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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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Effects of vitamin D3 (cholecalciferol) supplementation on systemic lupus erythematosus patients with hypovitaminosis D on serum pro-inflammatory cytokines (IL-6, IL-7, IFN-Gamma), anti-inflammatory cytokine (TGF-Beta) and anti-ds DNA levels Cesarius Singgih Wahono; Irene Saveria; Cameleia Diah Setyorini; Zoraida Dwi Wahyuni; Handono Kalim; Kusworini Handono
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.v12i2.150

Abstract

A B S T R A C TSystemic lupus erythematosus (SLE) is a chronic systemic autoimmune diseaseand can attack almost all organs and tissues of the human body. Beside geneticfactors, environmental factors are thought to play a role, such as ultraviolet light,viral infections and smoking, causing a breakdown of self-tolerance which cantrigger an autoimmune response. The study was conducted in the outpatient andinpatient units of the Rheumatology Division of the Department of InternalMedicine Saiful Anwar General Hospital/Faculty of medicine UniversitasBrawijaya, Malang. Subjects were female patients, aged > 18 years who had beendiagnosed as SLE by internist-rheumatologist based on the 1997 ACR criteria, withSLEDAI score > 3. After 3 months of supplementation, there was a significantdecrease in serum levels of the three pro-inflammatory cytokines (IL-6, IL-17, IFN-gamma), as shown in table 3, compared to before treatment, as well as anti-dsDNA levels.Serum TGF-beta1 levels increased significantly, while 25 (OH) D3 levels also increasedsignificantly.
A young lady with ANA negative SLE and Secondary Anti Phospholipid Syndrome Richmond Ronald Gomes; Deepankar Kumar Basak; Kaniz Rahman; Md. Rashidul Hasan
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.v12i2.154

Abstract

A B S T R A C TSystemic lupus erythematosus (SLE) is a chronic, inflammatory,autoimmune, multisystem connective multi system connective tissuedisease characterized by various autoantibodies to nuclear and cytoplasmicantigens and commonly affects the joints and a variety of organs due to anover activation of the body's immune system. There is wide heterogeneity inpresentation of SLE patients, including lung, central nervous system, skin,kidney, and hematologic manifestations. The presence of antinuclearantibodies (ANA) in serum is generally considered a decisive diagnostic signof SLE. However, a small subset of SLE patients who had the typical clinicalfeatures of SLE was reported to show persistently negative ANA tests. Ourreport describes a 24-yr-old female who presented with the clinicalmanifestations of SLE such as malar rash, photosensitivity, arthritis, oralulcer, and proteinuria. The serum autoantibodies were all negative exceptanti ribosomal P. She was also positive for lupus anticoagulantanti -coagulant. She was treated with oral prednisolone , hydroxychloroquinewith topical tacrolimus, and improved significantly. Three months after,repeat ANA, and anti-ds DNA showed persistent negativity, but lupus anti -coagulant remained positive. This case suggests that ANA may not berequired in the pathogenesis of SLE.
Manifestation of COVID-19 Mimicking Rheumatic Diseases : Review Article Laniyati Hamijoyo; Angkasa Ramatuan Hamdan
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.v12i1.156

