Indonesian Journal of Rheumatology
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Relationship between Knowledge Level and Preventive Behavior of SepticArthritis in Student Batch 2019-2020, Faculty of Medicine, University of NorthSumatra
Get PDFBackground: Septic arthritis is an infectious disease that severely damagesthe joints with clinical manifestations such as swelling, erythema andwarmth of the affected joint. The most common cause of this disease is theresult of hematogenous spread of microorganisms. Some of the risk factorsinclude injection drug use, prosthetic joints and skin infection. The incidenceof septic arthritis is 5 to 8 per 100,000 population per year with 5-10%mortality rate, therefore preventive behavior is needed to minimize theincidence of septic arthritis. Methods: This study is an observationalanalytic study with a cross-sectional approach. The research populationconsisted of students from batch 2019-2020 of the Faculty of Medicine,University of North Sumatra and the sample was determined using stratifiedrandom sampling method. Primary data were obtained directly from researchsubjects using questionnaires via Google Forms. Results: The univariateresearch analysis found that the knowledge level of the majority ofrespondents was in the good category, with 45 subjects (53.6%). The mostpredominant behavior observed in the respondents was negative behavior,with 49 subjects (58.3%). Bivariate analysis found that there was nosignificant relationship between knowledge level and septic arthritisprevention behavior with p value = 0.809. Conclusion: Students from batch2019-2020 of the Faculty of Medicine, University of North Sumatra, onaverage have a good level of knowledge and negative behavior on theprevention of septic arthritis. There is no relationship between the level ofknowledge with septic arthritis prevention behavior.
The The Correlation Between Serum Vitamin D Level and Quality of Life inSystemic Sclerosis Patients
No full textBackground: Systemic sclerosis (SSc) is an autoimmune rheumatic disease that is associated with disability and a reduced quality of life. Patients with SSc have lower levels of vitamin D than healthy people. Vitamin D influences the pathological mechanisms of SSc such as autoimmunity, vasculopathy, and fibrosis. The aim of this study was to know the correlation between serum vitamin D levels and the quality of life in SSc patients. Methods: This study was a cross-sectional study. Data were taken from the SSc patient registry at the Rheumatology Clinic of Dr. Hasan Sadikin General Hospital Bandung from September to November 2023. Vitamin D level were assessed by measuring serum 25-hydroxyvitamin D levels. The quality of life was measured using the Indonesian version of the Short Form (SF-36), which was divided into physical component summary (PCS) and mental component summary (MCS). Statistical analysis was performed using the Rank-Spearman test. Results: There were 81 SSc patients enrolled in this study. Vitamin D levels were found low in 44 subjects (54.3%), which were divided into 23 subjects deficiency and 21 subjects insufficiency. Thirty seven subjects (46.7%) had normal vitamin D levels. The results of this study showed that there was a significant weak positive correlation between serum vitamin D levels and PCS SF-36 (r=0.222, p=0.023) and MCS SF-36 (r=0.209, p=0.031) quality of life in SSc patients. Conclusion: Serum vitamin D levels of SSc patients had a significant weak positive correlation with physical and mental quality of life component
Plasmapheresis as a Promising Therapeutic Option to TreatMacrophage Activation Syndrome
Get PDFMacrophage activation syndrome (MAS) is a lethal complication ofautoimmune conditions. Its diagnosis and management remainschallenging till date in view of paucity of standard protocols.Plasmapheresis has shown promise if used early in the course ofdisease. We hereby describe a case report of a young male patient whopresented with multiorgan failure. He was diagnosed with MAStriggered by systemic lupus erythematosus (SLE). He was successfullytreated with steroids, cyclophosphamide and plasmapheresis
Initial Clinical Presentation of Systematic Lupus Erythematosus (SLE) Patientsin Cipto Mangunkusumo Hospital
Get PDFBackground. Systemic Lupus Erythematosus (SLE) is a systemicautoimmune disease characterized by highly diverse and nonspecificsymptoms with clinical presentations involving more than one organ systemwhich often leads to delayed diagnosis and poor prognosis. This study aimsto understand patients’ initial clinical presentation in order to enhance earlydetection and establish an early diagnosis. Methods. This descriptive crosssectionalquantitativestudy
included patients who commenced their visitsto the Rheumatology Clinic at RSCM from May 2021-December 2022. Aconsecutive sampling method was used, and data were analyzed for age,gender, symptom onset, as well as patients\u27 initial clinical presentations(SPSS 25.0). Results. Out of 231 subjects, 96.1% were females. A total of38.1% of the patients belonged to the 21-30 age group, and symptom onsetwas most commonly observed in the 0-1 year age group, accounting for67.5%. Approximately 24.2% of the patients exhibited constitutionalmanifestations with involvement of other organs, including musculoskeletal(87.4%), mucocutaneous (84%), hematologic (3.,5%), renal (33.3%), andneuropsychiatric (8.7%) systems. Lungs, heart, blood vessels, gastrointestinal and hepatic systems, eyes, obstetric, and endocrineinvolvements were not found in this study. Among the 231 subjects, 44.2%of them had simultaneous involvement of two organs, which emerged as theirinitial clinical presentation. Conclusion. Musculoskeletal andmucocutaneous involvement were most commonly observed as th e initialclinical presentation of SLE patients at RSCM, followed by hematologic,renal, and neuropsychiatric involvement.
