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Indonesian Journal of Rheumatology
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  This is an Open Access Journal Open Access journal
ISSN (Online) 2086-1435
Published by Universitas Indonesia Homepage  [20 journals]
  • Effect of Folic Acid Supplementation for Reducing Methotrexate Side
           Effects in Patients with Rheumatoid Arthritis: an Evidence-based Case

    • Authors: Athira Presialia, Bambang Setyohadi
      Pages: 274 - 278
      Abstract: Background: Rheumatoid arthritis is a chronic inflammatory joint disease,
      indicated by a symmetrical erosive synovitis. Disease-modifying anti-rheumatic
      drugs (DMARDs) are known to interfere with signs and symptoms of RA, improve
      physical function and therefore increase patient productivity. Methotrexate is an
      anchor drug for rheumatoid arthritis patients, however, its related mechanism of
      action with folate deficiency resulting in some side effects, including
      gastrointestinal and liver toxicity. Folic acid supplementation may reduce these
      side effects. Method: A search was conducted on Pubmed, Cochrane, EBSCOhost,
      and ProQuest. After the selection of title and abstract was done using inclusion
      and exclusion criteria, which led to one relevant article. The selected study was
      critically appraised for its validity, importance, and applicability. Result: In
      rheumatoid arthritis patient receiving methotrexate, there was a statistically
      significant reduction in the incidence of abnormal transaminase elevation (RR:
      0.19, 95% CI: 0.10-0.36), but the reduction in gastrointestinal side effects did not
      reach statistical significance (RR: 0.76, 95% CI: 0.57-1.01) Conclusion: Folic acid
      supplementation has an effect in reducing gastrointestinal and liver toxicity as side
      effects of methotrexate in rheumatoid arthritis patients.
      PubDate: 2021-02-17
      Issue No: Vol. 12, No. 2 (2021)
  • Behçet's Disease with Multiorgan Infection: Alternative Treatment to
           Systemic Immunosuppressants

    • Authors: Dian Hasanah
      Pages: 285 - 285
      Abstract: A B S T R A C T   Background. Behçet's disease is a rare systemic autoimmune vasculitis. The presence of infection makes it difficult to manage. Case. Ms. X, 19 years old, complained of mouth and genitalia ulcers and joints pain. She had typhoid fever two months before; and a week after recovery, she experienced reddish skin lesions on her legs. Her condition was weak and the pain visual analog score (VAS) was 9/10. Multiple oral ulcers were found in her oral cavity and vulva. Her lungs were hypersonor. There were hyperpigmented maculae in her lower extremities. Her ankle joints were painful in passive and active movements. Blood leukocytes: 13,210/µl, urine leukocytes: 20-23/hpf, ANA, anti-dsDNA and Pathergy tests were negative. The diagnosis of Behçet's disease was based on multiple oral and genital ulcers, history of erythema nodosum and arthritis. The patient was treated with topical triamcinolone. Joint ulcers and pain worsened; so that intravenous methylprednisolone was administer. Two days later, the patient had cough and oxygen desaturation. Chest X-ray showed emphysematous lungs and pneumonia. Methylprednisolone was stopped, ceftriaxone and levofloxacin were given, treatment for ulcers and arthritis was replaced with colchicine and rebamipide. Sucralfate is given for gargle and applied to the genital ulcers. On the seventh day, the ulcers were greatly reduced, joint pain resolved, cough subsided and VAS became 2/10. On the twelfth day, the chest X-ray was normal and ulcers were healed, ankle pain was suffered again accompanied by swelling. The patient was treated with methylprednisolone and azathioprine. Discussion. Treatment for this disease is immunosuppressants. In severe conditions with infection, colchicine can be an alternative treatment. Adjuvant treatment are rebamipide and/or sucralfate. Emphysematous lungs can be caused by alpha-1 antitrypsin deficiency or pulmonary vasculitis, which can be manifested in autoimmune diseases. Emphysematous lungs, leads us to follow up on the development to other autoimmune disorders such as lupus. Conclusion. Behçet's disease with infection can be successfully managed with colchicine, rebamipide and sucralfate.
      PubDate: 2021-02-17
      Issue No: Vol. 12, No. 2 (2021)
  • Correlation Between Mex-Sledai and Mean Platelet Volume In Systemic Lupus
           Erythematosus Patients

