Indonesian Journal of Rheumatology
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The Relationship between Disease Activity Level and the Incidence of Depression in Systemic Lupus Erythematosus Patients at Haji Adam Malik Hospital Medan
Get PDFBackground: Systemic Lupus Erythematosus (SLE) is a autoimmune disease that affects many
organs of the body. SLE is a disease that cannot be completely cured. Life is difficult with SLE
because the symptoms may come and go and it is unpredictable what will happen next. This
condition causes the SLE patients feel unhappy, frustrated, angry, and sad. If this happens for a
long time, it can cause SLE patients to experience depression.
Methods: This study used a cross sectional design of 63 respondents at H. Adam Malik General
Hospital Medan. This research data was obtained through history taking using primary data in the
form of MEX SLEDAI questionnaires and Patient Health Questionnaire 9 (PHQ 9) and secondary data
in the form of patient medical records.
Results: It was found that SLE patients at H. Adam Malik General Hospital were all female, most of
them were in the late adolescent age group with an age range of 17-25 years (39.7%), the last high
school education level (68.3%), not working (81%), Married (54%), duration of SLE disease 1-2 years
(36.5%), most SLE patients had mild disease activity levels (49.2%), most SLE patients have a mild
depression (34,9%). There is a significant relationship between the level of disease activity and the
incidence of depression in SLE patients at H. Adam Malik General Hospital (p ≤ 0.05) with a strong
and unidirectional relationship (ρ = 0.64).
Conclusion: There is a significant relationship between the level of disease activity and the incidence
of depression in SLE patients at H. Adam Malik Hospital Medan with a strong relationship
Risk Factor Associated with Carotid Intima-Media Thickness inPatients with Systemic Lupus Erythematosus
Get PDFBackground: Cardiovascular complications, including atherosclerosis, arethe highest causes of mortality in systemic lupus erythematosus (SLE)patients. The carotid artery intima-media thickness (cIMT) can effectivelyindicate the condition of atherosclerosis in patients. This study wasconducted to determine the associated risk factors for cIMT in patientswith SLE. Methods: This research was conducted as a cross-sectionalstudy at Prof. I.G.N.G. Ngoerah Hospital, Denpasar. From January 2023to June 2023, all SLE patients aged 18-55 for men and 18-65 for women,without infections, cancer, asthma, stage 5 chronic kidney disease, stroke,coronary heart disease, peripheral artery disease, or smoking history, wereincluded. Measurement of cIMT was performed using Dopplerultrasonography. Statistical analysis was conducted using descriptivestatistics and Fisher exact test to assess the association between variables.Results: 52 patients (51 women and 1 man) met the inclusion criteria wereincluded. The mean age was 33.67 ± 10.51 years, the duration of SLE bythe time of diagnose was 50.37 ± 40.39 months, and the disease activityscored by MEX SLEDAI was 2.58 ± 3.24. Moreover, the bivariate analysisshowed a significant association between hypertension and cIMT in SLEpatients (p = 0.001) with an Odd Ratio (OR) of 28.77. The age at diagnosiswas also found to be significantly associated independently with cIMT (p =0.003, OR = 14.93). This is associated with dysregulation of lectin -likeoxidized-LDL (ox-LDL) receptor-1 (LOX-1), leading to an increased risk ofatherosclerotic plaque formation. Conclusion: There is a notableassociation between the occurrence of hypertension and age at diagnosisto the elevated cIMT in SLE patients.
