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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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Osteomalacia Induced by Renal Tubular Acidosis Type 1 Steven Sutanto Sihombing; Anna Ariane; RM Suryo Anggoro Kusumo Wibowo; Bambang Setyohadi
Indonesian Journal of Rheumatology Vol. 9 No. 2 (2017): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Renal Tubular Acidosis, a group of disorders characterized by defective renal acid-base regulation, can impair mineralization of bone matrix in adults known as osteomalacia. RTA is classified into 3 major forms, such as proximal RTA or type 2; distal RTA or type 1; and hyperkalemic RTA or type 4. Among all type of RTA, proximal RTA or type 2 is known have association with Fanconi syndrome and bone involvement. However, distal RTA or type 1 can also cause osteomalacia. Hereby we report a case of 22 years old Asian woman who wasfirstly diagnosed with distal type RTA several years ago then started developing bone involvement recently. She was complaining with low back pain due to fracture on left medial side of inferior pubic ramus and endplate fracture on right side superior L4 and BMD examination showed low mineral density. She was diagnosed with osteomalacia induced by distal type RTA due to the loss of calcium salts from bone and hypophosphatemia.Keywords: Osteomalacia; Renal Tubular Acidosis; Hypokalemia; Hypophosphatemia

Diagnosis and management of osteomyelitis Gunawan Gunawan; Bambang Setiyohadi
Indonesian Journal of Rheumatology Vol. 2 No. 2 (2010): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Osteomyelitis is an infection of the bone that causes bone destruction and formation of new bone as the result of the infl ammatory process. Proper diagnosis in osteomyelitis is important since it determines the decision-making in the management of the disease: whether to perform aggressive treatments or administration of long-term antibiotic treatment. Imaging techniques play an important role in the diagnosis of osteomyelitis, but their results should be interpreted with care as they have a wide range of sensitivity and specifi city. A combination of imagingtechniques could improve their sensitivity and specifi city. Conventional radiography is an affordable and widely available technique, and has been proven to be usefulÂ in diagnosing and excluding the differential diagnosesof osteomyelitis. Surgical intervention to remove necrotic tissues and administration of antibiotics to eradicate pathogens are necessary in the anagementof osteomyelitis. Several antibiotics such as quinolones,rifampin, and clindamycin have been proven to havegood penetration into bone.

Tuberculous arthritis: an overview Laniyati Hamijoyo
Indonesian Journal of Rheumatology Vol. 2 No. 2 (2010): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Tuberculous arthritis is a part of tuberculosis infection. Although the number of this disease is very small compared to the other causes of muskuloskeletal infection, it can cause joint damage and eventually disability to the patient. Tuberculous arthritis should always be considered as one of the differential diagnosis in cases with insidiously developed monoarticulararthritis of the large weight-bearing joints, especially in developing countries where there is a high prevalence of tuberculosis. Early recognition and treatment with antituberculosis drugs provide better outcome for the patient; however, surgery due to unresponsiveness to medical treatment or presence of large abscess,arthroplasty, and arthrodesis may be necessary.

Role of diacerein in pain intensity and functional status in patients with knee osteoarthritis Yoga I Kasjmir; F Imelda; L Erawati
Indonesian Journal of Rheumatology Vol. 2 No. 2 (2010): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Background: Infl ammation is an important mechanism in the pathogenesis of osteoarthritis (OA). Proinfl ammatory mediators, especially interleukin-1Î² (IL-1Î²), play a signifi cant role in the occurrence of joint infl ammation, which lead to pain and limitation of daily activities. As an antiâ€“IL-1Î², 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-1Î² 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-1Î² 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-1Î² level. The median baseline VAS score was 65.00 (range 25â€“100) while the median baseline Lequesne score was 11.00 (range 1.5â€“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-1Î² 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.

Reliability and validity of European Quality of Life 5 Dimension (EQ-5D) for measuring health-related quality of life in knee osteoarthritis patients at Cipto Mangunkusumo General Hospital A Pramono; Sumariyono Sumariyono; Harry Isbagio
Indonesian Journal of Rheumatology Vol. 2 No. 2 (2010): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Background: Quality of life is very important to knee osteoarthritis (OA) patients. The term quality of life denotes one that is health-related. One of the questionnaires most frequently used to measure the quality of life is the European Quality of Life 5-Dimension (EQ-5D) questionnaire. At Cipto Mangunkusumo General Hospital, until today there has not been any instrument for measuring the health-related quality of life in knee OA patients that has been tested for its reliability and validity.Objective: To prove the reliability and validity of EQ-5D as a measurement tool inÂ determining the healthrelated quality of life in knee OA patients at Cipto Mangunkusumo General Hospital.Methods: This is a validity study in which all patients were asked to complete both the EQ-5D form and 36- item short form (SF-36) on their fi rst visit. They were subsequently asked again to complete only the EQ-5Dform one week after their fi rst visit.Results: Data were obtained from 86 respondents.The value of the intraclass correlation coeffi cient of each EQ-5D dimension, EQ-5D index, and visual analogue scale (VAS) was excellent (>0.75). Cronbachâ€™s Î± value for internal consistency reliability in this study was0.6772 (<0.7). The external validity of EQ-5D compared to SF-36 was analyzed with the Pearsonâ€™s correlation test and revealed a signifi cant correlation (p<0.01) of all EQ-5D dimensions, EQ-5D index, and EQ-5D VAS with total score of SF-36 except for the dimensions of self-care, pain, and anxiety/depression. The construct validity of EQ-5D showed that all of the dimensions were signifi cantly correlated with the EQ-5D index (p<0.01) except for self-care dimension.Conclusion: EQ-5D is a valid and reliable measurement tool. It is thus recommended for measuring the healthrelated quality of life in knee OA patients at CiptoMangunkusumo General Hospital.

