Indonesian Journal of Rheumatology
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B-Cell Activating Factor Profile and Quality of Life in Systemic LupusErythematosus Patients
Get PDFBackground: B-Cell Activating Factor (BAFF) is a cytokine that plays a rolein systemic lupus erythematosus (SLE) pathogenesis. BAFF increases B cellfunction, which will affect disease activity. In addition to decreasing diseaseactivity, good quality of life (QoL) is one of the goals to be achieved in SLEtherapy, which is also affected by disease activity. The purpose of this studyis to know the correlation of the BAFF profile with the QoL of SLE patients.Methods: This was a cross-sectional study using secondary data from aprevious study. The subjects of this study were SLE patients who had visitedthe rheumatology outpatient clinic or were hospitalized in Hasan SadikinHospital Bandung from September 2016 until February 2017. Subjects wereasked to complete the Short Form-36 and measure their BAFF level inserum. Demographic data were collected, and disease activity data wereassessed by Mexican Systemic Lupus Erythematosus Disease Activity Index(MEX-SLEDAI). The statistical analysis used in this study was the Spearmantest. Results: There was a positive correlation between BAFF and MEXSLEDAI
(r 0.238, p-value 0.038). There was also a negative correlationbetween MEX-SLEDAI and PCS, as well as the MCS score (r -0.392 and 0.371,
p-value <0.05). Conclusion: BAFF levels will increase in higherdisease activity which will affect a poorer quality of life.
Factors Related to Infection in Systemic Lupus Erythematosus PatientsAdmitted to the Hospital
Get PDFBackground: One of the causes of the increase in hospitalized SLE patientsis infection, and it is an important factor in morbidity and mortality, so it isnecessary to conduct a research to identify factors related to infection andthe type of infection caused in hospitalized SLE patients. Methods: Thisstudy is a retrospective, categorical descriptive study utilizing medicalrecords of SLE patients diagnosed with and treated for infection both onadmission and during their stay in Hasan Sadikin General Hospital betweenJanuary 2016 to June 2018. Results: Seventy- four patients were involvedinto this study. Female were 70 (94.6%), aged <40 years were 69 (93.2%)patients, and all 74 (100%) were entirely in an active disease condition witha mean Mexican systemic lupus erythematosus disease activity (MexSLEDAI)
score of 9 ± 5.2. Fifty-three (71.6%) subjects experienced majorinfections. Mucocutaneous and kidney were the most organs involvementfound in SLE patients during infection, 63 (85.1%) and 57 (77.0%)respectively. Sixty-two (83.7%) subjects had received corticosteroids beforethe onset of infection, while pneumonia was the most common infectionfound in 33 patients (44.6%). This study also noted 12 (16.2%) patientsdeceased related to infection with most causes were respiratory failure(66.7%). Conclusion: Age less than 40-year-old, mucocutaneous and kidneyinvolvement and previously on corticosteroids were found higher among inhospitalized SLE patients. Most experienced major infections andpneumonia is the most common type of infection.
The The Prevalence and Factors Associated with Metabolic Syndrome in RheumatoidArthritis Patients
No full textBackground: Rheumatoid arthritis (RA) is an independent risk factor ofcardiovascular disease (CVD), causing 30-50% mortality in RA patients.Metabolic syndrome is a combination of metabolic disorders that can bemanifested as central obesity, impaired blood pressure, or abnormalities ofcarbohydrate and lipid metabolism, which is closely associated with CVD inRA patients. The prevalence and factors associated with the incidence ofmetabolic syndrome in RA patients vary in previous studies. This studyaimed to determine the prevalence and factors associated with the incidenceof metabolic syndrome in RA patients at Cipto Mangunkusumo NationalCentral General Hospital, Jakarta. Methods: A total of 145 RA patients atthe Rheumatology Clinic of Cipto Mangunkusumo National Central GeneralHospital from October to December 2021 were included as research subjectsby consecutive sampling method. History taking about the disease anddemographic data, physical and anthropometric examination, andlaboratory tests were done on the patients. The prevalence of the metabolicsyndrome was determined using harmonization criteria. Statistical analysiswas performed to determine the association of the variables of age, smokinghabit, disease activity, duration of disease, glucocorticoid treatment, andmethotrexate treatment with metabolic syndrome in RA patients. Results:The prevalence of metabolic syndrome was 19.3% in RA patients with a mean age of 49.8 ± 11.6 years. The variables of gender, age, deformity, physical activity, extraarticular manifestation, smoking habit, disease activity,disease duration, glucocorticoid treatment, and methotrexate treatmentwere not statistically significant to the incidence of metabolic syndrome inRA patients. Conclusion: The prevalence of metabolic syndrome in RApatients in this study was 19.3%, and no variable was associated with theprevalence of metabolic syndrome.
