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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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Arthritis in leprosy without specific skin lesion Sumartini Dewi; Bambang Setiyohadi
Indonesian Journal of Rheumatology Vol. 2 No. 1 (2010): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Leprosy patients could display a great variability of signs and symptoms. An overabundance of rheumatic manifestations, occuring alone or in varying combinations, are associated with leprosy, particularly with lepra reactions A study involving seventy cases of leprosy found that rheumatic manifestations were seen in 61.42% of cases: arthritis in 54.28% and soft tissue rheumatism in 17.14%. Enthesitis was seen in 2.84% of cases. Rheumatic manifestations may be the primary complaint, thus delaying accurate diagnosis. Musculoskeletal involvement in leprosy is the third most frequent manifestation after dermatological and neurological involvements. It can occur at anytime during the infection. Articular inflammation in leprosy, which closely mimics other rheumatic disorders, usually occurs in reactive states, particularly erythema nodosum leprosum (ENL).1 About 1â€“5% of leprosy patients are reported of developing arthritis (synovial inflammation) at some stage of the disease but this rate increases to over 50% during lepra reactions.2 Here we report a case of arthritis in leprosywithout any typical skin lesion thus causing a delay in diagnosis.

Complete manifestations of BehÃ§etâ€™s disease V Umami; Bambang Setiyohadi
Indonesian Journal of Rheumatology Vol. 2 No. 1 (2010): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

BehÃ§etâ€™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 BehÃ§et 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. BehÃ§etâ€™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

Erosive osteoarthritis Jeffrey A Ongkowijaya; Bambang Setiyohadi; Sumariyono Sumariyono
Indonesian Journal of Rheumatology Vol. 2 No. 1 (2010): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

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.1â€“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.3â€“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.

Multiple autoimmune syndrome (Gravesâ€™ disease, systemic lupus erythematosus, and systemic sclerosis) in a young woman in Jakarta Sumartini Dewi; Bambang Setiyohadi; M I Mokoagow
Indonesian Journal of Rheumatology Vol. 2 No. 1 (2010): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Multiple autoimmune syndrome (MAS) is a condition in which patients have at least threedistinct autoimmune conditions. The definition of MAS is based on 91 reported cases of such associations in the literature. A review of the literature and cluster analysis of MAS disclosed systemic lupus erythematosus (SLE), SjÃ¶grenâ€™s syndrome, and autoimmune thyroid disease (AITD) as the â€œchaperonesâ€ of autoimmune diseases. This entity was described by Humbert and Dupond in 1988 as a syndrome consisting of the presenceof three or more autoimmune diseases in a single patient. While describing the syndrome, their observations led them to a rough classification of clusters based on the co-occurrence of autoimmune disease, which they identified as types one through three.1 In MAS-1, the authors grouped myasthenia gravis, thymoma, dermatopolymyositis, and autoimmune myocarditis together. In MAS-2, they grouped SjÃ¶grenâ€™s syndrome, rheumatoid arthritis,primary biliary cirrhosis, systemic sclerosis (SSc), and AITD. MAS-3 consists of AITD, myasthenia gravis and/or thymoma, SjÃ¶grenâ€™s syndrome, pernicious anemia, idiopathic thrombocytopenic purpura, Addisonâ€™s disese, type 1 diabetes, vitiligo, autoimmune hemolytic anemia, and SLE.1,2,3 The importance of this concept is the probability thathaving three autoimmune diseases simultaneously in one patient goes beyond epidemiological inferences or statistical chance. Disorders of autoimmune pathogenesis occur with increased frequency in patients with a history of another autoimmune disease. The tendency to develop another disease occurs in about 25% of these patients.3,4 We report a case in which the presence of Gravesâ€™ disease/AITD, SLE, vasculitis, and SSc with pulmonary hypertension and Raynaudâ€™s phenomenon in one patient

Risk of cardiovascular disease in rheumatoid arthritis patients A P Utari; Rudy Hidayat; Bambang Setiyohadi
Indonesian Journal of Rheumatology Vol. 3 No. 1 (2011): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Despite rheumatoid arthritis (RA) therapy development has been in advance level today, its mortality remains increasing in general population. The mortality is mainly caused by early-manifested atherosclerosis and other cardiovascular complications. Available evidences showthis condition appears in early stage of the disease. Thus, early detection and management of cardiovascular risk, followed by control of these factors are necessaryto reduce morbidity and mortality of RA patients

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 S C Widjanantie; A BM Tulaar; Yoga I Kasjmir; S B Prasetyo
Indonesian Journal of Rheumatology Vol. 3 No. 1 (2011): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

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.

