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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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A survey on the clinical diagnosis and management of gout among general practitioners in Bandung Hidayat, II; Hamijoyo, L; Moeliono, M A
Indonesian Journal of Rheumatology Vol 4, No 1 (2013)
Publisher : Indonesian Rheumatology Association

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Abstract

Backgrounds: The global prevalence of gout and hyperuricemia is increasing in recent years. As the most visited health care service, it is thus become more important that general practitioners have proper approach in the diagnosis and treatment of patients withgout, in order to prevent complications of the disease as well as adverse effects of inappropriate and improper use of medications.Objective: To determine whether the practice of general practitioners on the clinical diagnosis and management of gout in Bandung have been appropriate, with the implementation of evidence-based medicine.Methods: This was a descriptive cross-sectional qualitative study, done by survey using a questionnaire, conducted among general practitioners who attended medical symposia in Bandung from January to March 2011.Result: There were 173 respondents participating in this survey. Median age of respondents was 33 years (range 23–73 years), with median duration of practice of 7 years (range 0–45 years). The largest proportion of the respondents often suggested measurement of serum uric acid to patients with any joint pain (45.7%), did not recommend synovial fluid examination to patients suspected of having gout (80.8%), usually prescribedallopurinol to patients with asymptomatic hyperuricemia (52.6%), initiated allopurinol therapy during acute gout attack (35.8%), discontinued allopurinol therapy when serum uric acid normalizes (61.8%), and only very rarely gave prophylactic treatment to patients who started allopurinol therapy (43.4%).Conclusion: The majority of general practitioners had not applied or aware about evidence-based medicine in the diagnosis and management of gouty arthritis.
Sclerodermatomyositis Febyani, M; D, H Purbo; Hamijoyo, Laniyati; Sutedja, E; Suwarsa, O
Indonesian Journal of Rheumatology Vol 3, No 1 (2011)
Publisher : Indonesian Rheumatology Association

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Abstract

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, Raynaud’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 Gottron’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.
Tuberculous arthritis: an overview Hamijoyo, Laniyati
Indonesian Journal of Rheumatology Vol 2, No 3 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

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 leptin in the pathogenesis of systemic lupus erythematosus Suarjana, I Nyoman
Indonesian Journal of Rheumatology Vol 1, No 1 (2009)
Publisher : Indonesian Rheumatology Association

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Abstract

Leptin is a 16 kDa adipocyte-secreted hormone that regulates weight centrally and links nutritional status to neuroendocrine and immune functions. Several studies indicate that leptin plays an important role in immune responses. Leptin affects both innate and adaptive immunity. It can stimulate dendritic cells (DC), monocytes, macrophages, neutrophils and natural killer cells. Leptin is involved in DC maturation and survival,and can skew the cytokine balance of a T helper (Th)1 profi le. In adaptive immunity, leptin can promote naïve T cell survival and production of interferon-γ and interleukin-2, and activate Th1 cells while inhibiting Th2 cells. Leptin may play an important role in theregulation of the Th1/Th2 balance. As a survival factor, leptin has been shown to suppress B cell apoptosis. The role of leptin in the pathogenesis of systemic lupuserythematosus (SLE) is not fully determined yet. This review tries to link the role of leptin in immunity to the pathogenesis of SLE.
Complete manifestations of Behçet’s disease Umami, V; Setiyohadi, Bambang
Indonesian Journal of Rheumatology Vol 2, No 2 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Behçet’s disease (BD) is a chronic, relapsing, inflammatory disease characterized by recurrent oral aphthae and any of several systemic manifestations that include genital aphthae, ocular disease, skin lesions, neurologic disease, vascular disease, or arthritis. Hippocrates may had described BD in the fifth century B.C.; however, the first official description of the syndrome was attributed to the Turkish dermatologist Hulusi Behçet in 1924. In 1930, the Greek physician Adamantiades reported a patient with inflammatory arthritis, oral and genital ulcers, phlebitis, and iritis.1 Since then, the syndrome has been referred to as BD.1,2 The manifestations of BD are thought to be caused by an underlying vasculitis. Although this disease is recognized worldwide, the prevalence is highest in the eastern Mediterranean, the Middle Eastern, and East Asian countries, thus the nickname Silk Road disease. The disease tends to be more severe in areas where it is more common. Prevalence rates all over the world are increasing, probably because of improved recognition and reporting. Behçet’s disease occurs primarily in young adults. The mean age at onset is between 25 and 30 years. The incidence of disease in males and females is approximately equal along the Silk Road, but in Japan, Korea, and Western countries the disease occurs more frequently in women. Caseconfirmation can be challenging because many patients labeled as having BD have oral ulcers as the primary or sole manifestation.3
Interstitial lung disease in mixed connective tissue disease Tendean, Marshell; Nuriawan, Sazkia Aziza; Nugroho, Pringgodigdo
Indonesian Journal of Rheumatology Vol 9, No 1 (2017)
Publisher : Indonesian Rheumatology Association

