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"Pemphigus vulgaris is a relatively uncommon autoimmune disease marked with blister appearance of the skin tissue and mucosal membrane, resulting in loss of intercellular adhesion as well as the intact of epithelial cells, or so-called acantholysis. In this autoimmune disease the immune system forms autoantibodies attacking desmoglein, a specific protein at the skin tissue. The predisposing factors are presumed to include genetic and ethnic origin of the patient. Although at first usually without symptoms, after proceeding to the ulcerating stage the disease can result in fatal complications. Considering that almost 60% of the cases are first manifested in the oral mucosa, it is important that the dentists are aware of the basic etiology and immunology of the disease for correct diagnosis and therapy. This work reviews the etiopathogenesis of Pemphigus vulgaris, with emphasis on immunological aspects and immunotherapy."

"Penatalaksanaan kasus pemfigus vulgaris pada pasien lansia dengan riwayat penyakit kronis. Pemfigus vulgaris (PV) adalah sekelompok penyakit vesikulobulosa yang dapat mengenai kulit dan membran mukosa. PV merupakan penyakit autoimun dengan karakteristik adanya ikatan antara autoantibodi IgG dengan desmoglein 3 pada desmosom. Lesi PV merupakan bula berdinding tipis yang timbul pada kulit dan mukosa yang terlihat normal. Bula pada mukosa oral sangat mudah pecah dan dan membentuk ulser. Terdapat beberapa faktor yang dapat mencetuskan PV meliputi faktor genetik, usia, pemakaian obat-obatan dan makanan. Tulisan ini melaporkan penatalaksanaan kasus yang diduga adalah PV yang terjadi pada lansia dengan riwayat penyakit kronis. Kasus adalah wanita berusia 75 tahun dengan riwayat adanya lesi bula di kulit sejak 2 bulan dan ulserasi oral yang menetap sejak 1 bulan yang lalu. Ulserasi terlihat ditutupi oleh lapisan fibrin dan erosif eritema pada mukosa labial, bukal, dan gingiva. Terdapat riwayat hipertensi, diabetes mellitus, hepatitis, dan trombositopenia. Diagnosis PV ditegakkan berdasarkan keluhan subjektif dan klinis yang dapat dibedakan dengan penyakit vesikobulosa yang lain. Kortikosteroid sistemik diberikan bersama hepato protektor, obat kumur, terapi suportif, dan krim bibir. Bula pada kulit dan ulserasi yang menetap pada mukosa oral adalah manivestasi PV. Pada pasien lansia ini keadaan sistemiknya membutuhkan penatalaksanaan yang lebih intensif dan komprehensif.

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Pemphigus vulgaris (PV) is a group of vesicobullous disease that affects skin and mucous membranes. PV is associated with autoimmune diseases, characterized by binding of IgG autoantibodies to desmoglein 3 on desmosome. The lesion of PV is a thin-walled bulla arising on the normal skin or mucosa. The bulla of oral mucous are more fragile and rapidly break down, forming irreguler ulcers. There are several factors that can trigger PV including genetic factors, age, drugs and food. The purpose of this paper was to report the treatment of suspected pemphigus vulgaris in elderly patient with history of chronic diseases. A 75-year-old woman with 2 months history of bulla formation on skin and about a month history of persistent oral ulceration. Ulcers were covered with fibrin and erosive erythematous on labial mucosa, buccal mucosa and gingival. The patient has a story of hypertension, diabetes mellitus and hepatitis. On routine complete blood count was found thrombocytopenia. Diagnosis was confirmed by anamnesis, clinical examination and complete blood investigation. It should be distinguished from other vesicobullous disease. Systemic corticosteroid therapy was given concurrently with hepato-protector, mouthwash, supportive therapy and topical lip cream. Bulla on skin and persistent erosive ulcers of the oral mucosa are the manifestations of PV. Elderly patient with history of chronic diseases is a complex care of PV and this require more intensive and comprehensive treatment."

"Pemphigus vulgaris is an autoimmune–mediated disease of skin and mucous membran leading to progressive blistering and chronic erosions. It often begins with blister formations which easily rupture. The characteristic feature is positive nikolsky sign which may or not be presented simultaneously. Infrequently, ocular involvement may be seen as conjunctivitis. Establishment of early definite diagnosis is critical and requires correlation of clinical and histopathological findings. Because of this conditon is a potentially life-threatening, the risk of complications and mortality rate increases if initial management is non comprehensive and inadequate. Treatment is directed at supression of autoimmune process, typically administration of corticosteroids. This article report a case in a 51 years old woman who had painful chronic oral ulcer and poor general health condition. Prior to the visit to Oral Medicine clinic, patient was treated by her general practitioners for several months, without either established diagnosis nor comprehensive and adequate management, so that she had no clinical improvement. Clinical examination at the first visit in OralMedicine clinic Cipto Mangunkusumo Hospital, revealed bula in the skin, conjunctivitis, easily bleed oral mucosae, widespread erosions and ulcerations of the lips, gingiva, tongue, and buccal mucosae. Biopsy of one of skin erosions demonstarting suprabasal intraepithelial acantholysis. Multi divisions in Cipto Mangunkusumo Hospital, such as Oral Medicine, Dermatology, Internal Medicine, Ophtalmology, ENT, were involved in treating this case. Patient received high dose methylprednisolone sistemically and prednisone topically for the lips. General remission achieved in several days. Thus, establishment of early definite diagnosis and adequate management are important in management of Pemphigus vulgaris."

