Indonesian Journal of Rheumatology
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Secondary Trimester Pregnancy in Systemic Lupus Erythematosus Patients withPneumonia: A Case Report
Get PDFBackground. 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.
The Role of Antioxidants as Adjuvants of Fibromyalgia Management
Get PDFFibromyalgia 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.
A Patient with Granulomatosus with Polyangiitis (Wegener’s Granulomatosis): ACase Report
Get PDFBackground: 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
Get PDFBackground: 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.
Tuberculosis Arthritis: A Diagnostic Challenges
Get PDFBackground: 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.
Indonesian Rheumatology Association (IRA) Recommendations for Diagnosis and Management of Sjogren’s Syndrome
Get PDFBackground. 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.
Indonesian Rheumatology Association (IRA) Recommendations for Diagnosis and Management of Osteoarthritis (Knee, Hand, Hip)
Get PDFBackground: 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.
Simultaneous Cervical and Lumbar Spinal Degenerative Stenosis: Diagnostic andTreatment Challenge
Get PDFBackground: 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
Effect of Vitamin D Supplementation on Regulatory T Cells of Systemic LupusErythematosus: A Systematic Review
Get PDFBackground. Systemic lupus erythematosus (SLE) is associated with aglobal reduction in regulatory T cells (Tregs). Vitamin D supplementationthat is efficacious, safe, and reasonably priced has the potential to reducemorbidity in SLE. This study was aimed to systematically assess the efficacyof vitamin D supplementation in enhancing Tregs concentration or Tregsrelated
marker. Methods. A systematic review of the literature for clinicalstudies was performed on Pubmed, Proquest, and Google Scholar. Studieswere assessed for risk of bias using Newcastle Ottawa Scale. All clinicalstudies that investigated the effects of vitamin D supplementation on Tregsin SLE patients were included. Key evidence was analyzed and qualitativelysynthesized. Results. Three relevant studies were included. All studies wereof high-quality. Vitamin D supplementation consistently increased Tregsconcentration across all included studies. Conclusion. The current studysupports the evidence that vitamin D supplementation enhanced Tregsconcentration in SLE patients.
A A Systemic Lupus Erythematosus Accompanied with Myelodysplastic Syndrome,Grave’s Disease, and Sub-Acute Subdural Hemorrhage: A Case Report
No full textBackground: The systemic lupus erythematosus (SLE) is a disease ofautoimmune etiology affecting multiple systems, involving most commonlyfemales of the reproductive age group and different clinical manifestationsin each individual. Case presentation: A 23-year-old female patient withsystemic lupus erythematosus (SLE) presented with myelodysplasticsyndrome (MDS), Grave’s disease, and sub-acute subdural hemorrhage(SDH). She had chief complaints of severe headache and gum bleeding. Threeweeks earlier, the patient experienced a head injury. SLE was diagnosed onbiological and immunological clinical ACR criteria and the patient never hada therapy before. Bone marrow aspiration (BMA) test was performed withMDS result. Thyroid function test was performed with the result of decreasedThyroid Stimulating Hormone (TSH) and increased FT4 with diffusedenlargement of thyroid gland. Brain CT Scan resulted in sub-acute SDH withmidline shift of 1.13 cm to the left. The patient underwent subdural drainagewith local anesthesia and received steroid, azathioprine, thiamazole andnon- selective beta-blocker. She was hospitalized for 21 days and wasdischarged with good condition. Conclusion: Further investigation of thepatient is needed to fully understand the correlation between MDS, SubduralHemorrhage and Grave’s Disease in associated with SLE.