Correlation Between sCD28 and sCD80 Levels with Disease Actiity of SystemicLupus Erythematosus (SLE) Patients Based on SLEDAI Score
Get PDFBackground: Systemic Lupus Erythematosus (SLE) is an autoimmune diseasewith multisystem involvement that is caused by multifactorial. Prolongedexposure to autoantigens and sustained immune system activation, particularlyin memory T lymphocytes, can contribute to premature immunosenescence.Soluble costimulatory molecules such as sCTLA-4 and sCD86, originating fromCTLA-4 and CD86 respectively, contribute to the progression ofimmunosenescence in patients with SLE. This condition is associated with highermorbidity and mortality. This study aimed to investigate the relationshipbetween elevated levels of sCTLA-4 and sCD86 and the severity of SLE diseaseactivity, as assessed by the SLEDAI score. Methods: The study employed ananalytical observational design with a cross-sectional approach, involving 35female participants diagnosed with SLE according to the 2012 SLICC criteria. SLEdisease activity was assessed using the SLEDAI score, and serum levels of sCD28and sCD80 were measured using the ELISA method. The Mann-Whitney test wasused for group comparisons, while the Spearman test was conducted forcorrelation analysis, with statistical significance defined as p < 0.05. Results: SLEpatients had an average sCD28 and sCD80 level of 24.93 and 27.41, respectively.Spearman test results showed that sCD28 level had a significant correlation withSLEDAI score [R=0.364; p=0.031 (p<0.05)], while sCD80 level did not correlatesignificantly with SLEDAI score [R=0.048; p=0.786 (p<0.05)]. Conclusion: Therise in sCD28 levels showed a positively correlation with the SLE severity activity,as indicated by the SLEDAI score
Factors Contributed to a Difficult-To-Treat Juvenile IdiopathicArthritis: A Systematic Review and Meta Analysis
Get PDFBackground: Juvenile Idiopathic Arthritis is the foremost commonunremitting rheumatic illness in childhood, with a global prevalence rangingfrom 16 to 150 per 100.000 population. However, in some cases, clinicianmay face a difficult-to-treat Juvenile Idiopathic Arthritis (D-JIA), whichindicate to a group of patients who have not affected by administration ofstandard anti-rheumatic drugs. This study aims to identify factors thatcorrelate to D-JIA. Methods: We conducted a systematic review and metaanalysis, collecting studies from PubMed, Scopus, Embase, Cochrane, andGoogle Scholar. Eligible Studies were trials that analyze factors that maycontribute to D-JIA. Results: Six studies were included, enrolling 1.177patients. Female composes 70.9% (835) of the population (OR 1.04, CI 95%0.83-1.31, p=0.72). Median of age and duration of disease respectively were5.79 years and 11.06 months. Some factors correlate with occurancy of DJIA
including Caucasian race (OR 0.96, CI 95% 0.44-2.07, p=0.91), ANAnegative (OR 1.77, CI 95% 1.42-2.22, p<0.00001), HLA B27 positive (OR1.86, CI 95% 0.85-4.08, p=0.12), prescence of atypical skin lesion (OR 8.5,CI 95% 1.6-72.4, p=0.022), and spesific subtype of JIA such as Oligoarthritis(OR 0.86, CI 95% 0.70-1.07, p=0.17), Poliarthritis (OR 1.77, CI 95% 1.422.22,
p<0.00001), Systemic-type (OR1.22, CI 95% 0.60-2.49, p=0.58),Psoriatic (OR1.61, CI 95% 0.69-3.78, p=0.27), Enteritis-related (OR 1.33, CI95% 0.68-2.59, p=0.40), and Undiffrentiated (OR 1.46, CI 95% 0.55-3.83,p=0.45). Conclusion: Eventhough many factors identified, but only ANAnegativity, presence of atypical skin lesion, and Poliarthritis subtype thathave been statistically proved related in the development of D-JIA. Thisfinding may be due to the study\u27s limitations and remaining differences insubsequent results. Future studies are needed for further analysis regardingthis issue.