Correlation between Serum IL-17 Levels and 24-H Urinary Protein in Lupus Nephritis Patients at Ulin General Hospital Banjarmasin: A Cross-Sectional Study
Get PDFoai:ojs2.journalrheumatology.or.id:article/1124-h urinary protein is a marker and predictor of kidney function in Lupus Nephritis (LN). IL-17 appears to contribute to LN. The aim of this study was to determine the correlation between serum IL-17 levels and 24-h urinary protein in LN patients
Inflammatory Cascade in Aortic Wall: Latent Tuberculosis Complicating Takayasu Arteritis in a Young Bangladeshi Lady- The Silent Duo
Get PDFTakayasu disease or pulseless disease is a rare chronic granulomatous panarteritis
of unknown aetiology affecting large vessels, particularly the aorta and its main
branches. It mainly affects females more than males with the ratio of 8:1 and in the
second and third decade of life. Mechanism may be transmural fibrous thickening
of the arterial walls. Takayasu arteritis is characterized by inflammation of the vessel
wall, leading to occlusion of the vessel wall. It is represented with claudication, fever,
and arthralgia. Clinical features are chest pain, vascular bruits, hypertension. There
is indirect evidence signifying a potential link between tuberculosis (TB) and
Takayasu’s arteritis (TAK); however, the exact mechanism and relationship between
TAK and Mycobacterium tuberculosis (TB) remain elucidated. This case intends to
highlight the association between latent TB and TAK, as early detection can avoid
devastating consequences
Perfect Timing for Canakinumab Use in Gout
Get PDFGout is an inflammatory disease caused by the deposition of monosodiumurate (MSU) crystals. Recently, the American College of Rheumatology (ACR)has recommended the usage of interleukin (IL)-1 inhibitor in gout patientswho are refractory to typical anti-inflammatory drugs. An example of IL-1inhibitor is canakinumab. Not much is known regarding the usage ofcanakinumab in gout arthritis. Thus, we decided to conduct a narrativereview that summarizes the efficacy and safety of canakinumab in goutpatients. In this review, we found that canakinumab is superior to nonsteroidal
anti-inflammatory drugs (NSAIDs) and corticosteroids in treatingacute gout flares. In addition, canakinumab may also be considered as apreventive therapy for gout flares in patients receiving urate-loweringtherapy. Overall, canakinumab has mild side effects but may occasionallycause serious infections. Canakinumab is also generally safe for use duringpregnancy. Due to the lack of studies, the safety of canakinumab in lactatingwomen, geriatric patients, and patients with hepatic or renal impairment isstill unknown.
The The Role of 25-Hydroxy Vitamin D and Cartilage Oligomeric Matrix Protein(COMP) Serum in Knee Osteoarthritis
No full textBackground. Osteoarthritis (OA) is a prevalent disease of themusculoskeletal system that affects over 528 million individuals worldwide,with 73% of those diagnosed being aged 55 or older. The knee joint is mostcommonly affected, along with the hip and hand joints. Vitamin D isessential for maintaining bone and cartilage metabolism. In chondrocytes,the presence of the vitamin D receptor (VDR) regulates the expression ofmetalloproteinase. The purpose of this investigation is to examine thecorrelation between vitamin D (25(OH)D) and cartilage oligomeric matrixprotein (COMP) serum in knee osteoarthritis. Methods. The cross-sectionalstudy was conducted by the Rheumatology Division at RSMH Palembang.Patients diagnosed with knee osteoarthritis based on the 1990 ACR criteriawere included. The chemoluminescent immunoassay and the HumanCartilage Oligometric Matrix Protein ELISA Reagent were used to measurethe levels of vitamin D (25(OH)D) and COMP serum. Results. Thirtyparticipants took part in this study from July to December 2022. Accordingto this study, 33% had insufficiency and 67% had a deficiency of vitamin D.Spearman\u27s Rho test shows that there is a strong negative correlationbetween vitamin D (25(OH)D) and COMP serum. Conclusion. Vitamin D(25(OH)D) and COMP serum levels were significantly correlated in kneeosteoathritis.
