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INDONESIA
Indonesian Journal of Rheumatology
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.
Arjuna Subject : -
Articles 252 Documents
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The Correlation Value of DAS28 with Anti-CCP Titer on Rheumatoid Arthritis Patients in Cipto Mangunkusumo Hospital in 2012-2016 Deka Yuli Fadillah; Harry Isbagio
Indonesian Journal of Rheumatology Vol. 10 No. 2 (2018): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (197.268 KB) | DOI: 10.37275/ijr.v10i2.139

Abstract

Background: Rheumatoid Arthritis (RA) is one of the diseases associated with the immune system which causes joint damage and effect to the quality of patient’s life. DAS28 CRP value describes RA disease activity. The anti-CCP titer is a very specific examination which provide an overview prognosis of RA patient’s illness. The research on the correlation of anti-CCP Titers with DAS28 CRP values has never been done in Indonesia. Therefore, this research aims to determine the correlation between anti-CCP Titer and DAS28 CRP value in RA patient in Cipto Mangunkusumo hospital with DAS28 CRP value in RSCM. Method: The research design is cross-sectional with the sample amounted to 34. anti-CCP and DAS28 CRP were obtained through patient’s medical records.Result The result of this correlationstudy is (p = 0,582) and r = 0,086. Conclusion: In conclusion, there is no correlation between anti-CCP and DAS28 in Cipto Mangunkusumo hospital. Keywords: Anti-CCP; DAS28 CRP; Rheumatoid Arthritis
Comparison between Mycophenolate Mofetil and Azathioprine for Preventing Renal Relapse in Lupus Nephritis: An Evidence-based Case Report Muhammad Aji Muharrom; Bambang Setiyohadi
Indonesian Journal of Rheumatology Vol. 10 No. 2 (2018): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (329.406 KB) | DOI: 10.37275/ijr.v10i2.140

Abstract

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease which involved many organs. One of its severe manifestations is lupus nephritis (LN). Treatment of LN consists of two phases, induction and maintenance. Inappropriate treatment approach could increase morbidity and mortality in LN patients. Renal flare is among many bad outcomes of LN that should be mitigated with an appropriate therapeutic approach. Various guidelines stated usage of mycophenolate mofetil (MMF) or azathioprine (AZA) as an appropriate immunosuppresant in the maintenance phase. However, it is not clear which agent acts best in preventing renal flare. This paper presents a case of 21 years old SLE female patient with history of renal flare 1 month prior to admission. This study aimed to give evidence-based recommendation to adjust this patient’s therapy in order to prevent future renal flare episode. Method: Literature search was done on four online databases, namely PubMed, EBSCO, Cohrane Library, and ProQuest. Articles with randomized clinical trial (RCT), systematic review and meta-analysis study design were retrieved and selected based on inclusion and exclusion criterias. Critical appraisal was done using appraisal sheet provided by Oxford Centre of Evidence-based Medicine. Articles were appraised based on its validity, importance, and applicability.Results: There were 144 articles retrieved from literature searching. Further screening and full-text reading yields to 2 RCTs and 2 meta-analysis that were critically appraised. Both meta-analysis were satisfactory on their validity, while none of RCTs found were blinded studies. Both meta-analyses showed pooled risk ratio (RR) of0.70 (0.49 – 1.00) for renal flare outcome in the use of mycophenolate mofetil compared to azathioprine. Conclusion There are no significant differences between mycophenolate mofetil and azathioprinein prevention of renal flare. Based on applicability, azathioprine is more appropriate to be given in this patient, in accordance to her background.Keywords : Lupus Nephritis, Renal Flare, Mycophenolate Mofetil, Azathioprine, Systemic Lupus Erythematosus
Correlation between Anti-CCP Titer and Body Mass Index Score in Rheumatoid Arthritis Patients in Cipto Mangunkusumo Hospital Khadijah Fitriah; Harry Isbagio
Indonesian Journal of Rheumatology Vol. 10 No. 2 (2018): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (222.04 KB) | DOI: 10.37275/ijr.v10i2.141

