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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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Correlation between Severity of Knee Osteoarthritis and Serum Levels of Cartilage Oligomeric Matrix Protein Kambayana, Gede; Kurniari, Pande; Andriyasa, Andriyasa; Putra, T R
Indonesian Journal of Rheumatology Vol 5, No 1 (2014)
Publisher : Indonesian Rheumatology Association

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Abstract

Background: The sensitivity of radiographic examination in the diagnosis and severity assessment of knee osteoarthritis (OA) is still low. Various attempts have been made to find more reliable indicators of cartilage damage. One potential marker is cartilage oligomeric matrix protein (COMP), a substance that in previous animal studies had been shown to be released in proportion to the extent of joint cartilage damage.Objective: To evaluate the correlation between the severity of knee OA and serum level of COMP in human with normal renal function. Methods: This was a cross-sectional study performed at the outpatient clinic in Department of Internal Medicine, Sanglah Hospital, Denpasar. The diagnosis of knee OA was based on the American College of Rheumatology (ACR) criteria. The degreeof knee OA severity was determined by using the Kellgren-Lawrence criteria, while COMP values were checked by enzyme-linked immunosorbent assay (ELISA) method.Results: Forty five patients who were recruited were examined: 19 (42.2%) were female and 26 (57.8%) were male. The mean age of patients was 64.1±7.1 years. There were 4.4%, 26.7%, 46.7%, and 22.2% patients who had grade 1st, 2nd, 3rd, and 4th degree joint damage based on the Kellgren-Lawrence score, respectively. Mean serum level of COMP was 1081.4 ng/mL. We found a significant correlation ofthe severity of knee OA with serum level of COMP (r = 0.41, p = 0.005).Conclusion: Among the patients in this study, there was a significant correlation between the severity of joint damage in knee OA and serum level of COMP.
Invasive aspergillosis in a systemic lupus erythematosus patient Setiyohadi, Bambang; Azizi, M S; Yuliani, Ika Wulan; Sukmana, N; Suhendro, Suhendro; Simadibrata, M; Rumende, C Matin; Sulaiman, A S; Wahyuningsih, R; Lisnawati, Lisnawati; Yudharto, M A; Anggraini, N; Oktaviana, F; Sandra, R
Indonesian Journal of Rheumatology Vol 2, No 3 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

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 1–2 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%
Comparison of ultrasound therapy and local steroid injection in rotator cuff tendinitis Noviar, Noviar; Tulaar, A BM; Kasjmir, Y I; Sudarsono, S
Indonesian Journal of Rheumatology Vol 3, No 1 (2011)
Publisher : Indonesian Rheumatology Association

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Abstract

Objective: To evaluate the effectiveness of ultrasound therapy compared with local steroid injection for pain relief and movement limitation in rotator cuff tendinitis.Methods: Patients with rotator cuff tendinitis at the rheumatology and rehabilitation outpatient clinic at Cipto Mangunkusumo General Hospital were enrolled in a parallel randomized trial, in which each eligible patient were randomly assigned to one of two groups: one group received 10 sessions of ultrasound therapy given in 2 weeks, the other received a single dose of local steroid injection. Evaluation of the visual analog scale(VAS) was performed in 10 days (5 days for each week: day 1–5 and 8–12), while evaluation of the abduction as well as external and internal rotation range of motion(ROM) was performed twice a week (day 2, 5, 9, and 12). Change in the variables between the two groups at the end of the second week (day 12) was then compared. Results: Thirty patients, divided into two groups consisting of 15 patients each, were recruited in the study. Significant decrease in VAS during the followups was obtained in both groups, slightly earlier in the steroid injection group (day 2; p = 0.041) comparedwith the ultrasound group (day 3; p = 0.001). Significant increase in abduction ROM was achieved at the same rate (beginning at day 5) in both groups. Significant increase in internal rotation ROM was achieved at day 9 in the ultrasound group (p = 0.043) and day 12 in steroid injection group (p = 0.044). The increase in external rotation ROM in both groups was not found to be statistically signifi cant. At the end of the second week, signifi cant difference between the two groups was only shown in the abduction ROM, with higherincrease in the steroid group.Conclusions: Ultrasound therapy provided a comparable effectiveness to steroid injection inalleviating pain and improving ROM in patients with rotator cuff tendinitis.
Overview of Anemia among Systemic Lupus Erythematosus Patients in Reproductive Age Women based on Reticulocyte Hemoglobin Equivalent (RET-He) Level and Reticulocyte Count Modjaningrat, Ismiana Fatimah; Oehadian, Amaylia; Ghozali, Mohammad; Hamijoyo, Laniyati
Indonesian Journal of Rheumatology Vol 9, No 2 (2017)
Publisher : Indonesian Rheumatology Association