Abstract

Background: Diagnosing the newfound disease has been always the vital strategy of controlling and managing Corona Virus Disease (COVID)-19. Interestingly, patients with COVID-19 may also have features mimicking rheumatic diseases due to immunology responses and viral properties. Objective: In this systematic review, we aim to highlight features of COVID-19 that mimic those of rheumatic diseases, in hope to raise clinical awareness and prevention. Methods: We systematically searched both from MEDLINE (accessed from PubMed) and Google scholar from late of 2019 to June 2020 for related published articles. In both electronic databases, the used key words were “COVID-19” or “Corona virus”, “rheumatic diseases” and “clinical characteristics” Results: Through the search, we were able to conclude some characteristics that could be manifested both in COVID-19 infection and rheumatic diseases, including but not limited to constitutional manifestation, arthralgia and/or myalgia, myositis, hematologic manifestation, skin manifestation, acute interstitial pneumonia, myocarditis and gastrointestinal manifestation. Most studies were able to explain the possibility of immune dysregulation similar to what rheumatic diseases exhibit, include post mortem biopsy of a tissue damage similar to rheumatic complication in COVID-19 infection Conclusion: Since the possibility of overlap symptoms between COVID-19 infection and rheumatic diseases was able to be enucleated through our review, we believe that in the future clinical awareness to differentiate between autoimmune and infection origin of many rheumatic manifestations will hold pivotal role in prohibiting reemergence disease. Future study to assist clinicians to swiftly diagnose autoimmune diseases in the era of pandemic is essential.
Correlation Between Mex-Sledai and Mean Platelet Volume In Systemic Lupus Erythematosus Patients Ayu Paramaiswari; Dody Hendro Susilo; Deddy Nur Wachid Achadiono
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.v12i2.158

Abstract

A B S T R A C TBackground. Systemic lupus erythematosus (SLE) is a chronic autoimmunedisease which has a variety of clinical phenotypes with a complex clinical course.The clinical phenotypes are highly variable which can be characterized by acuteattacks, active periods, controllable or remission. Mean platelet volume (MPV) is astraightforward accessible indicator of platelet activity and is associated withsystemic inflammation. The routine usage of MPV as markers for disease activityin SLE remains problematic. Early detection of disease progression is pivotal in themanagement of SLE for obtaining better outcomes. Objective. The study aimed toconfirm that the measurement of the disease severity in patients with SLE usingMex-SLEDAI has a negative correlation with the decrease of MPV value. Methods.This cross-sectional analytic descriptive study was conducted using secondary datafrom the medical records of patients with SLE older than 18 years of age who werenot taking antiplatelets in the Internal Medicine policlinic of Dr. Sardjito GeneralHospital in 2018. Patients with a previous history of cardiovascular andcerebrovascular events, malignancies, receiving a treatment for infections,including sepsis, chronic infections (i.e. tuberculosis, cytomegalovirus, herpessimplex, herpes zoster), HIV, hepatitis B or hepatitis C, and incomplete data ofmedical record were excluded. The correlation between SLEDAI Mex and MPVvalues was evaluated using the Spearman's correlation test. Results. Sixty-sevensubjects (65 women, 2 men) aged 34 ± 11 years were recruited in the study. Themedian duration of diagnosis was 38,2 ± 45,7 months. Arthritis, skin rash andphotosensitivity were identified in 81,1%, 53,7%, and 46,3% of patients,respectively. The Mex-SLEDAI score ranged from 0 to 16. The average of MPV valueis 9.73 ± 1.21 fL. A significant correlation between MPV and SLEDAI Mex wasobserved (p = 0.03 (p <0.05), r = -0.255). Conclusion. The more severe SLE diseaseactivity (based on the Mex-SLEDAI scoring), the more negative correlation with theMPV value.
Characteristics of Patients with Autoimmune Rheumatic Disease in the Era of COVID-19 Pandemic in Indonesia Rudy Hidayat; Harry Isbagio; Anna Ariane; Faisal Parlindungan; Laniyati Hamijoyo; I Nyoman Suarjana; Dwi Budi Darmawati; Rakhma Yanti Hellmi; Gede Kambayana; IA Ratih Wulansari Manuaba; Awalia Awalia
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.v12i1.159

