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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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Sclerodermatomyositis M Febyani; H Purbo D; Laniyati Hamijoyo; E Sutedja; O Suwarsa
Indonesian Journal of Rheumatology Vol. 3 No. 1 (2011): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

The classification of rheumatic diseases is still challenging due to several reasons. First, those diseases have several differential clinical features, which giving overlap symptoms. Second, the etiopathogenesis of those diseases remains elusive.Diagnosis of overlap syndrome is made when there are more than one well-defined connective tissue diseases in one patient, which may develop simultaneously or sequentially.1,2 The prevalence of overlap syndrome among autoimmune diseases is25%.2 The term sclerodermatomyositis or scleromyositisis is used to describe an overlap syndrome in patients with scleroderma and dermatomyositis/polymyositis (DM/PM).2,3,4 Sclerodermatomyositis usually affects adults, and it is rarely found in children.4 The clinical features of this syndrome are myalgia or myositis, arthralgia, scleroderma-like skin changes, Raynaudâ€™s phenomenon (RP),2,3 interstitial lung disease, calcinosis,3 mask-like facies, dysphagia or esophageal dysmotility,4 as well as the presence of specific antibody Pm/Scl.2 Skin manifestations as the part of dermatomyositis include periorbital erythema and Gottronâ€™s papules.3 We report this case due to its very rare occurrence. According to medical records in the Department of Dermatology as well as Rheumatology at Hasan Sadikin Hospital, Bandung, this is the first case recorded in the last 10 years.

Septic arthritis in malignancy Bambang Setiyohadi; D Santosa; Titis Titis; A A Abdullah
Indonesian Journal of Rheumatology Vol. 3 No. 1 (2011): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Septic arthritis is an infection of a joint, which canbe caused by bacteria, viruses, fungi, or parasites. The infection may happen in distant sites of the body, which then spread hematogenously, or it could also result from open wounds, surgery, or unsterile injections.1 Septic arthritis is a serious condition that, if left undiagnosed and untreated, can cause joint destruction and an irreversible loss of joint function.2,3 Based on epidemiological data, the incidence of septic arthritis in general population is 2â€“10 cases in 100,000 people annually and is increased in those who have risk factors for septic arthritis, such as rheumatoid arthritis (RA) and joint prosthesis. In those with RA, the incidence of septic arthritis rises up to 30â€“70 cases in 100,000 people annually, and in those with prosthesis the figure is around 40â€“68 cases in 100,000 people annually.4,5 Septic arthritis can affect all age groups, but it is more prevalence in the elderly and in children under 5 years old, in which the prevalence is 8.4 and 5 cases, respectively, in 100,000 people annually.5 Septic arthritis is usually monoarticular, whereas polyarticular involvement occurs in only 10â€“15% of cases. The knee is involved in around 50% of cases.Septic arthritis is still a challenge for cliniciansince there has not been a significant decline in both morbidity and mortality in the last two decades.2 Late recognition and therapy can cause permanent joint dysfunction and even death; thus, early diagnosis and prompt therapy is expected to decrease the morbidity and mortality rate in septic arthritis.6 In this case report we would like to present a case of a woman suffering from septic arthritis with an underlying immunocompromised condition of malignancy

Pathogenesis of atherosclerosis in rheumatoid arthritis Joko Rilo Pambudi; Harry Isbagio
Indonesian Journal of Rheumatology Vol. 5 No. 1 (2014): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Increased morbidity and mortality in patients with rheumatoid arthritis (RA) is largely associated with cardiovascular disease. In this case, the factors that play a role is chronic inflammation. A chronic inflammatory associated with condition which accelerate atherosclerosis and increased cardiovascular morbidity and mortality. Inflammatory and atherogenic mediators have a role in pathogenesis of RA and atherosclerosis. Atherogenesis in RA start when cytokines from the inflamed synovial tissue are released into the systemic circulation. Circulating cytokines affects the function of other tissues such as adipose tissue, skeletal muscle, liver and vascular endothelium that would lead to proatherogenic transformation process such as insulin resistance, prothrombotic effects, pro-oxidative stress and endothelial dysfunction. Size, weight and durationof systemic inflammatory response in RA are the most important factor causing damage. IMT (Intima Media Thickness) measurement on common carotid arteries byB-mode ultrasound is a rapid non-invasive examination of the structural anatomy, reproducible and relatively low risks that are advantageous for assessing therisk of cardiovascular disease and monitoring disease progression.