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Abstract

Background: Anemia is a common manifestation found among patients with Systemic Lupus Erythematosus (SLE). It may be caused by iron-deficiency, autoimmune hemolytic, and chronic inflammation. Each anemia has different therapy approachments. Without adequatemanagement, anemia may lead to poor prognosis. By identifying the etiology of anemia, appropriate management could be conducted. Reticulocyte Hemoglobin Equivalent (RET-He) and reticulocyte count test may distinguish anemia based on its etiology. This study aimed to give scientific portrayed of the proportion of anemia based on its etiology among patients with SLE using RET-He and reticulocyte count.Method: This study involved women diagnosed with SLE underwent outpatient treatment in Rheumatology Clinic, Dr. Hasan Sadikin General Hospital during SeptemberOctober 2016. Data were collected from blood exam using 35-parameters hematology Sysmex by calculating levels of hemoglobin, RET-He, and reticulocyte count.Results: Seventy four female patients were volunteered as subject in this study with median of age was 29.5 (16-70) years old. Thirty four (46%) of 74 subjects weresuffering from anemia and 12 (35%) of them were between 25-34 years old. Proportion of iron-deficiency anemia, autoimmune hemolytic anemia, and chronic inflammatory anemia were 14 ( 41%), 13 (38%), and 7 (21%), respectively.Conclusion: Based on hemoglobin, RET-He, and reticulocyte count, iron-deficiency anemia is the most common anemia among patients with SLE in repoductive age.Keyword: Age, Anemia, Reticulocyte, RET-He, Systemic Lupus Erythematosus (SLE)
Validity test of anti-c1q serum as diagnostic marker for lupus nephritis Enrica, M; Tjandrawati, A; Rachmayati, S; Hamijoyo, Laniyati
Indonesian Journal of Rheumatology Vol 8, No 1 (2016)
Publisher : Indonesian Rheumatology Association

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Abstract

Background: Lupus nephritis is defined as renal involvement in systemic lupus erythematosus (SLE) patients and the most important cause of morbidity and mortality. The diagnostic criteria that used to diagnose lupus nephritis are 1997 American Collegeof Rheumatology is 24 hours urine protein ≥500 mg and/or cellular cast, but significant renal damage can occur without proteinuria or cellular cast. Anti-C1q is an autoantibody that is produced by a chronic alteration of C1q collagen domain. Anti-C1q is a new specific marker for renal marker.Objective: To determine the validity of anti-C1q serum by using 1997 American College of Rheumatology criteria as a gold standard. Methods: This is a cross sectional study, conducted in October to December 2014 at Hasan Sadikin Hospital Bandung. The subjects had systemic lupus erythematosus with and without renal involvement, based on 1997 American College of Rheumatology criteria for SLE.Results: There were 65 subjects included in this study, 64 subjects were female and 1 subject was male. The age average was 32 (SD 11.7) years old. As many as 66.2% subjects had been diagnosed with lupus erythematosus systemic at least 3 years. Twenty four hours urine protein was measured using spectrophotometry, urine sediment was examinedfor cellular cast, and anti-C1q serum was measured using micro enzyme linked immunosorbent assay. Based on American College of Rheumatology criteria, 34 subjects were classified as lupus nephritis group while 31 subjects were classified as non-lupus nephritis group. The area under the curve of anti-C1q was 0.610. The cut-off value used in this study was 10.43 U/ml. The sensitivity, specificity, positive predictive value,negative predictive value and accuracy of anti-C1q assay were 41.18%, 77.42%, 66.67%, 54.55% and 58.46% respectively.Conclusion: Anti-C1q assay, based on this study, hasa low sensitivity and medium specificity to detect lupusnephritis
Predictor of joint damage in rheumatoid arthritis Sumariyono, Sumariyono; Isbagio, H
Indonesian Journal of Rheumatology Vol 2, No 2 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Objective: This study was implemented to determine the joint damage predictor in rheumatoid arthritis (RA).Methods: A cross-sectional study was conducted on outpatients of the rheumatology clinic at Cipto Mangunkusumo General Hospital who had suffered from RA for more than 2 years during the period from October 1, 1999 to June 30, 2000. During this period, we obtained 23 RA patients who fulfi lled the inclusion and exclusion criteria. We evaluated the patients’ medical data that included gender, education, age of onset, rheumatoid factor (RF), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Then we carriedout examinations and tests including X-ray of hand and wrist joints, RF, CRP, and ESR. The degree of joint damage was evaluated using the Larsen score.Results: Twenty three patients—all women, mean age of onset was 36.7 years, mean duration of disease was 62.8 months, educational level with high school degree or above were found in 19 cases (82.6%), and RF (+) at initial treatment were found in 10 cases (43.5%). The mean ESR at initial treatment was 77.9 mm/hr and CRP at initial treatment was between 0 and 768 mg/dL. The Larsen score ranged between 0 and 68 with a meanof 21.7. In bivariate analysis, the Larsen score was signifi cantly higher in the group with positive RF at initial treatment compared to that in the group with negative RF at initial treatment (p = 0.031). C-reactive protein and ESR at initial treatment and the age of onset did not have any signifi cant correlation with the Larsen score, but there was a signifi cant correlation of CRP and ESR during the study with the the Larsen score.Conclusion: RF level was the most signifi cant predictor in determining the degree of joint damage according to the Larsen score while initial positive RF had lower signifi cance level.
Correlation Betweeen Skin Fibrosis Based On Modified Rodnan Skin Score And B-Cell Activating Factor Serum In Systemic Sclerosis Alfarish, M Arzan; Dewi, Sumartini; Hamijoyo, Laniyati; Wachjudi, Rachmat Gunadi
Indonesian Journal of Rheumatology Vol 9, No 1 (2017)
Publisher : Indonesian Rheumatology Association