Abstract

Background Coronavirus Disease 2019 (COVID-19) could be fatal in high-risk patient including autoimmune rheumatic patients. Nowadays, the management of these patients becomes dilemma because the use of steroids and disease-modifying anti-rheumatic drugs could suppress the immune system however, poor control of the underlying disease increases the infection risk. Understanding the characteristics of these patients in the COVID-19 pandemic is essentials to establish management guidelines and identify patients who are more susceptible to COVID-19. This study aimed to determine the characteristics of autoimmune rheumatic patients in the era of COVID-19 pandemic in Indonesia. MethodA descriptive study using national scale survey method was conducted. The subjects were autoimmune rheumatic patients in Indonesia and recruited using consecutive sampling. The variables evaluated in this study were demographic data, history of disease, current medications taken, daily activities in the COVID-19 pandemic, and also data related to COVID-19. The surveys distributed in online form to patients with autoimmune rheumatic disease in Indonesia. ResultTotal participants in this study were 570 patients, mostly women (93.9%), aged <60 years old (97.2%), and diagnosed with systemic lupus erythematosus (62.8%). Glucocorticoid (70.2%) especially low dose glucocorticoid (52.6%) is the most medication taken by patients. A 30.5% of patients is taking hydroxychloroquine/chloroquine and 88.1% of them have good compliance. During COVID-19 pandemic, 76.5% respondents still do normal activities/work and only 53.2% use personal protective equipment. Eleven of 541 respondents had positive PCR test and confirmed to COVID-19. The risk of COVID-19 infection based on British Society of Rheumatology (BSR) scoring system showed that 57.9%, 28.6%, and 13.5% patients in high, moderate and low risk, respectively. ConclusionPatients with autoimmune rheumatic diseases might be more susceptible to COVID-19 than the general population. Interplay of aging, therapies and disease-specific factors, comorbidities and the proper use of personal protective equipment seem to contribute. Keywords :autoimmune rheumatic disease, characteristic, COVID-19, Indonesia
Indonesian Rheumatology Association Recommendation for Management of Autoimmune Rheumatic Disease Patients During COVID-19 Pandemic Cesarius Singgih Wahono; Perdana Aditya; Herlina Yani; RM Suryo Anggoro KW; Faisal Parlindungan; Anna Ariane; Andi Raga Ginting; Ika Vemilia; Lisa Kurnia Sari
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.v12i1.160

Abstract

Background: Coronavirus-19 (COVID-19) disease is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), first reported from Wuhan, the capital of Hubei province, China, in December 2019. Since the occurrence of COVID-19 pandemic, there have been concerns about the risk of SARS-CoV-2 infection and complications in systemic autoimmune-rheumatic patient. Therefore, we intend to make recommendations for the management of autoimmune rheumatic diseases during this pandemic. Method: Indonesian Rheumatology Association (IRA) held an online meeting on May 17th2020 and formed a task force that was in charge to make recommendation for management of adult autoimmune rheumatic disease patients during COVID-19 pandemic. This task force consisted of 9 IRA members that held their first online meeting on May 18th2020. The draft of the recommendation were reviewed in three online meetings that resulted in final recommendation through consensus from all of task force members. The final draft of recommendation was approved by IRA executive board on July 10th2020. Result: The management of autoimmune-rheumatic diseases during the COVID-19 pandemic must consider several important factors such as underlying rheumatic-autoimmune disease factors, risk factors for COVID-19 exposure in autommune-rheumatic disease patients and the presence of COVID-19 infection symptoms Discussion: Recommendations for pharmacological management of autoimmune rheumatic disease patients during COVID-19 pandemic are according to exposure to COVID-19 and the presence of symptoms. There are four groups of patients that are the focus of this recommendation: 1) autoimmune rheumatic disease patients without symptoms of infection AND without risk of exposure to COVID-19; 2)autoimmune rheumatic disease patients without symptoms of infection AND with close contact (exposure) to COVID-19 probable or confirmed patients; 3) autoimmune rheumatic disease patients with symptoms of COVID-19 infection but the infection status is not yet known (suspected and probable case of COVID-19); and 4) autoimmune rheumatic disease patients with confirmed COVID-19 infection. Each groups have different management approaches. Conclusion: Recommendations for the management of autoimmune rheumatic diseases during this pandemic is needed to guide doctors that treat autoimmune rheumatic diseases.
A 38 Years Old Man with ANCA Negative Wegener’s Granulomatosis Vasculitis with Type 2 Diabetes Mellitus and Electrolyte Imbalance: A Case Report: ANCA Negative Wegener’s Granulomatosis Vasculitis Bryan Arief Aji Rudita; Yulyani Werdiningsih; Arief Nurudhin; Nurhasan Agung Prabowo; Zainal Arifin Adnan
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.v12i2.163

