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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 302 Documents
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Indonesian Rheumatology Association (IRA) Recommendations for Diagnosis and Management of Osteoarthritis (Knee, Hand, Hip) Hellmi , Rakhma
Indonesian Journal of Rheumatology Vol. 15 No. 1 (2023): IJR VOL 15 No 1
Publisher : Indonesian Rheumatology Associantion

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Abstract

Background: Osteoarthritis (OA) is the most common form arthritis in theworld, and its prevalence is predicted to rise higher in the future due toincreasing life expectancy and growing number of elderly population. Withthe emergence of new treatment options in the last several years, a betterunderstanding of OA diagnosis and management is required by everyphysician in Indonesia. Methods: A panel of eight selected rheumatologistsfrom the Indonesian Rheumatologist Association (IRA) developedrecommendations based on key questions formulated by a steeringcommittee from IRA. These recommendation materials were taken fromseveral online databases such as PubMed, Science Direct, and GoogleScholar. Level of evidence and grades of recommendation were thenassigned, and each member of the panelist team will assign a score toexpress their level of agreement. Results: A total of 25 recommendationsdiscussing the diagnosis, pharmacological and non-pharmacologicaltherapies, as well as monitoring for OA were formulated. Conclusion: Theserecommendations can be used to help clinicians in accurately diagnosing OA and choosing the most suitable therapy for their patients. Allrecommendation statements were tailored to the clinical setting, facility, and drug availability in Indonesia.  
The Role of Antioxidants as Adjuvants of Fibromyalgia Management Chusnul Chotimah , Sabrina
Indonesian Journal of Rheumatology Vol. 15 No. 1 (2023): IJR VOL 15 No 1
Publisher : Indonesian Rheumatology Associantion

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Abstract

Fibromyalgia is a condition with complex polysymptomatology characterizedby chronic widespread pain, fatigue, sleep disturbances, and functionalsymptoms. Oxidative stress plays a role in the etiology of pain which is themain symptom of fibromyalgia. The symptoms of fibromyalgia are related tothe balance of oxidant and antioxidant. Antioxidants from certain nutrientscan act to counter the high level of free radicals, in order to maintain theoxidative stress/antioxidant balance. Antioxidant such as coenzyme Q10,vitamin C and E, magnesium, and acetyl-L-carnitine have the potentialbenefit as adjuvants in treating fibromyalgia by reducing pain. 
Tuberculosis Arthritis: A Diagnostic Challenges Saraswati Seputra , Desak Putu Gayatri
Indonesian Journal of Rheumatology Vol. 15 No. 1 (2023): IJR VOL 15 No 1
Publisher : Indonesian Rheumatology Associantion

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Abstract

Background: Tuberculosis infection still poses a significant health problem,especially in developing countries. While most of tuberculosis cases affectthe pulmonary organ, this infection may also involve other organs such asbones and joints. Case presentation: We reported a case of 23-year-oldfemale patient with a history of recurrent pain and swelling in the right knee. On physical examination of the right knee, bulging sign was found,accompanied by tenderness, warmth on palpation, and limited active and passive movement. Radiographic examination was suggestive for septicarthritis in the right knee. Debridement and biopsy were performed, and TBPCR examination of the debridement tissue was found to be positive forMycobacterium tuberculosis. The histopathological finding was alsoconsistent with tuberculosis infection. The patient was subsequently treatedwith antituberculosis drugs and underwent rehabilitation therapy, resultingin a satisfying response. Conclusion: Diagnosis of tuberculosis arthritis inthis case was established based on the presence of clinical symptoms, radiological findings, tissue TB PCR, and histopathological findings. Both surgical and pharmacological interventions were performed, which yieldedfavorable results. Tuberculosis arthritis was often misdiagnosed as arthritis for other causes, resulting in delays in providing medical intervention.Therefore, increased understanding of tuberculosis arthritis is necessary tofacilitate early diagnosis and improve therapeutic outcome. 
A Patient with Granulomatosus with Polyangiitis (Wegener’s Granulomatosis): ACase Report Hardian , Harris
Indonesian Journal of Rheumatology Vol. 15 No. 1 (2023): IJR VOL 15 No 1
Publisher : Indonesian Rheumatology Associantion