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Abstract

Background: Progression and expansion of skin fibrosis are the most important characteristics in determining clinical responses and prognosis of Systemic Sclerosis(SSc). Using modified Rodnan skin score (mRSS) can not rapidly detect a slight changes of skin fibrosis in SSc patients. Biomarker assessment is needed to make a more objective, quantitative and rapid evaluation of the changes. Suggested potential useful biomarker isB-cell Activating Factor (BAFF), a positive regulator of B cell survival and maturation process. This study aimed to evaluate correlation between skin fibrosis based on mRSS and BAFF serum in SSc patients.Methods: We used cross sectional methods. Enrolled all patients who met ACR EULAR 2013 criteria for SSc in Rheumatology Clinic Hasan Sadikin Hospital, Bandung, from November 2015 to March 2016. Subjects underwent medical record review, physical examination,mRSS measurement by rheumathologist, and blood tests. Data were analized using Rank-Spearman Correlation.Results: Thirty seven subjects, with mean age 40+10 years old. Subjects consisted of 23(62.2%) limited SSc and 14(37.8%) diffuse SSc. Mean BAFF serum was 1160.2+424.7 pg/mL, no statistical difference were found between limited and diffuse type (p=0.662).Median mRSS results was 16 ranged from 2 to 36.Correlation between mRSS and BAFF serum was not significant (r=0.077; p=0.326).Conclusion: There is no correlation between mRSS and BAFF serum in systemic sclerosis at Hasan Sadikin Hospital.Keywords: mRSS, BAFF, Systemic Sclerosis
Prevalence of Albuminuria and Associated Factors among Gout Arthritis Patients in Cipto Mangunkusumo Hospital Mahardhika, Jeffrey Christian; Anggoro, R.M. Suryo
Indonesian Journal of Rheumatology Vol 10, No 1 (2018)
Publisher : Indonesian Rheumatology Association