Comparison of ultrasound therapy and local steroid injection in rotator cuff tendinitis Noviar Noviar; A BM Tulaar; Y I Kasjmir; S Sudarsono
Indonesian Journal of Rheumatology Vol. 3 No. 1 (2011): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Objective: To evaluate the effectiveness of ultrasound therapy compared with local steroid injection for pain relief and movement limitation in rotator cuff tendinitis.Methods: Patients with rotator cuff tendinitis at the rheumatology and rehabilitation outpatient clinic at Cipto Mangunkusumo General Hospital were enrolled in a parallel randomized trial, in which each eligible patient were randomly assigned to one of two groups: one group received 10 sessions of ultrasound therapy given in 2 weeks, the other received a single dose of local steroid injection. Evaluation of the visual analog scale(VAS) was performed in 10 days (5 days for each week: day 1â€“5 and 8â€“12), while evaluation of the abduction as well as external and internal rotation range of motion(ROM) was performed twice a week (day 2, 5, 9, and 12). Change in the variables between the two groups at the end of the second week (day 12) was then compared. Results: Thirty patients, divided into two groups consisting of 15 patients each, were recruited in the study. Significant decrease in VAS during the followups was obtained in both groups, slightly earlier in the steroid injection group (day 2; p = 0.041) comparedwith the ultrasound group (day 3; p = 0.001). Significant increase in abduction ROM was achieved at the same rate (beginning at day 5) in both groups. Significant increase in internal rotation ROM was achieved at day 9 in the ultrasound group (p = 0.043) and day 12 in steroid injection group (p = 0.044). The increase in external rotation ROM in both groups was not found to be statistically signifi cant. At the end of the second week, signifi cant difference between the two groups was only shown in the abduction ROM, with higherincrease in the steroid group.Conclusions: Ultrasound therapy provided a comparable effectiveness to steroid injection inalleviating pain and improving ROM in patients with rotator cuff tendinitis.

Comparison of the prevalence of hyperuricemia in families of patients with and without gouty arthritis among Balinese people Gede Kambayana; T R Putra
Indonesian Journal of Rheumatology Vol. 3 No. 1 (2011): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Background: Gout is a metabolic disorder caused by hyperuricemia, which results from changes in uric acid metabolism. Both internal (e.g., genetics) and external factors (e.g., diet, habits, comorbidities) play role in the occurrence of hyperuricemia and the difference of hyperuricemia prevalence in different populations.Objective: To compare the prevalence of hyperuricemia in families of gout and non-gout patients among Balinese people.Methods: This cross-sectional study was carried out at the rheumatology clinic at Sanglah Hospital, Denpasar. Samples were collected using consecutive method and consisted of gout and non-gout patients. Several characteristics (alcohol and purine consumption,medications, blood pressure, body mass index, serum uric acid level, and serum creatinine) in both groups were collected and compared. Family members (fi rstdegree relatives) of patients in each group were also recruited and had their serum uric acid level measured and compared.Results: A total of 46 patients and 116 family members (23 patients and 58 family members in each group) were enrolled. Among gout patients, there was signifi cantlyhigher prevalence of hyperuricemia, serum uric acid level, blood pressure, and serum creatinine; and lower creatinine clearance compared with the non-gout patients. There was signifi cantly higher prevalence of hyperuricemia among families of gout patients comparedwith families of non-gout patients (60.3 vs. 29.3%, respectively; p = 0.001), with a prevalence ratio of 2.06. Mean serum uric acid level of the family members of gout patients were also signifi cantly higher than the family members of non-gout patients (7.24 (SD 1.74) vs. 5.92 (SD 1.63) mg/dL, respectively; p = 0.000).Conclusion: Among Balinese people in this study, significantly higher prevalence of hyperuricemia and mean serum uric acid level was observed in families of gout patients compared with families of non-gout patients.

Diagnostic criteria of knee osteoarthritis in rheumatology outpatient clinic, Dr. Sardjito Hospital, Yogyakarta Nyoman Kertia; Deddy Nur Wachid; P N Krishnan
Indonesian Journal of Rheumatology Vol. 3 No. 1 (2011): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Background: Osteoarthritis (OA) is a chronic condition characterized by the breakdown of joints cartilage. Approximately 25% of persons 55 years of age or older have knee pain on most days and about half of them have radiographic OA in the knee. Prevalence of knee OA increases with age and it is more common in women than men. It is not easy to establish the diagnosis of knee OA since other knee disorders have similar clinicalsigns and symptoms.Objective: The purpose of this study was to observe the diagnosis pattern of knee OA in rheumatology outpatient clinic at Dr. Sardjito Hospital based on clinical and radiographic criteria of American College of Rheumatology (ACR). Method: The design of this study was cross-sectional. Data of the patients with knee OA were investigated from their medical records. Results: There were 212 subjects diagnosed with knee OA during the year 2000â€“2010. Most of the subjects (90.56%) were more than 50 years old. Women were more frequent affected by OA than men. All of the subjects (100%) had knee pain. Crepitus was found in98.11% subjects. Morning stiffness less than 30 minutes was found in 86.79% subjects. Osteophyte appearances were found in 79.72% subjects.Conclusion: Knee pain, crepitus, and age more than 50 years old were the most frequent criteria used to diagnose knee OA. Morning stiffness less than 30 minutes and osteophyte appearances were also frequent in knee OA.

Experience with cyclophosphamide in the treatment of a young woman with refractory dermatomyositis Bambang Setiyohadi; R Sinto
Indonesian Journal of Rheumatology Vol. 3 No. 1 (2011): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Dermatomyositis is an idiopathic inflammatory myopathy characterized by the presence of rash and moderate-to-severe muscle weakness secondary to inflammation of the muscle. It can be a difficult condition to treat. Systemic corticosteroids are the first choice of treatment. However, about a quarter of patients either fail to respond to steroids or develop steroid-related toxicity. Second-line agents such as azathioprine and methotrexate are then added either alone, or in combination with corticosteroids. Failure of the disease to respond tosecond-line agents can then be a problem and this is often referred to as â€œrefractory dermatomyositisâ€. Unfortunately, there is neither agreement nor wellestablished guidelines on the best regimen or combination of immunosuppressive agents in the case of refractory dermatomyositis.

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