Association Between Adiponectin Levels with Markers of Atherosclerosis In Patients with Rheumatoid Arthritis Tanggo Meriza; Harry Isbagio; Rahmad Mulyadi; Murdani Abdullah
Indonesian Journal of Rheumatology Vol. 5 No. 1 (2014): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Background: Several studies have shown that atherosclerosis underlying processes of Cardiovascular disease (CVD), increased in rheumatoid arthritis (RA) and occurred early (premature). The cause of accelerated atherosclerosis in RA are still unknown.Adipokines have known that the adipokines play a role in the pathophysiology of RA and CVD. Accumulation of visceral fat associated with dysregulation of adipokinesthat influence the development of the atherosclerotic and disruption plaque. Obesity and pathological changes in fat mass and fat dysfunction as well as a change inthe pattern of secretion of proinflammatory adipokines, may have a correlation between heart disease and rheumatic diseases. Adiponectin is one of the mostwidely-studied adipokines. In RA, adiponectin is involved in the pathophysiology of RA that produces of various proinflammatory and prodestructive molecules. So far, adiponectin has been known to provide antiatherosclerotic effects in patients with non-RA. But, several recent studies in RA patients get opposite results in which increased levels of adiponectin are associated with increased prevalence of atherosclerosis. The effect of adiponectin on atherosclerosis in patient with RA is still unknown.Objective: to determine the relationship of adiponectin with atherosclerosis in patients with rheumatoid arthritis. Methods: This is a cross-sectional study conducted on outpatients of theÂ rheumatology clinic at Cipto Mangunkusumo General Hospital from January untilApril, 2013. Subjects consisted of 50 patients were diagnosed based on ACR 1987/EULAR 2010 criteria. The collection of data obtained by consecutive sampling and evaluated the patientsâ€™ medical data that included age, long-suffering of RA, body mass index (BMI), lipid profile, rheumatoid factor levels, levels of anti-cyclic citrullinated peptide (anti-CCP), C-reactive protein (CRP), erythrocyte sedimentation rates (ESR), blood pressure, fasting blood glucose, 2 hour post prandial blood glucose, ECG, examination of serum adiponectin levels and bilateral carotid ultrasound to measure the carotid artery intima media thickness.Results: From the results of the 50 patients studied, obtained 28 (56%) of patients had increased levels of adiponectin. Atherosclerosis was found in 13 (26%) subjects. The median value was 9.46 Î¼g / ml with the lowest levels of 4 Î¼g/ml and the highestlevels of 24Î¼g/ml. The Spearmanâ€™s test showed no significant correlation between adiponectin serum and atherosclerosis in patients with RA (p = 0706 and r = 0.055). The analysis results of the correlation of adiponectin with atherosclerosis based on age, disease duration, ESR, rheumatoid factor, DAS 28, CRP, BMI, dyslipidemia showed no significant correlation.Conclusion : From this study, researchers found no statistically significant correlation between adiponectin levels with marker of atherosclerosis (CIMT) in patients with rheumatoid arthritisKeywords : Adiponectin, Atherosclerosis