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Abstract

Interstitial lung diseases (ILD) are known as a debilitating pulmonary complications that may be occured in almost all systemic connective tissue diseases (CTD), including mixed connective tissue disease (MCTD). ILD is usually found in more than half of MCTD patients after 2-4years after the diagnosis made. A-47-years-old female initially diagnosed as systemic lupus erythematosus (SLE) developed a severe progressive dyspnea. She has recently diagnosed as MCTD with ILD after 9 months of initial symptoms. She was giving with Cyclophosphamide 500 mg IV pulse dose. However, after 1 months she developed severe pneumonia andpronounced demise due to intractable septic shock. The debilitating course of ILD is commonly seen in most systemic CTD. Therefore, it is important to perform initial screening and prevention. Systemic corticosteroid with or without immunosupressor agent(s) are indicated inILD-MCTD. Patients with progressive diseases will have poor prognosis.Keywords : ILD, MCTD, Corticosteroid
Septic arthritis caused by Salmonella sp Hambali, Wirawan; Sumariyono, Sumariyono; Chen, K
Indonesian Journal of Rheumatology Vol 2, No 1 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Septic arthritis is a rare joint disorder, and can be caused by various pathogenic microorganisms, including bacteria, virus, mycobacterium, and fungus. The incidence of this infection is between 2 to 10 cases per 100,000 populations annually andcan reach as high as 30 to 70 cases per 100,000 in immunodeficient population. This disorder is frequently unidentified in early phase of the disease due to its unspecific symptoms and signs.1 This joint infection can cause numerous problems to the patient ranging from joint damage, bone erosion, osteomyelitis, fibrosis, ankylosis, sepsis,or even death.1-5 The case-fatality rate for this disorder can reach up to 11%, comparable to the case fatality rate for other community infections such as pneumonia.2,6 Salmonella sp. is a Gram-negative bacillus bacterium with main invasion predilection in intestinal villi.7 This microorganism rarely causes septic arthritis although several cases have been reported before. Ortiz-Neu et al. demonstrated that septic arthritis caused by Salmonella sp. has high relapse incidence and a tendency to turnchronic, making the treatment more difficult and challenging
24-Hour Proteinuria Weakly Correlated with Estimated Glomerular Filtration Rate in Lupus Nephritis Patients Praptama, Suhendra; Aini, Yulia Hayatul; Ghozali, Mohammad; Hamijoyo, Laniyati
Indonesian Journal of Rheumatology Vol 8, No 2 (2016)
Publisher : Indonesian Rheumatology Association

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Abstract

Background: Lupus Nephritis (LN) is still the most frequent complication in Systemic Lupus Erythematous (SLE) patients which causing the major and significance morbidity and mortality. Proteinuria and Glomerular Filtration Rate (GFR) serves as objective and routine examinations to assessrenal function. 24-hour proteinuria still regarded as gold standard to quantify amount protein in urine. Estimated GFR (eGFR) is preferably used due its convenient. On the hand, estimated GFR (eGFR) is preferably used due its convenient. However, both of them should be measured in order to determine renal progression and prognosis. Only few studies have been conducted to find out the correlation between 24-hour proteinuria and eGFR in lupus nephritis patients as both of them serve as potential marker in progression of renal involvement. Thisstudy addressed to find out correlation between 24-hour proteinuria and eGFR in lupus nephritis patients.Method: Analytic-correlation study with cross-sectional approach at Dr. Hasan Sadikin Hospital, Bandung was done. Secondary data was used and paralleled with previous study entitled “Correlation of Random Urine Protein Creatinine (P-C) Ratio with 24-Hour Protein Urinein Lupus Nephritis Patients” carried out from October to December 2014.Correlation coefficient was analyzed by Spearmans’ correlation test.Results: Forty five samples were obtained based on inclusion criteria. Spearmans’ correlation test revealed non significant and very weak correlation between 24-hour proteinuria and eGFR (r=-0.095) with p>0.05.Conclusion: The 24-hour proteinuria and eGFR are weakly correlated. Despite the weak  correlation, these examinationsshould be considered as important markers to monitor prognosis of renal involvement in lupus nephritis patients Keywords: Estimated glomerular filtration rate (eGFR),Lupus Nephritis (LN), Proteinuria, Systemic Lupus Erythematosus (SLE).
The Use of Tocilizumab in Combination with Methotrexate in Indonesian Rheumatoid Arthritis Patients (PICTURE INA Study) Setyohadi, Bambang; Isbagio, Harry; Wachjudi, Rachmat Gunadi; Soeroso, Joewono; Kalim, Handono; Achadiono, Deddy Nur Wachid
Indonesian Journal of Rheumatology Vol 10, No 1 (2018)
Publisher : Indonesian Rheumatology Association