Quantitative Evaluation of Proteinuria with Urinalysis Test and Comparing ItsCorrelation with Random Spot Urine PCR and 24-Hour Urine Protein in SLEPatients
Get PDFIntroduction: Lupus nephritis is an important concern among systemiclupus erythematosus (SLE) patients in Asia, and its mortality rate wasreported to be 6 times higher compared to the general population. 24-hoururine protein collection has long been used as the gold standard test toassess proteinuria. This study aimed to assess the correlation of urinalysistest with random spot urine protein-creatinine ratio (PCR) compared with24- hour urine protein. Methods: This was a retrospective study. Theelectronic medical records of all SLE patients seen in the rheumatology clinic of Hospital Sultan Ismail from 1st January 2017 to 1st January 2021 were reviewed. Patients who had urinalysis, urine protein-creatinine ratio, and24-hour urine protein tests were identified. Data on demography, urinalysis, random spot urine protein-creatinine ratio, and 24-hour urine protein were obtained and analysed. Results: The correlation between urinalysis and 24hour
urine protein was strong (r=0.702), whereas the correlation betweenurinalysis and urine PCR was stronger (r=0.797). Our study also showed thecorrelation between random urine protein-creatinine ratio and 24-hour urineprotein is strong (r=0.782). Conclusion: Urinalysis correlates well with bothrandom spot urine protein-creatinine ratio and 24-hour urine protein, andthe correlation is stronger with urine protein-creatinine ratio.
Is There Any Correlation between Anti-Ro 52 Antibody Level with HematologicalAbnormalities in Systemic Lupus Erythematosus?
Get PDFBackground: Systemic lupus erythematosus (SLE) is a complexautoimmune disease with various clinical and serological manifestations.Previous studies have shown conflicting results about the association of antiRo
52 autoantibodies with hematological abnormalities in SLE. Weinvestigated the correlation between anti Ro 52 autoantibody with anemia,leucopenia, and thrombocytopenia in patients with SLE. Methods: Sixty-twobio archives serum of an SLE patient at the Division of Rheumatology,Department of Internal Medicine, Hasan Sadikin General Hospital,Bandung, Indonesia from 2017 to 2019 were enrolled in the study. Anti-Ro52 levels were examined using the ELISA method. The clinical data,treatment, and hematology paparametersere were analyzed retrospectively.Results: Among 62 bio-archive serum, four subjects were excluded becauseof incomplete data. Fifty-eight patients, all females were enrolled. Weidentified 57 (98.3%) subjects corticosteroid, 31 (53.4%) azathioprine and 28(48.3%) chloroquine. A correlation coefficient of anti-Ro 52 levels andhemoglobin, leukocyte and platelets were -0.037 (p = 0.391), 0.065 (p =0.315) and 0.092 (p = 0.246), respectively. Conclusion: No correlation wasfound between anti Ro 52 antibody levels with haematological abnormalitiesin patients with SLE. Further studies need to evaluate whether otherantibodies play important role in haematological abnormalities in SLE.
Single Case Experience of Immunosuppressant Administration to SystemicSclerosis-ILD Patients with Aspergilloma
Get PDFBackground: Systemic sclerosis (SSc) is a chronic autoimmune disease thatstill poses a great challenge to clinicians. SSc is characterized by immunedysregulation and progressive fibrosis that typically affects variable internalorgan involvement such as lungs. Interstitial lung disease (ILD) is a commonmanifestation of SSc and a leading cause of death. The immunosuppressivedrug is the main treatment to suppress the inflammation process in SSc.Case presentation: In this case we report a 40-year-old female to suffer ILDSSc.
According to High-Resolution Computed Tomography (HRCT) thorax,we found that it was interstitial lung disease with aspergilloma. She gotmethylprednisolone 3x8 mg and azathioprine 2x50 mg. At the end of thetreatment, the patient showed improvement in her clinical condition andshowed no worsening condition in the HRCT evaluation for her fungalaspergilloma. Conclusion: Systemic sclerosis (SSc) is a rare autoimmunedisease involving the skin and internal organs. The immunosuppressiveagent is still the drug of choice for most autoimmune diseases.Immunosuppressive may promote fungal growth and have been associatedwith increased risk in most serious fungal diseases including aspergilloma
The Relationship between Anti-dsDNA Antibody Levels and Clinical Manifestationin Systemic Lupus Erythematosus Patients
Get PDFBackground: Anti-double-stranded deoxyribonucleic acid (anti-dsDNA)antibodies have been long known as specific autoantibodies in systemiclupus erythematosus (SLE) patients. Their central role in the pathogenesisof SLE also had been proposed for a long time. But many studies have failedto show a consistent association between anti-dsDNA levels and clinicalmanifestation in SLE patients. This phenomenon raised controversies aboutanti-dsDNA’s role in the development of the disease. This study aimed to givemore description of the relationship between anti-dsDNA antibodies leveland clinical manifestation of SLE. Methods: This study took place in Dr.Sardjito General Hospital, Yogyakarta, Indonesia, from July 2017 to July2020. This study is a descriptive-analytic study with a cross-sectionaldesign. Sixty-three females with new cases of SLE were included in thisstudy. We used Alegria® ORGENTEC ORG204S kits to measure anti-dsDNAantibody levels in those patients. All organ involvement and anti-dsDNA leveldata were collected from the subject’s medical record. We categorized thepatient into two groups, one group with a high level of anti-dsDNA antibodiesand the other with the normal one. The statistical analysis was conductedby using the chi-square test to associate the anti-dsDNA antibodies level withthe clinical manifestation of SLE that developed in those patients. Results:The haematological manifestation was the most prevalent clinicalmanifestation of SLE (69.8%), followed by cutaneous (66.7%) andmusculoskeletal manifestation (63.5%), respectively. Thirty subjects had ahigh level of anti-dsDNA, and 33 subjects had the normal one. Anti-dsDNAantibody levels were only significantly associated with the development ofhaematological manifestation (p=0.026). Conclusion: Haematologicalmanifestation tends to develop in SLE patients with high anti-dsDNAantibody levels.