Correlation between sCTLA-4 and sCD86 Levels with Disease Activity of SystemicLupus Erythematosus (SLE) Patients Based on SLEDAI Score
Get PDFBackground. Systemic Lupus Erythematosus (SLE) is an autoimmunedisease with multisystem involvement which arises from multifactorialcauses. Continuous exposure to autoantigens and chronic activation of theimmune system, especially memory T lymphocytes, contribute to prematureimmunosenescence. sCTLA-4 and sCD86 are soluble costimulatorymolecules of CTLA-4 and CD86, which play a role in the occurrence ofimmunosenescence in SLE. The presence of immunosenescence will causehigher morbidity and mortality. This research was conducted to establishthe correlation between the increased levels of sCTLA-4 and sCD86 and theseverity of SLE, as measured by the SLE Disease Activity Index (SLEDAI)score. Methods. This analytical observational research utilized a crosssectional approach involving 35 female SLE patients diagnosed according to the SLICC 2012 criteria. SLE disease activity was measured using SLEDAI score. Serum sCTLA-4 and sCD86 levels were measured using the ELISA method. Statistical analysis was conducted using the Mann-Whitney test for comparisons and the Spearman test for correlation analysis, with a significance level of p<0.05. Results. sCTLA-4 levels were higher and significantly different in patients with moderate SLE (p=<0.001; p<0.05), and there was no significant difference in sCD86 levels (p=0.915; p>0.05).Increased sCTLA-4 levels were positively correlated with the severity of SLE(r =0.361, p=0.033), while no significant correlation was observed in sCD86levels (r=-0.094, p=0.591). Conclusion. Elevated sCTLA-4 levels werepositively correlated with increased severity of SLE based on the SLEDAIscore.
Use of Methotrexate for More Than 4 Years Is Not Associated with Liver Fibrosisin Rheumatoid Arthritis Patients
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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
Characteristics and Treatment Responses of Rheumatoid Arthritis Patients at Dr.Cipto Mangunkusumo National General Hospital
Get PDFIntroduction. Rheumatoid arthritis (RA) is a chronic progressiveautoimmune rheumatic disease that primarily affects the joints. The goal ofRA treatment is to achieve remission or low disease activity, using a treatto-target
approach. This study aims to explore the characteristics of RApatients and evaluate their treatment responses in Dr. CiptoMangunkusumo National General Hospital (RSCM). Methods. This crosssectionalstudyisconductedbycollectingdemographicandclinicaldata,as
wellasinterviewingadultpatientsthathavebeendiagnosedwithRAatthe
Rheumatology
Clinic of RSCM and have been on disease-modifyingantirheumatic drugs (DMARD) treatment for a minimum of 6 months.Results. A total of 94 patients were included in this study. Subjects werepredominantly female (93.6%) and had no formal jobs (64.9%). A majority ofRA patients exhibited moderate disease activity (48.9%, based on DiseaseActivity Score-28 with erythrocyte sedimentation rate [DAS-28 ESR]), with arelatively high level of steroid use (86.2%). Notably, most patients startedDMARD treatment more than 2 years after the onset of symptoms (45.7%).The proportion of patients achieving therapy target (remission to low diseaseactivity) was 41.5%, with 13.8% attaining remission. Furthermore, HealthAssessment Quality (HAQ) scores were found to be significantly lower amongthe target-achieving group, indicating better quality of life. Conclusion.Therapy target was achieved in 41.5% of RA patients in RSCM, with 13.8%achieving remission. Further research can be conducted to evaluate factorswhich may affect treatment response among RA patients.
Sjögren\u27s Syndrome: A Rare Clinical Entity in Children
No full textBackground. Sjögren\u27s 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.