The Effect of Vitamin D Supplementation on Disease Activity and Neutrophyl-Lymphocyte Count Ratio in Systemic Lupus Erythematosus Patients with Hypovitaminosis D : A Preliminary Study Y Maslim; Sumartini Dewi; A Oehadian; Rachmat Gunadi Wachjudi
Indonesian Journal of Rheumatology Vol. 5 No. 1 (2014): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Background : Previous studies showed a significant role of Vitamin D in modulating inflammation and immune abnormality in SLE. The correlation between vitamin D supplementation and SLE disease activity remains controversy. Neutrophyl-Lymphocyte count Ratio (NLCR) as an inflammation marker was significantly increased in SLE patients.Objective : To evaluate the effect of vitamin D supplementation on disease activity and neutrophyllypmhocyte count ratio (NLCR) in SLE patients with hypovitaminosis D.Methods : This is a pre-post test study without control group using a consecutive sampling method. SLE patients were enrolled from Rheumatology Clinic of HasanSadikin General Hospital from November 2013-March 2014. Subjects received vitamin D3 2000 IU/day for 3 months. Data was analyzed using Wilcoxon test.Results : We analyzed 28 subjects with 89,3% of vitamin D deficiency and 10,7% of vitamin D insufficiency, which converted to 25% of vitamin D deficiency, 32,1% vitamin D insufficiency and 42,9% normal vitamin D plasma level at the end of the study.After supplementation, Mexican Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI) and NLCR was significantly decreased (median 4(3-8) to 2(0-6) and median 2,95(1,17-7,27) to 2,28 (1,07-4,87), p<0,001, respectively). SLE organ involvement such as mucocutan, hematology and renal also high BMI (>23 kg/m2) were risks of hypovitaminosis D. Vitamin D supplementation increased mean 25(OH)D serum level by 164,7%, 46,7% decreased of MEX-SLEDAI, and 24,2% decreased of NLCR (p<0,001). Nine subjects (32,1%) achieved remission, 19 subjects (67,9%) atdisease persistence and no subjects experienced flare up after supplementation.Conclusion : The effects of vitamin D3 2000 IU/day supplementation for 3 months are reduced disease activity and NLCR in SLE patients with hypovitaminosisD. The role of NLCR as a simple inflammation marker in this pilot study needs further investigation.

Correlation between Severity of Knee Osteoarthritis and Serum Levels of Cartilage Oligomeric Matrix Protein Gede Kambayana; Pande Kurniari; Andriyasa Andriyasa; T R Putra
Indonesian Journal of Rheumatology Vol. 5 No. 1 (2014): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Background: The sensitivity of radiographic examination in the diagnosis and severity assessment of knee osteoarthritis (OA) is still low. Various attempts have been made to find more reliable indicators of cartilage damage. One potential marker is cartilage oligomeric matrix protein (COMP), a substance that in previous animal studies had been shown to be released in proportion to the extent of joint cartilage damage.Objective: To evaluate the correlation between the severity of knee OA and serum level of COMP in human with normal renal function. Methods: This was a cross-sectional study performed at the outpatient clinic in Department of Internal Medicine, Sanglah Hospital, Denpasar. The diagnosis of knee OA was based on the American College of Rheumatology (ACR) criteria. The degreeof knee OA severity was determined by using the Kellgren-Lawrence criteria, while COMP values were checked by enzyme-linked immunosorbent assay (ELISA) method.Results: Forty five patients who were recruited were examined: 19 (42.2%) were female and 26 (57.8%) were male. The mean age of patients was 64.1Â±7.1 years. There were 4.4%, 26.7%, 46.7%, and 22.2% patients who had grade 1st, 2nd, 3rd, and 4th degree joint damage based on the Kellgren-Lawrence score, respectively. Mean serum level of COMP was 1081.4 ng/mL. We found a significant correlation ofthe severity of knee OA with serum level of COMP (r = 0.41, p = 0.005).Conclusion: Among the patients in this study, there was a significant correlation between the severity of joint damage in knee OA and serum level of COMP.

Osteoarticular Tuberculosis: A Secondary Manifestations to Tuberculous Pleural Effusion Gurmeet Singh; Cleopas M Rumende; Bambang Setyohadi
Indonesian Journal of Rheumatology Vol. 5 No. 1 (2014): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Tuberculosis appears to be increasing throughout the world after years of continuous decline, despite the introduction of effective chemotherapy. This resurgence is related to the increasing number of patients immunocompromised by chemotherapeutic agents used to treat other diseases or Acquired Immunodeficiency Syndrome (AIDS); the appearance of multiple drug-resistant strains of tuberculosis, and aging population. Musculoskeletal tuberculosis arises from haematogenous seeding of the bacilli soon after the initial pulmonary infection.1 Osteoarticular TB can occur in the knee - one study found of 1074 cases, 8.3 percent - or 90 cases - affected the knee.2 The clinicalÂ symptoms are insidious onset, pain, swelling of the joint and limited range of movements. Investigations for suspected cases include: Mantoux test, radiological imaging, fine needle aspiration biopsy, surgical biopsy, bacteriological examination, histopathological examination, and polymerase chain reaction (PCR) of a suitable specimen. The mainstay of treatment is multidrug antitubercular chemotherapy. The main reason for poor outcome is delayed diagnosis.1 We report a case of osteoarticular manifestation of tuberculosis infection affecting the left knee presenting in a man with a history of tuberculosis pleural effusion. This case highlights, firstly, osteoarticular disease is always secondary to a primary lesion in the lung and, secondly, the diagnosis of tubercular arthritis can be challenging, particularly in the presence of confounding factors such as preexisting arthritis. Ethical approval was not required for this case study.