Adult-Onset Still\u27s Disease (AOSD): A Case Report
No full textBackground: Adult-Onset Still\u27s Disease (AOSD) is a rare multisystemicautoinflammatory disorder with an unknown etiology, and the diagnosis isdifficult due to various differential diagnoses. AOSD diagnosis is gettingbetter because medical developments and therapeutic strategies fromvarious studies have benefited from advances in understandingautoinflammatory and autoimmune diseases. Case presentation. A womanpatient has a complaint of periodic high fever with joint pain for more than1 month and reddish spots on the skin, fatigue, and menstrual disorders.Patients had been treated several times and performed a blood transfusion,but complaints still occur frequently. The patient is diagnosed with AdultOnsetStill’sDisease with secondary amenorrhoea.Conclusion:This case is rarely found, so it requires quite difficult therapy and diagnostics. Therefore,this case was presented as a case report in order to get better therapy
Indonesian Rheumatology Association (IRA) Recommendations for Diagnosis andManagement of Glucocorticoid-induced Osteoporosis
Get PDFBackground: Patients receiving long-term glucocorticoid therapy are at riskof developing GIOP. However, until today, there is still no guideline thatspecifically explains how to diagnose and manage GIOP patients inIndonesia. Methods: 10 selected rheumatologists from the IndonesianRheumatologist Association (IRA) made recommendations based on keyquestions formed by a steering committee from IRA. These recommendation materials were taken from several online databases such as Pubmed, Science Direct, and Cochrane. Level of evidence and grades of recommendation were then assigned, and every member of the panelist team will assign a score for the level of agreement. Results: A total of 17 recommendations regarding screening, prevention, diagnosis, therapy, and monitoring for GIOP weremade. Conclusion: These recommendations can be used for adult patientsreceiving long-term glucocorticoids with or at risk of developing GIOP. Theprevention measure, diagnostic, therapy, and monitoring algorithm in thisrecommendation are all created with the consideration of Indonesia’s clinical setting, facility, and drug availability.
The Effect of Polyunsaturated Fatty Acids Omega-3 Supplementation on theComponents of Rheumatoid Arthritis Disease Activity: A Systematic LiteratureReview
Get PDFBackground: Rheumatoid arthritis (AR) is a chronic disease that causesdeformity in most productive age and can lead to death as disease activityincreases. Omega-3 polyunsaturated fatty acids (PUFAs) have the potentialto complement available therapies in reducing disease activity. Currently,the effect of omega-3 PUFAs on disease activity components is still unclear.This study aimed to determine the effect of omega-3 PUFAs’ supplementationon the components of RA disease activity. Methods: This research is asystematic study with PRISMA guidelines. Literature identification usingPubmed, MDPI, and clinicaltrials.gov. The inclusion criteria used were:giving omega-3 PUFAs, free full-text, RCT, in English or Indonesian, andassessing disease activity and its components; while the exclusion criteriawere: unpublished, comparisons were inappropriate. Assessment ofliterature quality with the Cochrane Collaboration tool. Results: The studyincluded six studies from 1994 to 2017. The effect of omega-3 PUFAs isdiversity in changes of disease activity in 4 of 5 studies. Another effect is asignificant reduction in the number of joint pains in the literature by dailydoses above 2.9 grams or at lower doses taking longer, and swollen joints in2 studies that were only affected in doses above 2.9 grams. Another changeis a significant reduction in pain severity in the studies. Change increaseswith higher doses. There are variable LED and CRP changes with minimalstudy resources. Conclusion: Omega-3 PUFAs depend on their dose andadministration duration and can, directly and indirectly, affect diseaseactivity through the influence of most of its components, namely: the numberof joints affected, the degree of pain, but the results of the ESR and CRPexaminations are not sufficient.