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Abstract

Background: Granulomatosus with Polyangiitis (GPA) is an Antineutrophilic Cytoplasmic Antibodies (ANCA) Associated Vasculitis (AAV)which involves small to moderate-sized vessels. GPA has a variety of clinicalmanifestations caused by tissue ischemia and organ affected. Diagnosis ofGPA remains challenging, and its actual incidence may be higher thanreported. In 1990, the American College of Rheumatology (ACR) publisheddiagnostic criteria for GPA. Guidelines of management of GPA has improvedsurvival in last decade, but results remain unsatisfactory. Induction agentswith immunosuppressive agents and glucocorticoid, and the newer agentRituximab are recommended as first choice treatment. Case presentation:A 64-year-old male presented with current episode of joint pain and a historyof recurrent respiratory tract infections. After a series of laboratory andradiologic examinations, lung biopsy was performed, and the result wassuggestive of GPA. The patient was managed with induction remission agentand reported improvement in both clinical and laboratory parameters.Conclusion: Granulomatosus with Polyangiitis is a limitedly reported case.This report was presented to raise awareness of the diagnosis when facedwith similar clinical symptoms. Early detection and diagnosis in GPA allowfor prompt and better management with the target to achieve and maintainremission, as demonstrated in this case. 
Efficacy and Safety of Stem Cell Transplantation in Rheumatoid Arthritis: ASystematic Review of Trials Krisandi , Grady
Indonesian Journal of Rheumatology Vol. 15 No. 1 (2023): IJR VOL 15 No 1
Publisher : Indonesian Rheumatology Associantion

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Abstract

Background: Rheumatoid arthritis (RA) is an autoimmune disorder thatdeteriorates the quality and function of the synovium membrane, resultingin chronic inflammation, pain, and progressive joint destruction. Based onprevious clinical research, stem cell transplantation has shown a promisingtherapeutic effect for RA based on its anti-inflammatory,  immunomodulatory, and regenerative properties. This systematic reviewaims to evaluate the efficacy and safety of stem cell transplantation forrheumatoid arthritis therapy. Methods: A literature search was performedvia PubMed, ProQuest, EBSCOHost, EMBASE, SCOPUS, Cochrane, DOAJ,and clinicaltrial.gov databases, selecting studies that evaluated the effect ofstem cells on rheumatoid arthritis from inception to April 7, 2023. TheCochrane Risk of Bias was used to assess randomized controlled trials andROBINS-I was used to assess clinical trials. Results: 7 randomizedcontrolled trials (RCTs) and 12 non-randomized studies involving 682subjects were included in this review. Stem cell transplantation was relatedwith better outcomes based on significant improvement of the DAS28 score, HAQ score, ACR score, and laboratory parameters. There were no significant changes in safety parameters compared to the baseline value and control group. Fever, flu-like symptoms, nausea, and vomiting were the most frequently reported adverse effects. Nevertheless, this review revealed a moderate risk of bias and high heterogeneity of the efficacy outcomes of RCTs. Conclusion: Stem cell-based therapies provide clinical benefits for rheumatoid arthritis patients with satisfactory safety measures.  
Simultaneous Cervical and Lumbar Spinal Degenerative Stenosis: Diagnostic andTreatment Challenge Joelle Stéphanie, Wendlassida
Indonesian Journal of Rheumatology Vol. 15 No. 1 (2023): IJR VOL 15 No 1
Publisher : Indonesian Rheumatology Associantion

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Abstract

Background: In simultaneous cervical and lumbar degenerative stenosis (tandem spinal stenosis), the cervical clinical signs may mask the lumbarones. Treatment is initially conservative in non-plegic cases. In the event ofsurgery, there is no consensus regarding the segment to be approached first.The purpose of this work was to describe our management of this condition. Methods: This was a 6-year retrospective study in the rheumatology andneurosurgery departments. All usable medical records of cases ofsimultaneous degenerative stenosis of the cervical and lumbar spine wereincluded. Results: We retained 84 squares. The average age was 57.1 years;the sex ratio 0.9. All the patients presented cervical and lumbar clinicalsigns. They had started at the lumbar spine in 46 cases (54.8%) and cervicalin 38 cases (45.2%). A full spinal MRI had been performed in 50%.Conservative treatment was effective in 36 patients (42.9%). Of the 32patients (66.7%) operated, 16 had been operated both the cervical andlumbar spine (7 simultaneous surgeries including percutaneous discolysisin one of the segments in 4 cases). The cervical spine had been operated onfirst in 7 of the 9 cases of staggered surgery. After an average follow-up ofone month, the evolution was favorable in 47 cases (56%); stationary 21(25%). Conclusion: Conservative treatment was effective in about half of thecases. Full spine MRI and staggered surgery were the most commonlyperformed. However, simultaneous surgery prioritizing the least aggressivegestures seems better.
Secondary Trimester Pregnancy in Systemic Lupus Erythematosus Patients withPneumonia: A Case Report Mahardika , Reza
Indonesian Journal of Rheumatology Vol. 15 No. 2 (2023): IJR VOL 15 No 2
Publisher : Indonesian Rheumatology Associantion

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Abstract

Background. Systemic lupus erythematosus (SLE) is an autoimmunedisease that can attack multiple organs and has a high prevalence in women.Due to its treatment and resulting pathological conditions, SLE makes thepatient susceptible to infections. Furthermore, physiological changes in thebody that occur during pregnancy renders pregnant women with SLEvulnerable to disease exacerbation. Therefore, the management of suchcases necessitates the evaluation and intervention of a multidisciplinarymedical team. Case Presentation. We present the case of a female patientin her second trimester of pregnancy who complained of shortness of breath.The patient has a history of SLE diagnosed five years ago. Within 7 days oftreatment, the patient experienced an improvement in symptoms. Conclusion. This is a rare case, and we report on the outcomes of treatmentand our limitations to ensure better future treatment for pregnant womenwith SLE to prevent maternal and fetal death. 
Indonesian Rheumatology Association (IRA) Recommendations for Diagnosis and Management of Sjogren’s Syndrome Wachid Achadiono , Deddy Nur
Indonesian Journal of Rheumatology Vol. 15 No. 2 (2023): IJR VOL 15 No 2
Publisher : Indonesian Rheumatology Associantion