Chronic Osteomyelitis of Wrist Joint in An Immunocompromised Host Amanda P Utari; Dina Oktavia; Sumaryono Sumaryono; Bambang Setyohadi
Indonesian Journal of Rheumatology Vol. 5 No. 1 (2014): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Osteomyelitis is heterogenous in its pathophysiology, clinical presentation, and management. Osteomyelitis is generally categorized as acute or chronic based on histopathologic findings, rather than duration of the infection. Necrotic bone ispresent in chronic osteo-myelitis, and symptoms may not occur until six weeks after the onset of infection.1 Epidemiology of chronic osteomyelitis is less well characterized compared with acute osteomyelitis. Adult osteomyelitis most commonly arisesfrom open fractures, diabetic foot infections, or the surgical treatment of closed injuries. HematogenousÂ osteomyelitis accounts for approximately 20% of cases of osteomyelitis in adults. It is more common in males regardless of age. Although rare in adults,it most frequently involves the vertebral bodies.2 S.aureus is the most common isolate in all types of bone infection and is implicated in 50-70% of cases of chronic osteomyelitis.3

Avascular necrosis of the right femoral head in female patient with Systemic Lupus Erythematosus A Sinaga; H Nufus; Bambang Setiyohadi
Indonesian Journal of Rheumatology Vol. 5 No. 1 (2014): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Avascular necrosis (also known as osteonecrosis, aseptic necrosis, or ischemic necrosis) represents collection of pathologic conditions from various etiologies causing impairment of blood supply to particular bone resulting in bone cellular death.Avascular necrosis remains a significant cause of morbidity in patients with systemic lupus erythematosus (SLE).1 It often involves multiple joints in SLE, in which the femoral head is involvedin most of these patients. Corticosteroids use is known as a major risk factor in the development of this complication.2-3 We report this case due to its quite common occurrence in SLE patients. The early recognition of avascular necrosis is essentialto prevent morbidity

Do we need to perform bilateral hip bone mineral density examination? Annisa Layalia Widjanarko
Indonesian Journal of Rheumatology Vol. 8 No. 2 (2016): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Background: Bone mineral density (BMD) measurement is one of the method for making osteoporosis diagnosis. World Health Organization (WHO) recommends the measurement of BMD conducted at antero-posterior lumbar vertebrae, unilateral hip (femur), and radius. However, there was a concern about osteoporosis under diagnosis if the measurement is only conducted at unilateral hip. Some studies found significant differences of BMD between both femur and evidence of the importance to examine both femur in making the diagnosis of osteoporosis. This study aims to determine anydifference between right and left femur BMD measurement and to investigate the bone status result with measurement of BMD of bilateral femur in Hasan Sadikin General Hospital. Methods: A retrospective study was conducted from June to November 2015. Patients who received dual-femur BMD testing using General Electrics (GE) Lunar Prodigy dual-energy x-ray absorptiometry at the DXA Facility in Hasan Sadikin General Hospital,Bandung between January 1, 2006 to December 31, 2014 were included. Statistical analysis performed to assess the difference and the correlation between theBMD of two femurs (g/cm2). T-scores of the subject were implemented into bone status according to WHO Diagnostic Criteria for Osteoporosis.Results: From sixty-one patients included in this study, there were difference bone status resulted from BMD of the femoral neck, Wardâ€™s triangle, trochanter, andtotal hip area between right and left femur, although no statistically significance were found. There was a positive correlation between BMD of right and left femurat all areas of femur. There were 16 subjects (26.1%) showed combination level of bone status (normal, osteopenia, or osteoporosis in one femur).Conclusion: BMD results in each area of the right and left femurs are different.Therefore, performing bilateral hip BMD examination as a routine measurement for makingdiagnosis of osteoporosis is important.Keywords: Bone Mineral Density, Dual-energy X-ray Absorptiometry, Femur, Osteoporosis

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