Correlation of interleukin-17 with disease activity and hand joint damage in patients with rheumatoid arthritis Jeffrey Arthur Ongkowijaya; Bambang Setiyohadi; Ida Ayu Ratih Wulansari Manuaba; Yoga I Kasjmir
Indonesian Journal of Rheumatology Vol. 2 No. 2 (2010): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Background: Rheumatoid arthritis (RA) is a disease involving various types of cytokines. One of them is interleukin-17 (IL-17), which is known to have a pleiotropic effect on various of cells and is thought to be a cytokine effector contributing to the pathogeniccondition in RA.Methods: The study was conducted on 46 RA patients at rheumatology clinic at the Cipto Mangunkusumo General Hospital who were diagnosed based on the 1987 American College of Rheumatology criteria. Sample selection was done using consecutive sampling. Tests on patients were conducted to collect data needed to obtain the scores for 28-joint Disease Activity Score (DAS28), global health visual analogue scale, swollen joint count, tender joint count, sedimentation rate, Sharp score (radiograph of both hands), and the IL-17 level.The correlation between IL-17 level and DAS28 wasÂ calculated using the Pearsonâ€™s correlation test while the correlation between IL-17 level and Sharp score was calculated using the Spearmanâ€™s test.Results: The majority of patients (87%) were women. The largest percentage was in the 51- to 60-year-old group (39.1%). Most patients (43.1%) had moderate disease activity. There were 27 patients (58.69%) with positive rheumatoid factor. The mean IL-17 level was17.28 pg/mL with a standard deviation of 11.43 pg/mL. There was no correlation of IL-17 level with disease activity (p = 0.446, r = 0.021) and Sharp score (p = 0.304, r = 0.077) in subjects of this study.Conclusion: There was no signifi cant correlation of IL-17 with disease activity and joint damage.

Prevalence of antiâ€“C-reactive protein autoantibody and its correlation with disease activity in systemic lupus erythematosus patients at Cipto Mangunkusumo General Hospital Lusiani Lusiani; Bambang Setiyohadi; N Sukmana; M Abdullah
Indonesian Journal of Rheumatology Vol. 2 No. 2 (2010): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Background: Systemic lupus erythematosus (SLE) is a complex autoimmune disease with various underlying mechanisms characterized by autoantibody overproduction. It has been known that mortality and morbidity of SLE was higher in Asian patients compared with white patients. Several studies had showed that C-reactive protein (CRP) has the ability to suspend the progression of SLE through regulatory and clearance pathway, and low level of CRP and high level of anti-CRP antibody has been detected in SLE patients. A question raise whether mortality and morbidity in Asian SLE patients are associated with anti-CRP antibody.Objective: To study the prevalence of anti-CRP antibody and its relationship with disease activity in SLE patients at Cipto Mangunkusumo General Hospital,Jakarta.Methods: This is a cross-sectional study conducted at Cipto Mangunkusumo General Hospital from December 2009 until May 2010. Subjects were SLE patients whowere diagnosed based on the 1982 American College of Rheumatology criteria. Disease activity was measured using the Mexican SLE Disease Activity Index scoringsystem. Anti-CRP antibody assay was performed using the Western blot analysis. Correlation between the presence of anti-CRP antibody and disease activitywas evaluated using the T-test and multivariate logistic regression analysis.Result: Forty SLE patients with a mean age of 31.65 (SD 8.84) were enrolled in the study, 33 of which (82.5%) had positive autoantibody to CRP pentamer. The anti-CRP antibody was signifi cantly correlated (p = 0.024) with disease activity. Conclusions: There was a relatively large proportion of patients with positive anti-CRP antibody among SLE patients in Cipto Mangunkusumo General Hospital. Therewas also a signifi cant correlation between anti-CRP antibody and the disease activity.