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Abstract

Background Gout arthritis associates with many comorbodities such as hyperuricemia, hypertension, hyperglycemia, obesity, and dyslipidemia, which are also factors for the development of/or predisposition factors of chronic kidney diseases (CKD). Albuminuria is a predictor factors for CKD. Screening for albuminuria is needed to be done in patients with high risk of CKD. This research was conducted to examine the prevalence of albuminuria and the associated factors in gout arthritis patients.Methods This research was a cross-sectional study from gout arthritis patients’ medical records in Cipto Mangunkusumo Hospital. We included all gout patients who treated within 2011−2015. Subjects with chronic kidney disease, in kidney replacement therapy, hypertension ≥ 10 years, and diabetes ≥ 5 years were excluded. Albuminuria was determined by urine dipstick result of protein ≥ 1+. Factors associated were age, sex, hyperuricemia, hypertension, stage of hypertension, hyperglycemia, obesity, dyslipidemia, uric acid level, and body mass index (BMI). Data associated with the factors were recorded and the associations were tested with chi square, fisher’s exact, or independent t-test.Results from 54 subjects included in this research, the prevalence of albuminuria was 20.4%. There were no significant associations between all factors and albuminuria tested by chi square and fisher’s exact test. Independent t-test’s results also showed no significant associations between all the factors and albuminuriaConclusion The prevalence of albuminuria in gout arthritis patient was 20.4%. There were no significant associatons between age, sex, hyperuricemia, hypertension, hyperglycemia, obesity, dyslipidemia, uric acid level, and body mass index (BMI) tested with albuminuria in gout arthritis patients in Cipto Mangunkusumo Hospital from 2011−2015.Keywords: Prevalence, Albuminuria, Gout Arthritis, Risk Factors
Correlation between anti-cyclic citrullinated peptide antibodies and the severity of clinical manifestation, laboratory manifestation, and radiological joint destruction in rheumatoid arthritis patients Suwito, Mat; Handono, Kusworini; Suryana, Bagus Putu Putra; Kalim, Handono; Wahono, Cesarius Singgih
Indonesian Journal of Rheumatology Vol 2, No 1 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Background. The second generation anti-cyclic citrullinated peptide test (CCP2) displays sensitivity comparable to that of rheumatoid factor (RF) (approximately 80%) but with superior specificity (98%) . Several observations have indicated that early rheumatoid arthritis (RA) patients with positive anti-CCP may develop a more erosive disease than those without anti-CCP.Objective. The purpose of this cross-sectional study was to investigate the correlation between anti-CCP antibodies and clinical and laboratory parameters and radiological joint destruction in RA patients.Methods. We studied 31 patients with RA fulfilling the 1987 revised criteria of American College of Rheumatology in Rheumatology Clinic of Saiful Anwar General Hospital, Malang, Indonesia. Clinical parameters were collected such as age, sex, visual analog scale,disease duration and diseases activity score (DAS28-3(CRP)). Laboratory parameters were WBC, hemoglobin, platelet count, erythrocyte sedimentation rate, and Creactive protein. Analyzed autoantibody profiles were RF and anti-CCP (ELISA methode). Radiological jointdestruction was evaluated from bilateral postero-anterior manus x ray (Sharp score).Results. Anti-CCP antibodies were detected in 48.4% of RA patients with mean antibody concentration was 291.24±143.67 (range 16-523.8) units. Anti CCP level was significantly correlated with duration of RA (month) (p=0.04, r=0.371), RF level (p=0.002, r=0.542) andSharp score (p=0.048, r=0.358), but was not significantly correlated with other clinical and laboratory parameters.Conclusion. Anti-CCP level was correlated with duration of disease, RF, and Sharp score.
Diagnostic values of DAS28 and DAS28-squeeze in evaluating Rheumatoid Arthritis disease Santosa, David; Hidayat, Rudy; Prasetyo, Marcel; Nugroho, Pringgodigdo
Indonesian Journal of Rheumatology Vol 8, No 2 (2016)
Publisher : Indonesian Rheumatology Association

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Abstract

Background : In recent years, rheumatoid arthritis (RA) uses a “treat to target”  treatment strategy. This strategy requires a valid and accurate tool for assessing disease activity. The most widely used tool is DAS28, which was developed from DAS with the omission of ankle and foot joints. There has been many critization aboutthe accuracy of DAS28 in classifying the state of RA disease. Most importantly, when an active disease state was misclassified as an inactive state (false negative)which lead to under treat and subsequently to disability. The difference between DAS28 and DAS lies mainly in the exclusion of ankle and foot joints, thus DAS28-squeeze, a new and simple tool has been proposed. It comprises the same 28 joints in DAS28 added with a sqeeze test on both metatarsophalangeal joints. However, this new tool has never been validated with any imaging techniques.Objective : To assess the diagnostic values of DAS28 and DAS28-squeeze.Methods : This study comprised a cross-sectional diagnostic study, using Power Doppler sonography as a standard reference in evaluating the diagnostic value ofDAS28 and DAS28-squeeze. This study uses the most sringent sonography criteria of active disease which is an active Doppler signal with a moderate synovial hypertrophy on B-mode. Results : Over the study period, 56 subjects underwent diagnostic tests using DAS28, DAS28-squeeze and Power Doppler sonography. There were 4 false negativecases in DAS28 and 1 case in DAS28-squeeze. The sensitivities of DAS28 and DAS28-squeeze to identify active disease using Power Doppler sonography as reference standard were 73.3% (95%CI ± 11.59) and 93.3% (95%CI ± 6.55), respectively. While the specificities of DAS28 and DAS28-squeeze were 36.6% (95%CI ± 12.62) and 34.1% (95%CI ± 12.42), respectively. Furthermore the negative likelihood ratioof DAS28 and DAS28-squeeze were 0.73 and 0.19, respectively.Conclusion : This study is the first to validate DAS28- squeeze using imaging techniques. From this study the false negative rate of DAS28-squeeze is lower thanDAS28. DAS28-squeeze has a better sensitivity and negative likelihood ratio than DAS28 in identifying RA disease state.Keywords : Rheumatoid Arthritis, DAS28, DAS28-squeeze, treat to target, Power Doppler, squeeze test

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