Abstract

A B S T R A C TBackground: Wegener's granulomatosis is a very rare long-term systemicdisorder, in which granuloma formation occurs and inflammation of bloodvessels (vasculitis). The cause of disorder is not yet known, but geneticfactors are thought to play an important role. Clinical symptoms are oftensimilar to other disorders, making diagnosis difficult. However, earlydiagnosis is very important in order to provide effective management.Objective: Diagnosis and management in a rare case of Wegener’sgranulomatosis vasculitis, especially it was found with other comorbidities.Methods: This case report showed a-38-years-old-man that came to theemergency room of Dr Moewardi Hospital with complaints of swellingaccompanied by redness and stiff on the face, hands and feet that worseningsince 7 days ago. He also complained of fever fluctuating, nasal congestionaccompanied by clear discharge and sometimes hearing loss in the rightear. Since the last 3 months, he was often experience similar complaints.History of diabetes was recognized by the patient for 5 years, but he did notregularly take medication. Results: In this case, examination of vital signswithin normal limits. Physical examination revealed a saddle nose with cleardischarge, swelling and redness around the face, hands and feet. Laboratorytests showed hemoglobin 12.9 g/dl, HbA1c 8.4%, sodium level 128 mmol/L,potassium level 3.1 mmol/L, calcium level 1.12 mmol/L. The Anti -Neutrophil Cytoplasmic Antibodies (ANCAs) and Anti Nuclear Antibody(ANA) Indirect Immunofluorescence (IF) method were negative.Electrocardiogram and chest x-ray examination within normal limits.Histopathological examination revealed epidermal atrophy and multiplegranulomas of the dermis. The patient underwent treatment for 10 dayswith tappering-off dose steroid, immunosuppressants, insulin, calcium,and potassium preparations therapy. Conclusions: Wegener’sgranulomatosis vasculitis is a rare case. Prompt and accurate diagnosis andmanagement will prevent poor progression of them, especially it was foundwith other comorbidities.
Correlation Between Anti-Topoisomerase I and C-Reactive Protein Antibody Level with Modified Rodnan Skin Score On Systemic Sceloris Patients Sumartini Dewi; Wisynu Tresnadi A.B; Rachmat Gunadi Wachjudi
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.v12i2.164

Abstract

A B S T R A C TSystemic sclerosis is characterized by extensive and progressive organfibrosis processes leading to organ failure and death. Modified Rodnan SkinScore (mRSS) had been used as a clinical parameter of skin fibrosis. Anti-topoisomerase I and C-Reactive Protein (CRP) are potential biomarkers forassessing disease activity. The study was performed to determine theassociation of anti-topoisomerase I and CRP antibodies with mRSS values.We performed an observational analytic study based on primary andsecondary data. Systemic sclerosis patient sera data was obtained fromDewi S et al's study, taken from May 2015 to June 2017. Serum Anti -topoisomerase I antibody and CRP level analysis were performed inDecember 2017.Fifty six samples analyzed. Fifty four subjects (96.4%) out of 56 subjects arewomen with an average age of 37 ± 11 years, 41 subjects (73.3%) hasdisease duration over 2 years, 34 subjects (60.7%) has difuse systemicsclerosis, 41 subjects (73.3%) in steroid therapy and 50 subjects (89.3%) inmethotrexate therapy. The statistical analysis showed no correlationbetween anti-topoisomerase I antibody and CRP levels with mRSS values(r = 0.205, p = 0.064; r = -0.134, p = 0.167), but there was a positivecorrelation of anti-topoisomerase I antibody level with mRSS (r = 0,422 p =0,007) and negative correlation between CRP level and mRSS (r = -0,511 p= 0,001) in diffuse sclerosis systemic.From this study we concluded that anti-topoisomerase I antibody and CRPlevel were not correlated with mRSS, but in patient with diffuse systemicsclerosis there was a positive correlation of anti-topoisomerase I antibodylevel with mRSS and negative correlation between CRP level and mRSS.
Pulmonary Hypertension in Systemic Lupus Erythematosus with Raynaud’s Phenomenon: Case Report Agnes Dina Irene Dorithy Zagoto; Ayu Paramaiswari
Indonesian Journal of Rheumatology Vol. 13 No. 1 (2021): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v13i1.145