Abstract

Background: Rheumatoid Arthritis (RA) is a chronic systemic inflammation that attacks and damages joints of upper and lower extremities. RA causes morbidity and disability, hence, affects the quality of life. Chronic inflammation, as the disease progressing causes lowering of body mass index in RA patients. Titer of anti-CCP is specific for RA which indicates the progressivity and severity of the disease. Study about anti-CCP titer and body mass index has not been done in Indonesia. Therefore, this study done to understand the correlation between anti-CCP titer and body mass index score in rheumatoid arthritis patients in Cipto Mangunkusumo hospital. Method: The design of this study is cross-sectional study with 42 samples. The data included anti-CCP titer, body weight, height, and body mass index are collected from patients’ medical records. Results: RA patients in Cipto Mangunkusumo hospital in 2012-2016 with negative and positive anti-CCP titer consecutively are 28.6% and 71.4%. The result of this correlation study is p>0.05; r-0.03. Conclusion: In conclusion, there is no correlation between anti-CCP titer and body mass index score in RA patients in Cipto Mangunkusumo hospital Keywords: Anti-CCP; Body Mass Index; Rheumatoid Arthritis
Correlation Between Cognitive Function with Disease Activity of Systemic Lupus Erythematosus Patients in Dr. Hasan Sadikin Hospital Bandung: An Analytical Cross-Sectional Study Aep Saepudin; Paulus Anam Ong; Syarief Hidayat; Andri Reza Rahmadi; Laniyati Hamijoyo
Indonesian Journal of Rheumatology Vol. 11 No. 1 (2019): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v11i1.142

Abstract

Background: Cognitive dysfunction was found in 55-80% Neuropsychiatry Systemic Lupus Erythematosus (NPSLE) patients. Serious concern from clinicans was needed as its impact to patient’s quality of life. Disease activity is expected to be affecting patient’s cognitive function. Previous studies regarding correlation between disease activity and cognitive dysfunction showed various results. This study aimed to evaluate the correlation between disease activity and cognitive function in SLE patients.Methods: This study is an analytical cross-sectional study. Subjects were SLE patients at the rheumatology clinic of Dr. Hasan Sadikin Hospital Bandung during June-August 2017. Subject’s evaluations included disease activity assessment using SLE disease activity index-2K (SLEDAI-2K) and cognitive function assessment using MoCA-Ina test. Data were analyzed by using Spearman Rank correlation test. Results: Mean age of the subjects was 31 ± 8 years old, most of them were senior high school graduates (65.8 %) and median length of study was 12 years. Subject’s median duration of illness was 44 months. Their MoCA-Ina median score was 25, while SLEDAI-2K median score was 6. Cognitive dysfunctions were found in more than half of subjects (52.63%), which memory domain (78.95%) was most frequently impaired. Most of subjects were patients with active SLE (63.2%). Correlation test showed there was no correlation between SLEDAI-2K score and MoCA-Ina score (rs=0.023, p=0.445).Conclusion: There was no correlation between disease activity (SLEDAI-2K score) and cognitive function (MoCA-Ina score). Keywords: Cognitive dysfunction, MoCA-Ina, Systemic lupus erythematosus, SLEDAI-2K
Effect of Folic Acid Supplementation for Reducing Methotrexate Side Effects in Patients with Rheumatoid Arthritis: an Evidence-based Case Report Athira Presialia; Bambang Setyohadi
Indonesian Journal of Rheumatology Vol. 12 No. 2 (2020): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v12i2.113

Abstract

Background: Rheumatoid arthritis is a chronic inflammatory joint disease,indicated by a symmetrical erosive synovitis. Disease-modifying anti-rheumaticdrugs (DMARDs) are known to interfere with signs and symptoms of RA, improvephysical function and therefore increase patient productivity. Methotrexate is ananchor drug for rheumatoid arthritis patients, however, its related mechanism ofaction with folate deficiency resulting in some side effects, includinggastrointestinal and liver toxicity. Folic acid supplementation may reduce theseside effects. Method: A search was conducted on Pubmed, Cochrane, EBSCOhost,and ProQuest. After the selection of title and abstract was done using inclusionand exclusion criteria, which led to one relevant article. The selected study wascritically appraised for its validity, importance, and applicability. Result: Inrheumatoid arthritis patient receiving methotrexate, there was a statisticallysignificant reduction in the incidence of abnormal transaminase elevation (RR:0.19, 95% CI: 0.10-0.36), but the reduction in gastrointestinal side effects did notreach statistical significance (RR: 0.76, 95% CI: 0.57-1.01) Conclusion: Folic acidsupplementation has an effect in reducing gastrointestinal and liver toxicity as sideeffects of methotrexate in rheumatoid arthritis patients.
Behçet's Disease with Multiorgan Infection: Alternative Treatment to Systemic Immunosuppressants Dian Hasanah
Indonesian Journal of Rheumatology Vol. 12 No. 2 (2020): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v12i2.122