Invasive aspergillosis in a systemic lupus erythematosus patient Bambang Setiyohadi; M S Azizi; Ika Wulan Yuliani; N Sukmana; Suhendro Suhendro; M Simadibrata; C Matin Rumende; A S Sulaiman; R Wahyuningsih; Lisnawati Lisnawati; M A Yudharto; N Anggraini; F Oktaviana; R Sandra
Indonesian Journal of Rheumatology Vol. 2 No. 2 (2010): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Systemic lupus erythematosus (SLE) is an autoimmune disease with a broad clinicalmanifestation characterized by production of antibodies against cellular nuclear components. The prevalence of SLE among many countries is variable, ranging from 2.9 to 400 per 100,000. In Cipto Mangunkusumo General Hospital, the incidence of SLE between 1990 and 1998 is 37.3 per 10,000 hospitalization.1 Patients with autoimmune disease have at least twofold risk of acquiring infections compared with healthy individuals. This may be due to the immunosuppresant therapy but could also caused by the primary immune dysregulation that was the basis for the pathogenesis of their disease, or other autoimmune disease manifestations such as lymphopenia.2 Infection is the main factor increasing the mortality and morbidity of SLE patients. A study in New York conducted between 1966 and 1976 involving 223 SLE patients reported 150 cases of infection, of which 23 were opportunistic infection: 12 were candidiasis while 11 others were deep fungal infection. The use of corticosteroids in SLE is the main factor that predispose patients to infection, particularly fungal infection.3 Aspergillosis is the term used to denote all disease caused by any one of the pathogenic and allergenic species of Aspergillus. The annual incidence of aspergillosis in the United States is reported to be 1â€“2 per 100,000.4 Aspergillus fumigatus is the cause of most cases of invasive aspergillosis, almost all cases of chronic aspergillosis, and most allergic syndromes. The mortality rate of invasive aspergillosis is 50% when properly diagnosed and treated; otherwise it could be as high as 100%

Tuberculous osteomyelitis in an immunocompetent patient with miliary tuberculosis Gunawan Gunawan; A Harahap; Bambang Setiyohadi; Cleopas Martin Rumende
Indonesian Journal of Rheumatology Vol. 2 No. 2 (2010): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Osteomyelitis is an infection of the bone, which may be caused by direct pathogen inoculation following trauma of surgery, contiguous spread from adjacent soft tissue or joint, or hematogenous spread from a focus of infection. Hematogenous osteomyelitis accounts for 20% of all cases of osteomyelitis.1 This type of osteomyelitis most often affect the long bones and vertebrae, although it could also affect other sites such as pelvic bones or clavicle.1 Mycobacterium tuberculosis is one of the causes of hematogenous osteomyelitis,comprising of 10 to 35 percent of extrapulmonary tuberculosis, or 2% of all tuberculosis cases.2,3 Joint involvement, when occur, is usually monoarticular, and mainly affect the weight-bearing joints such as hip or knee. Polyarticular cases occur in 10â€“ 15% of extrapulmonary tuberculosis cases in developing countries.4 Tuberculous osteomyelitiscases are reported to be decreasing in number, probably because of earlier diagnosis and promptmanagement. In this article we report a case oftuberculous osteomyelitis in a patient with miliary tuberculosis

Prevalence and factors associated with vitamin D deficiency in systemic lupus erythematosus patients Y Pangestu; S Setiati; Bambang Setiyohadi; N Sukmana
Indonesian Journal of Rheumatology Vol. 4 No. 1 (2013): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Background: In addition to the calcium-phosphorus metabolism, vitamin D might also play a role in the immune system. Studies have showed lower levels of vitamin D among SLE patients compared with controls. Researches regarding vitamin D in SLE patients have only been conducted in four seasonsâ€™ countries (Caucasians subjects in a large part) , but no data has been available in tropical countries, particularly Indonesia. The presence of VDR gene polymorphism in different populations will affect the role of vitamin D in the immune system. Objectives: To determine the prevalence of vitamin D deficiency and identify its risk factors such as lack of sunlight exposure, sunscreen usage, long-term corticosteroid therapy, disease activity, insufficient vitamin D supplementation, and obesity in SLE patientswith vitamin D deficiency.Methods: A cross-sectional study was conducted on SLE patients who were under treatment at Cipto Mangunkusumo General Hospital or members of Indonesian Lupus Foundation. Then those patients completed questionnaires and their 25(OH)D serum levels were measured. The cut-off value of 25(OH) D levels for vitamin D inadequacy is 75 nmol/L, which then grouped into vitamin D insufficiency (25(OH)D 25 - <75 nmol/L) and vitamin D deficiency (25(OH)D <25 nmol/L). SLE activity was assessed with MEX-SLEDAI.Results: During May-June 2008, 80 SLE patients were enrolled with 96.3% female subjects, median age of 26 years (range 17-56 years), 66.3% non-obese, 93.8% using steroid, 62.5% with active disease, and 63.8%have adequate sun exposure. In addition, 81.5% didnot use sunscreen and 83.8% did not take vitamin D supplementation. All patients had vitamin D inadequacy with 41.2% in insufficiency level and the other 58.8% in deficiency level. The median of 25 (OH)D levels were 21.85 nmol/L (range 11.5-57.7 nmol/L). It also has been found that vitamin D deficiency occurred more in subjects who were obese, used sunscreens, had lower exposure to sunlight, in a long-term high-dose steroid therapy, had active SLE disease, and had no vitamin D supplements.Conclusions: All SLE patients had vitamin D inadequacy. Vitamin D deficiency occurred more in subjects who were obese, used sunscreens, had lower exposure to sunlight, in a long-term high-dose steroid therapy, had active SLE disease, and had no vitamin Dsupplements.

Page 17 of 26 | Total Record : 252

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