    • Authors: Ayu Paramaiswari, Dody Hendro Susilo, Deddy Nur Wachid Achadiono
      Pages: 293 - 301
      Abstract: A B S T R A C T
      Background. Systemic lupus erythematosus (SLE) is a chronic autoimmune
      disease which has a variety of clinical phenotypes with a complex clinical course.
      The clinical phenotypes are highly variable which can be characterized by acute
      attacks, active periods, controllable or remission. Mean platelet volume (MPV) is a
      straightforward accessible indicator of platelet activity and is associated with
      systemic inflammation. The routine usage of MPV as markers for disease activity
      in SLE remains problematic. Early detection of disease progression is pivotal in the
      management of SLE for obtaining better outcomes. Objective. The study aimed to
      confirm that the measurement of the disease severity in patients with SLE using
      Mex-SLEDAI has a negative correlation with the decrease of MPV value. Methods.
      This cross-sectional analytic descriptive study was conducted using secondary data
      from the medical records of patients with SLE older than 18 years of age who were
      not taking antiplatelets in the Internal Medicine policlinic of Dr. Sardjito General
      Hospital in 2018. Patients with a previous history of cardiovascular and
      cerebrovascular events, malignancies, receiving a treatment for infections,
      including sepsis, chronic infections (i.e. tuberculosis, cytomegalovirus, herpes
      simplex, herpes zoster), HIV, hepatitis B or hepatitis C, and incomplete data of
      medical record were excluded. The correlation between SLEDAI Mex and MPV
      values was evaluated using the Spearman's correlation test. Results. Sixty-seven
      subjects (65 women, 2 men) aged 34 ± 11 years were recruited in the study. The
      median duration of diagnosis was 38,2 ± 45,7 months. Arthritis, skin rash and
      photosensitivity were identified in 81,1%, 53,7%, and 46,3% of patients,
      respectively. The Mex-SLEDAI score ranged from 0 to 16. The average of MPV value
      is 9.73 ± 1.21 fL. A significant correlation between MPV and SLEDAI Mex was
      observed (p = 0.03 (p <0.05), r = -0.255). Conclusion. The more severe SLE disease
      activity (based on the Mex-SLEDAI scoring), the more negative correlation with the
      MPV value.
      PubDate: 2021-02-17
      Issue No: Vol. 12, No. 2 (2021)
  • Effects of vitamin D3 (cholecalciferol) supplementation on systemic lupus
           erythematosus patients with hypovitaminosis D on serum pro-inflammatory
           cytokines (IL-6, IL-7, IFN-Gamma), anti-inflammatory cytokine (TGF-Beta)
           and anti-ds DNA levels

    • Authors: Cesarius Singgih Wahono, Irene Saveria, Cameleia Diah Setyorini, Zoraida Dwi Wahyuni, Handono Kalim, Kusworini Handono
      Pages: 302 - 308
      Abstract: A B S T R A C T
      Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease
      and can attack almost all organs and tissues of the human body. Beside genetic
      factors, environmental factors are thought to play a role, such as ultraviolet light,
      viral infections and smoking, causing a breakdown of self-tolerance which can
      trigger an autoimmune response. The study was conducted in the outpatient and
      inpatient units of the Rheumatology Division of the Department of Internal
      Medicine Saiful Anwar General Hospital/Faculty of medicine Universitas
      Brawijaya, Malang. Subjects were female patients, aged > 18 years who had been
      diagnosed as SLE by internist-rheumatologist based on the 1997 ACR criteria, with
      SLEDAI score > 3. After 3 months of supplementation, there was a significant
      decrease in serum levels of the three pro-inflammatory cytokines (IL-6, IL-17, IFN-
      gamma), as shown in table 3, compared to before treatment, as well as anti-dsDNA levels.
      Serum TGF-beta1 levels increased significantly, while 25 (OH) D3 levels also increased
      PubDate: 2021-02-17
      Issue No: Vol. 12, No. 2 (2021)
  • A 38 Years Old Man with ANCA Negative Wegener’s Granulomatosis
           Vasculitis with Type 2 Diabetes Mellitus and Electrolyte Imbalance: A Case

    • Authors: Bryan Arief Aji Rudita, Yulyani Werdiningsih, Arief Nurudhin, Nurhasan Agung Prabowo, Zainal Arifin Adnan
      Pages: 309 - 313
      Abstract: A B S T R A C T
      Background: Wegener's granulomatosis is a very rare long-term systemic
      disorder, in which granuloma formation occurs and inflammation of blood
      vessels (vasculitis). The cause of disorder is not yet known, but genetic
      factors are thought to play an important role. Clinical symptoms are often
      similar to other disorders, making diagnosis difficult. However, early
      diagnosis is very important in order to provide effective management.
      Objective: Diagnosis and management in a rare case of Wegener’s
      granulomatosis vasculitis, especially it was found with other comorbidities.
      Methods: This case report showed a-38-years-old-man that came to the
      emergency room of Dr Moewardi Hospital with complaints of swelling
      accompanied by redness and stiff on the face, hands and feet that worsening
      since 7 days ago. He also complained of fever fluctuating, nasal congestion
      accompanied by clear discharge and sometimes hearing loss in the right
      ear. Since the last 3 months, he was often experience similar complaints.
      History of diabetes was recognized by the patient for 5 years, but he did not
      regularly take medication. Results: In this case, examination of vital signs
      within normal limits. Physical examination revealed a saddle nose with clear
      discharge, swelling and redness around the face, hands and feet. Laboratory
      tests showed hemoglobin 12.9 g/dl, HbA1c 8.4%, sodium level 128 mmol/L,
      potassium level 3.1 mmol/L, calcium level 1.12 mmol/L. The Anti -
      Neutrophil Cytoplasmic Antibodies (ANCAs) and Anti Nuclear Antibody
      (ANA) Indirect Immunofluorescence (IF) method were negative.
      Electrocardiogram and chest x-ray examination within normal limits.
      Histopathological examination revealed epidermal atrophy and multiple
      granulomas of the dermis. The patient underwent treatment for 10 days
      with tappering-off dose steroid, immunosuppressants, insulin, calcium,
      and potassium preparations therapy. Conclusions: Wegener’s
      granulomatosis vasculitis is a rare case. Prompt and accurate diagnosis and
      management will prevent poor progression of them, especially it was found
      with other comorbidities.
      PubDate: 2021-02-17
      Issue No: Vol. 12, No. 2 (2021)
  • Correlation Between Anti-Topoisomerase I and C-Reactive Protein Antibody
           Level with Modified Rodnan Skin Score On Systemic Sceloris Patients