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Abstract

Background Aim of this research is to assess the efficacy and safety of tocilizumab (TCZ) in combination with methotrexate (MTX) in Indonesian patients with moderate to severe active rheumatoid arthritis (RA) who have an inadequate response to non-biologic DMARDs.Methods This was a interventional, prospective, single arm, multicenter, study in  Indonesian male or female patients aged ≥ 18 years old, with a diagnosis of RA for > 6 months based on ACR 1987 revised criteria with moderate to severe disease activity (DAS28 score > 3.2) after ≥ 12 weeks of non-biologic DMARDs treatment. The treatment consisted of tocilizumab, 8 mg/kg, intravenous (IV), every 4 weeks for a total of 6 infusion in combination with oral MTX (10−25 mg) every week. Efficacy was assessed based on the percentage of patients achieving low disease activity state (DAS28 < 3.2), percentage of patients achieving reduction > 1.2 point of DAS28, percentage of patients achieving remission (DAS28 < 2.6), and percentage of patients with ACR20, ACR50, and ACR70 responses. Descriptive statistics will be used for presentation of results.Results 100% patients reached low disease activity (DAS28 ≤ 3.2) at last study visit (week 24) and clinically significant improvement (reduction at least 1.2 units) at every visit in DAS28, both for ITT or PP patients. Remission (DAS28 < 2.6) was observed in 82.1% (ITT patients) and 93.1 % (PP patients) on last study visit. ACR20, ACR50, and ACR70 were achieved in 20%, 34%, and 34% (ITT patients), and 7%, 24%, and 62% (PP patients) on week 24. There were 3 out of 39 patients (7.69%) with adverse events (AE) and serious adverse events (SAE) that resulted in discontinuation of TCZ treatment, consisting of 1 patient with SAE of sepsis ec acquired community pneumonia, 1 patient with SAE of pneumonia tuberculosis, and 1 patient with AE of candidiasis. Most common adverse events were hepatic dysfunction (30.7%), hypercholesterolemia (23.1%), followed by arthralgia (20.5%) Twelve percent of patients needed dose modification due to elevated liver enzyme (elevated ALT/SGPT level).Conclusion Tocilizumab seems to be efficacious and likely to have good safety profile in non- biologic DMARD nonresponsive RA patients of PICTURE INA study.   Keywords: Rheumatoid Arthritis, Tocilizumab, DMARD, DAS28
Knee arthritis in an HIV positive patient - not associated with antiretroviral therapy Suarjana, I Nyoman; Kasjmir, Yoga I; Setiyohadi, Bambang
Indonesian Journal of Rheumatology Vol 1, No 1 (2009)
Publisher : Indonesian Rheumatology Association

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Abstract

Human immunodefi ciency virus (HIV)-associated arthritis is an oligoarthritis which predominantly affect the knees and ankles. It tends to be selflimited and to last less than six weeks. However, some patients with HIV-associated arthritis have been reported to have a disease course of more than six weeks with joint destruction. Synovial fl uid cultures are typically sterile and radiographs of the affected joints are usually normal except in those rare patients with a prolonged duration of symptoms in whom joint-space narrowing can occur.1,2 The pathophysiology of HIV specific arthritis types is not fully understood but drugs of the highly active antiretroviral therapy, in particular indinavir, are supposed to cause arthritis or rheumatological complaints.3 However,recently both human T-lymphotropic virus (HTLV) type I and HTLV-II have been suggested to induce infl ammatory or autoimmune reactions which can increase signifi cantly the incidence of arthritis.4 We report a patient with HIV infection presenting as knee arthritis which was apparently not associated with antiretroviral therapy.

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