Abstract

A B S T R A C T Background. Behçet's disease is a rare systemic autoimmune vasculitis. The presence of infection makes it difficult to manage. Case. Ms. X, 19 years old, complained of mouth and genitalia ulcers and joints pain. She had typhoid fever two months before; and a week after recovery, she experienced reddish skin lesions on her legs. Her condition was weak and the pain visual analog score (VAS) was 9/10. Multiple oral ulcers were found in her oral cavity and vulva. Her lungs were hypersonor. There were hyperpigmented maculae in her lower extremities. Her ankle joints were painful in passive and active movements. Blood leukocytes: 13,210/µl, urine leukocytes: 20-23/hpf, ANA, anti-dsDNA and Pathergy tests were negative. The diagnosis of Behçet's disease was based on multiple oral and genital ulcers, history of erythema nodosum and arthritis. The patient was treated with topical triamcinolone. Joint ulcers and pain worsened; so that intravenous methylprednisolone was administer. Two days later, the patient had cough and oxygen desaturation. Chest X-ray showed emphysematous lungs and pneumonia. Methylprednisolone was stopped, ceftriaxone and levofloxacin were given, treatment for ulcers and arthritis was replaced with colchicine and rebamipide. Sucralfate is given for gargle and applied to the genital ulcers. On the seventh day, the ulcers were greatly reduced, joint pain resolved, cough subsided and VAS became 2/10. On the twelfth day, the chest X-ray was normal and ulcers were healed, ankle pain was suffered again accompanied by swelling. The patient was treated with methylprednisolone and azathioprine. Discussion. Treatment for this disease is immunosuppressants. In severe conditions with infection, colchicine can be an alternative treatment. Adjuvant treatment are rebamipide and/or sucralfate. Emphysematous lungs can be caused by alpha-1 antitrypsin deficiency or pulmonary vasculitis, which can be manifested in autoimmune diseases. Emphysematous lungs, leads us to follow up on the development to other autoimmune disorders such as lupus. Conclusion. Behçet's disease with infection can be successfully managed with colchicine, rebamipide and sucralfate.
The Correlation of Asymptomatic Hyperuricemia Patients and their Comorbidities at Sint Carolus Hospital Cindy Oey; Emon Winardi Danudirgo; Bettia Bermawi
Indonesian Journal of Rheumatology Vol. 12 No. 1 (2020): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v12i1.130

Abstract

Background Gout is a progressive disease due to Mono Sodium Urate (MSU) crystal deposition at joints, kidney, and other connective tissue, caused by chronic hyperuricemia.1 In both developed and developing countries, there were increasing prevalence and incidence of gout in recent decades. Patients with hyperuricaemia are at risk of developing a variety of comorbidities, such as hypertension, chronic kidney disease, cardiovascular diseases, and metabolic syndromes.2 Method Total 303 patients with asymptomatic hyperuricemia from Internal Medicine, Neurology, and Cardiology departments of Sint Carolus Hospital Jakarta admitted in January until December 2019 were recorded and analyzed for its comorbidities. Result The number of asymptomatic hyperuricemia patients was higher that gouty arthritis, mostly men, middle-aged, with the median level of uric acid 7.7 mg/dl. The most frequent comorbidity found in this study was hypertension. Majority of the population has 2 comorbidities, higher UA level (>8 mg/dl) had more comorbidities compared to lower UA level (≥6.8-8 mg/dl), 4 vs 2 comorbidities respectively. Fisher exact test shown that higher UA level has a significant relatioship with the presence of hypertension, dislipidemia, cardiovascular disease, chronic renal failure, stroke, and diabetes mellitus (p <0.05). Conclusion Hyperuricemia can be easily detected in routine medical care and might be a potential biomarker independently predicting the development of hypertension, dislipidemia, cardiovascular disease, chronic renal failure, stroke, and diabetes. Thus we suggested that every person with hyperuricemia should be systematically screened for associated comorbidities, which should be addressed as an integral part of the management of hyperuricemia. Keywords : asymptomatic hyperuricemia, comorbidities, sint carolus hospital.
Successful Treatment of Primary Sjogren's Syndrome Associated with Interstitial Lung Disease Laniyati Hamijoyo; Kevin Yonatan Budiman; Reza Kurniawan Tanuwihardja
Indonesian Journal of Rheumatology Vol. 12 No. 1 (2020): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v12i1.143