    • Authors: Sumartini Dewi, Wisynu Tresnadi A.B, Rachmat Gunadi Wachjudi
      Pages: 314 - 321
      Abstract: A B S T R A C T
      Systemic sclerosis is characterized by extensive and progressive organ
      fibrosis processes leading to organ failure and death. Modified Rodnan Skin
      Score (mRSS) had been used as a clinical parameter of skin fibrosis. Anti-
      topoisomerase I and C-Reactive Protein (CRP) are potential biomarkers for
      assessing disease activity. The study was performed to determine the
      association of anti-topoisomerase I and CRP antibodies with mRSS values.
      We performed an observational analytic study based on primary and
      secondary data. Systemic sclerosis patient sera data was obtained from
      Dewi S et al's study, taken from May 2015 to June 2017. Serum Anti -
      topoisomerase I antibody and CRP level analysis were performed in
      December 2017.
      Fifty six samples analyzed. Fifty four subjects (96.4%) out of 56 subjects are
      women with an average age of 37 ± 11 years, 41 subjects (73.3%) has
      disease duration over 2 years, 34 subjects (60.7%) has difuse systemic
      sclerosis, 41 subjects (73.3%) in steroid therapy and 50 subjects (89.3%) in
      methotrexate therapy. The statistical analysis showed no correlation
      between anti-topoisomerase I antibody and CRP levels with mRSS values
      (r = 0.205, p = 0.064; r = -0.134, p = 0.167), but there was a positive
      correlation of anti-topoisomerase I antibody level with mRSS (r = 0,422 p =
      0,007) and negative correlation between CRP level and mRSS (r = -0,511 p
      = 0,001) in diffuse sclerosis systemic.
      From this study we concluded that anti-topoisomerase I antibody and CRP
      level were not correlated with mRSS, but in patient with diffuse systemic
      sclerosis there was a positive correlation of anti-topoisomerase I antibody
      level with mRSS and negative correlation between CRP level and mRSS.
      PubDate: 2021-02-17
      Issue No: Vol. 12, No. 2 (2021)
  • A young lady with ANA negative SLE and Secondary Anti Phospholipid

    • Authors: Richmond Ronald Gomes, Deepankar Kumar Basak, Kaniz Rahman, Md. Rashidul Hasan
      Pages: 327 - 332
      Abstract: A B S T R A C T
      Systemic lupus erythematosus (SLE) is a chronic, inflammatory,
      autoimmune, multisystem connective multi system connective tissue
      disease characterized by various autoantibodies to nuclear and cytoplasmic
      antigens and commonly affects the joints and a variety of organs due to an
      over activation of the body's immune system. There is wide heterogeneity in
      presentation of SLE patients, including lung, central nervous system, skin,
      kidney, and hematologic manifestations. The presence of antinuclear
      antibodies (ANA) in serum is generally considered a decisive diagnostic sign
      of SLE. However, a small subset of SLE patients who had the typical clinical
      features of SLE was reported to show persistently negative ANA tests. Our
      report describes a 24-yr-old female who presented with the clinical
      manifestations of SLE such as malar rash, photosensitivity, arthritis, oral
      ulcer, and proteinuria. The serum autoantibodies were all negative except
      anti ribosomal P. She was also positive for lupus anticoagulantanti -
      coagulant. She was treated with oral prednisolone , hydroxychloroquine
      with topical tacrolimus, and improved significantly. Three months after,
      repeat ANA, and anti-ds DNA showed persistent negativity, but lupus anti -
      coagulant remained positive. This case suggests that ANA may not be
      required in the pathogenesis of SLE.
      PubDate: 2021-02-17
      Issue No: Vol. 12, No. 2 (2021)
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Heriot-Watt University
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