Is It Obesity or Metabolic Syndrome Which Has a Greater Prevalence ToCause Muscoloskeletal Complaints? A Cross Sectional Study in theCepokomulyo District, Malang Regency
Get PDFIntroduction: Musculoskeletal (MSK) complaints including pain,swelling, stiffness, or immobility of joints and muscles are among themost common health issues that biomechanical factors are one of therisk factors. Metabolic syndrome is a combination of several riskfactors including obesity, hypertension, low HDL-C levels,hypertriglyceridemia, and impaired glucose tolerance. These issues areknown to influence the incidence of metabolic inflammation associatedwith several MSK diseases, in which obesity is one of the mainbiomechanical factors. Aim: To compare the Prevalence Odd Ratio(POR) of MSK complaints associated with metabolic syndrome (MetS)and obesity. Conclusion: This study included 260 patients, with 49.6%(n=129) of them having metabolic syndrome. The most common MSKcomplaint region was the right knee (n=85). MSK complaints were mostcommon in the group of patients with MetS and obesity (n=109),compared to the group with MetS or obesity alone. Prevalence OddRatio (POR) results show that Group III (group of patients with obesityand without MetS) has the highest prevalence of MSK complaints whencompared to the other three groups
Relationship Between Interleukin 6 (IL-6) and Organ Damage Based on SLICCDamage Index -SDI Score in Systemic Lupus Erythematosus Patients
Get PDFBackground: Systemic Lupus Erythematosus (SLE) is a heterogeneousand complex chronic autoimmune disease. Interleukin 6 (IL-6) is acytokine known to be elevated in people with SLE. This research wasconducted to determine the relationship between IL-6 levels and organdamage based on the SLICC Damage Index-SDI Score in SLE patients.Method: The study was a retrospective cross-sectional study involving67 SLE patients conducted based on the SLICC 2012/ACR EULAR2019 criteria at least 6 months prior to their inclusion. They werepatients treated at the Rheumatology Clinic of Adam Malik GeneralHospital in Medan from June to August 2023, who met the inclusionand exclusion criteria. Organ damage assessment was done using theSLICC Damage Index (SDI) score, while disease activity degree wasmeasured using the SLE Disease Activity Index (SLEDAI-2K) scoringsystem. Results: 94 % subject were women with a median SLEDAI-2Kscore of 6 (10 – 16) where the moderate degree of activity was themajority in this study (41.8%), followed by the mild degree (37.3%),severe (16, 4%), and remission (4.5%). The median IL-6 level was63.3932 pg/ml (8.88 – 5966.67) where a significant correlation wasfound between IL-6 levels and the SDI score (p=0.017) and the degreeof disease activity and the SDI score (P<0.001). Conclusion: Asignificant positive correlation was found between IL-6 levels and SDIscores in SLE patients (p=0.017).
Massive Pericardial Effusion – An Uncommon Initial Presentation in aMale Patient With Systemic Lupus Erythematosus
Get PDFSystemic lupus erythematosus (SLE) is an autoimmune disease whichhas predilection for female gender. Usually, it manifests as myriad ofclinical signs and symptoms which can involve any organ system of thebody, however cardiovascular involvement solely as an initialpresentation is uncommon. Here we present a case of a male patientwho initially presented with a large pericardial effusion. Later, onextensive workup he was diagnosed with SLE with lupus nephritis.
Acute Lupus Pneumonitis with Cytomegalovirus Co-infection in Patients withLupus Nephritis
Get PDFIntroduction: Most patients with systemic lupus erythematosus (SLE) showsigns of pulmonary involvement. The clinical manifestations of LupusPneumonitis are the similar to those of acute interstitial pneumonia. The useof cyclophosphamide in lupus nephritis (LN) is associated with high CMVtiters. Ganciclovir is the main choice of therapy for CMV pneumoniainfection. Case presentation: A 19-year-old female with previous history oflupus nephritis presented with worsening dyspnea, productive cough withyellowish sputum and hemoptysis. Following physical, laboratory andradiological examinations, the patient was diagnosed with acute lupuspneumonitis, with a differential diagnosis of pneumonia infection. Duringtreatment in the intensive care unit (ICU), she was put on ventilator andreceived routine hemodialysis due to pulmonary edema. She was givenintravenous antibiotics before the culture results came out, but there wasno clinical improvement. Once the culture results returned negative, theantibiotics were discontinued and IV pulse methylprednisolone was started.There was significant clinical, radiological, and laboratory improvements.After discharge, the patient experienced hemoptysis again due to CMVpneumonia infection and was given ganciclovir therapy with satisfactoryresults. Conclusion: In patients with advanced LN and pulmonaryinvolvement, distinguishing between infection and SLE flares may bechallenging, which can cause dilemma in diagnosis and treatment decisions.Adequate oxygenation with ventilator, hemodialysis, and administration ofganciclovir and mycophenolic acid provides significant improvements inpatient care.