Abstract

We report a rare case of interstitial lung disease as the first clinical manifestation of primary Sjögren’s syndrome. A 49-year-old woman was assessed, complaining of dyspnea, dry cough, dry mouth, inflamed right cheek, dry skin, bilateral gastrocnemius pain, multiple peripheral arthralgia, and generalized weakness for the previous 2 months. Serology examination was positive for Sjögren’s syndrome antibodies. Thorax CT demonstrated Crazy Paving appearance. Glucocorticoid alone did not improve the respiratory symptoms, hence azathioprine was given. Subsequent dyspnea regression and disease control obtained after 5 months of therapy. This case demonstrated that ILD could be the first clinical manifestation in pSS, and azathioprine could be used as the first line therapy for Sjögren’s syndrome-related lung disease.
Systemic Lupus Erythematosus with Severe Renal Dysfunction and Severe Hematological Manifestation Lead to Septic Shock: A Case Report I Nyoman Suarjana; Ayu Cahya Andhayani
Indonesian Journal of Rheumatology Vol. 12 No. 1 (2020): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v12i1.147

Abstract

Abstract: Background:Systemic Lupus Erythematous (SLE) is an autoimmune disease that can cause major mortality and morbidity if untreated well. Various clinical manifestations and adverse events may affect the patient condition. Case Report: We reported a case of a 31 years old female patient with systemic lupus erythematosus who presented with lupus nephritis and a hematological manifestation lead to septic condition and septic shock. This is a case where initially the patient is well controlled for 1.5 years but due to 6 months of absence treatment, the SLE flareupand she suffers an end-stage renal disease(ESRD). This patient was treated with mycophenolate acid in combination with high dose steroids, antibiotics, granulocyte-colonystimulating factor and underwent hemodialysis. Because of the ESRD and a manifestation of severe neutropenia and lymphopenia, the patient experienced urinary tract infection. She suffered from severe septic with shock condition and passed away later on. Conclusion:A SLE patient with a severe manifestation of neutropenia and lymphopenia accompanied with end-stage renal failure can cause an opportunistic infection that leads to severe septic shock condition and multi-organ failure. Keyword:Systemic lupus erythematosus, lupus nephritis, hematological manifestations, septic shock, Case Report
Serum Nerve Growth Factor in the Occurrence of Peripheral Neuropathy in Rheumatoid Arthritis Patients Rudy Hidayat; Ridho Adriansyah; Ahmad Yanuar Safri; Sukamto Koesnoe
Indonesian Journal of Rheumatology Vol. 12 No. 1 (2020): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v12i1.149

Abstract

Abstract Background Peripheral neuropathy (PN) is an extraarticular manifestation in rheumatoid arthritis (RA). In type-2 diabetes mellitus (DM) patients, Nerve Growth Factor (NGF) is associated with PN. The correlation between NGF level and PN among RA has not been concluded yet. This study aimed to determine the mean levels of NGF blood serum and its relationship to PN among RA patients. Method A cross sectional study using consecutive sampling method including patient of rheumatology clinic Cipto Mangunkusumo Hospital was performed between July 2015 to March 2016. The NGF level measurement and Electromyography-Nerve Conduction Velocities (EMG-NCV) were examined to the subjects. Patients were classified into 2 groups; PN positive and PN negative. Bivariate analysis was done to investigate the relationship between NGF and PN among groups. Secondary data such as age, sex, Erythrocyte Sedimentation Rate (ESR), CRP, Disease Activity Score (DAS)28-ESR and CRP are obtained from medical record. Result Among 132 subjects, PN was found in 60 subjects. The median of NGF level in RA patients was 4.11 pg/mL (0.0-24.5). The median of NGF level of RA patients with PN was 4.11 pg/mL (1.1-20.83) and without PN was 3.89 pg/mL (0.0-24.5). Types of neuropathy among patients were polyneuropathy (21.97%), mononeuropathy multiplex (15.15%) and Carpal Tunnel Syndrome (11.36%). In this study we found no association between NGF serum level and PN among RA patients (p = 0.716). Conclusion The median of serum NGF level among PN group was higher than without PN. There was no relationship between serum NGF level and PN among patients with RA. Keywords :rheumatoid arthritis, peripheral neuropathy, nerve growth factor

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