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organs such as skin, joints, kidneys, heart, lungs, nervous system and blood. Pulmonary hypertension is a rare complication of SLE.1 Systemic lupus erythematosus associated with pulmonary hypertension was defined as an increase in the average pressure in the pulmonary artery at rest ? 25 mmHg with pulmonary capillary wedge pressure ?15 mm Hg and an increase in pulmonary vascular resistance.2 The prevalence of pulmonary hypertension in SLE approximately 0.5 to 17.5%. Predictors factors of the occurrence of pulmonary hypertension in LES is Raynaud's phenomenon, anti-U1RNP antibody, and antibody positive anticardiolipin.3 A woman aged 37 years came with a chief complaint of pain in the fingers and toes with black-colored wounds felt since 6 months before admission. From the anamnesis, physical examination, support to meet 5 of the classification criteria for systemic lupus erythematosus based on the 1997 ACR criteria which includes manifestations of arthritis, mucocutaneous, serositis, lupus antiokoagulan, and ANA IF positive. In these patients also found the typical signs and symptoms of Raynaud's phenomenon which leads to the symptoms of pain in the fingers of both hands when exposed to cold and pale to red when heated and has been confirmed from the results of arteriography. From the results of echocardiography reveal any pulmonary hypertension. This patient was treated with steroids, immunosuppressants and antiplatelet. The case was removed because of pulmonary hypertension is a complication LES rare and necessary sharpness in diagnosis. Patients with pulmonary hypertension of unknown or untreated can become a progressive right heart failure and lead to death.3
The Relationship Between Modified Rodnan Skin Score (mRSS) With Pulmonal Hypertension and Lung Fibrosis in Systemic Sclerosis Patients Syaifur Rohman; Rakhma Yanti Hellmi; Friska Anggraini HS
Indonesian Journal of Rheumatology Vol. 13 No. 1 (2021): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v13i1.161

Abstract

Background: Systemic sclerosis (SSc) is a connective tissue disease, which affects the skin, blood vessels, heart, lungs, kidneys, gastrointestinal tract and musculoskeletal system. The manifestations in blood vessels include pulmonary hypertension which can be seen from echocardiography, while the manifestations to the lungs in the form of pulmonary fibrosis are examined by high-resolution computed tomography (HRCT). Modified Rodnan Skin Score (mRSS) a method for measuring skin thickness in SSc patients. Objective: This study aims to determine the relationship between mRSS and pulmonary hypertension and pulmonary fibrosis in SSc patients. Methods and Materials: Research with a cross sectional approach at Dr Kariadi Hospital. There were 23 study subjects with SSc patients having their mRSS measured by a rheumatologist and an HRCT examination by a radiologist to see the percent of lung damage and echocardiographic examination by a cardiologist to measure the Tricuspid Regurgitation Velocity Maximum (TRV Max) as a marker of pulmonary hypertension. Normality test using Saphiro-Wilk. The Spearman rank correlation test was used to analyze the relationship between the mRSS score, pulmonary hypertension and pulmonary fibrosis. Results: The proportion of study subjects with a mean age of 40.39 years, women, and 4.43 years of illness. The mean mRSS score was 17.43. Examination of pulmonary hypertension from echocardiography found most of the light category 95.6%, heavy category 4.4%, while the HRCT examination found pulmonary fibrosis of 86.9%, normal 13.1%. There are significant relationship between mRSS and pulmonary fibrosis (r = 0.485, p = 0.019), and significant relationship between pulmonary hypertension (r = 0.63, p = 0.001) Conclusion: There is a significant relationship between mRSS, pulmonary fibrosis and pulmonary hypertension.

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