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Abstract

Background. Sjogren’s syndrome (SS) is a systemic autoimmune diseasethat affects exocrine glands. Dealing with SS is challenging due to the lowlevel of awareness and knowledge about SS, as well as the difficulty indiagnosing and treating the disease. Diagnosing SS requires manysupporting examinations from many medical specialties. Therefore, theserecommendations were developed to serve as a guide for health practitionersin diagnosing and treating SS. Methods. Six selected rheumatologists fromthe Indonesian Rheumatologist Association (IRA) formulated therecommendations based on key questions formed by a steering committeefrom IRA. These recommendation materials were taken from several onlinedatabases such as PubMed, Science Direct, and Google Scholar. Level of evidence and grades of recommendation were then assigned, and everymember of the panellist team will assign a score for level of agreement.Results. The panel generated a total of 19 recommendations discussing thediagnosis, pharmacological and non-pharmacological therapy, andprognosis for SS. Conclusion. These recommendations can be used to helpclinicians correctly diagnose and choose the most suitable therapy for SSpatients. All recommendation statements were created with theconsideration of Indonesia’s clinical setting, facility, and drug availability. 
Use of Methotrexate for More Than 4 Years Is Not Associated with Liver Fibrosisin Rheumatoid Arthritis Patients Muliani , Tati
Indonesian Journal of Rheumatology Vol. 15 No. 2 (2023): IJR VOL 15 No 2
Publisher : Indonesian Rheumatology Associantion

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Abstract

v Background. Methotrexate is an anchor drug in the management ofrheumatoid arthritis (RA). However, the association between methotrexateand development of liver fibrosis remains a subject of controversy. Non invasivemethodstoassessliverfibrosis, such as the FIB-4 score, have beendeveloped. RA patients on methotrexate therapy should be monitored for anysigns of liver fibrosis. This study aims to investigate the correlation betweenmethotrexate cumulative dose and the FIB-4 score in rheumatoid arthritispatients who received methotrexate therapy to assess the hepatotoxic effectsof methotrexate. Methods. This cross-sectional study involved rheumatoidarthritis patients who received methotrexate therapy at Dr. Hasan SadikinGeneral Hospital Bandung from September 2022 to November 2022. Clinicaldata, laboratory tests (including platelet values and liver function test), andcumulative methotrexate doses were extracted from medical records. Datawere analyzed using the Spearman correlation test. Results. This studyinvolved 100 subjects aged between 22-82 years, comprising 93% women and7% men. The median FIB-4 score was 0.73 (0.24-6.80), while the medianmethotrexate cumulative dose was 2477.5 mg, with a range of 1005-10400mg. The results showed that correlation coefficient between the FIB-4 scoreand methotrexate cumulative dose in rheumatoid arthritis patients was 0.089 (p=0.378).Conclusion.There is no significant correlation between FIB 4score and cumulative dose of methotrexate inrheumatoid, arthritis, patients. The use of methotrexate in RA patientsover 4 years is relativelysafe as it does not  increase the risk of liver fibrosis.
Sjögren's Syndrome: A Rare Clinical Entity in Children Hamri , Laila
Indonesian Journal of Rheumatology Vol. 15 No. 2 (2023): IJR VOL 15 No 2
Publisher : Indonesian Rheumatology Associantion

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Abstract

Background. Sjögren's syndrome (SS) is a rare autoimmune disease inchildren, with only a few hundred reported cases. Its clinical presentation isatypical. We report the case of a 14-year-old boy diagnosed with recurrentparotitis. Case Presentation. Our patient, a 14-year-old male, presentedwith a one-year history of recurrent bilateral parotid swellings. Clinicalexamination revealed an objective oculo-buccal dryness. Ultrasound imagingshowed hypoechoic hypertrophy of the parotid glands. Anti-SSA/SSBantibodies were strongly positive. Histological study of the accessory salivaryglands revealed lymphocytic sialadenitis with a focus score of 3. Thediagnosis of SS was confirmed according to the ACR/EULAR 2016 criteria.The combination of treatment with hydroxychloroquine and corticosteroidsresulted in the resolution of clinical signs and biological inflammatorymarkers. Conclusion. Given the rarity of SS in children, several diagnosticand therapeutic difficulties arise, in the absence of classification criteriaadapted to the juvenile form of the disease, and the absence of therapeuticrecommendations consolidated by clinical trials in children. 

Page 28 of 31 | Total Record : 302

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