE who developed calcinosis and myocarditis.

Role of interleukin-17 in the pathogenesis of rheumatoid arthritis Jeffrey A Ongkowijaya; Bambang Setiyohadi; Sumariyono Sumariyono; Yoga I Kasjmir
Indonesian Journal of Rheumatology Vol. 2 No. 1 (2010): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

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 Î±, 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,Â 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 Ida Ayu Ratih Wulansari Manuaba; Sumariyono Sumariyono; Harry Isbagio
Indonesian Journal of Rheumatology Vol. 2 No. 1 (2010): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

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 andÂ 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.

Predictor of joint damage in rheumatoid arthritis Sumariyono Sumariyono; H Isbagio
Indonesian Journal of Rheumatology Vol. 2 No. 1 (2010): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

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 patientsâ€™ 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 patientsâ€”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 matrix metalloproteinase-9 level, erythrocyte sedimentation rate, rheumatoid factor, and the duration of illness with radiological findings in rheumatoid arthritis patients G Aji; Ida Ayu Ratih Wulansari Manuaba; Jeffrey A Ongkowijaya; Bambang Setiyohadi; Sumariyono Sumariyono
Indonesian Journal of Rheumatology Vol. 2 No. 1 (2010): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

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.

Atherosclerosis prevalence and the correlation between atherosclerosis risk factors and carotid intima-media thickness in below 40-year-old women with systemic lupus erythematosus R M Sari; Yoga I Kasjmir; D Antono; S Setiati
Indonesian Journal of Rheumatology Vol. 2 No. 1 (2010): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

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 andÂ 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.

Page 12 of 26 | Total Record : 252

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