"ABSTRAKLatar Belakang: Penyakit autoimun terjadi karena tubuh tidak mampu untuk mengenali sel atau jaringan tubuh sendiri, sehingga tubuh memberikan respons seperti proses eliminasi antigen terhadap sel atau jaringan tubuh sendiri. Berbagai faktor risiko, antara lain genetik, lingkungan dan nutrisi berperan pada perkembangan penyakit autoimun. Saat penyakit autoimun telah menimbulkan gejala, pasien memiliki risiko mendapat nutrisi yang tidak adekuat. Selain itu, kondisi autoimun akan menimbulkan respons inflamasi terus-menerus di dalam tubuh. Bila kondisi ini terus berlanjut akan menyebabkan peningkatan status metabolisme, status nutrisi, status imun dan menimbulkan gangguan kapasitas fungsional pada pasien. Pasien dengan penyakit autoimun harus didukung dengan edukasi dan mendapat terapi nutrisi yang tepat dan adekuat, terutama saat menjalani proses terapi sehingga kebutuhan nutrisi dapat terpenuhi sesuai dengan kondisi pasien. Metode: Laporan serial kasus ini menguraikan empat kasus penyakit autoimun. Dua kasus merupakan kasus neurologi, sementara dua kasus lain adalah kasus penyakit kulit. Dua pasien memiliki status nutrisi malnutrisi berat, satu pasien berat badan normal berisiko malnutrisi dan satu pasien obes I berisiko malnutrisi. Terapi nutrisi sesuai mengacu pada diet seimbang. Semua pasien mendapat terapi nutrisi sejak dikonsulkan ke Departemen Medik Ilmu Gizi hingga hari terakhir perawatan di RS. Asupan energi dan protein diberikan meningkat bertahap sesuai dengan kondisi klinis dan toleransi pasien. Suplementasi mikronutrien diberikan kepada pasien. Pemantauan pasien meliputi keluhan subjektif, hemodinamik, analisis dan toleransi asupan, pemeriksaan laboratorium, antropometri, imbang cairan, dan kapasitas fungsional. Hasil: Selama pemantauan di RS, asupan pasien dapat mencapai kebutuhan energi total dan mikronutrien diterima oleh pasien. Perbaikan klinis dan perbaikan kapasitas fungsional terjadi pada 3 pasien. Satu pasien mengalami perburukan dan meninggal akibat sepsis pada hari perawatan ke-33. Kesimpulan: Terapi nutrisi pada pasien autoimun dapat mendukung proses pengobatan berupa perbaikan kapasitas fungsional dan lama rawat 3 pasien.

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ABSTRACTObjective Autoimmune disease is a condition of body inability to recognize the cells or tissues itself. It will response as antigen elimination process against the cells or tissue itself. Autoimmune risk factors, such as genetic, enviromental and nutrients play a role in the development of autoimmune diseases. When the symptoms occur, the patient have a risk of inadequate nutrition. In addition, autoimmune condition will cause continuous inflammatory response. This situation will increase patients rsquo s metabolic, nutritional, and immune status. Thus, reduce the patient rsquo s functional capacity. Patient with autoimmune disease should be supported by appropriate and adequate nutrition education and therapy, especially during the therapeutic process so that the nutrition requirements can be fulfilled according to the patient 39 s condition. Methods These case report outlines four cases of autoimmune disease. Two cases are cases of neurology, while the other two cases are cases of skin disease. Two patients had severe malnutrition, one normoweight patient at risk for malnutrition and one obese patient at risk of malnutrition. Management of appropriate nutrition refers to a balanced diet. All patients received nutritional therapy from the Clinical Nutrition Department until the last day of hospitalization. The energy and protein intake increase gradually in accordance with improved clinical conditions and patient rsquo s tolerance. Supplementation of micronutrients is given to the patient. Patient monitoring includes subjective, hemodynamics, analysis and tolerance of intake, laboratory examination, anthropometry, fluid balance, and functional capacity Results During hospital monitoring, the patient 39 s nutrition intake can achieve the total energy and protein requirement as well as the micronutrients. Clinical condition and functional capacity improvements occurred in 3 patients. One patient had worsening condition and died due to sepsis in the 33rd day of treatment. Conclusion Nutritional therapy for patients with autoimmune disease can support the treatment process in improvement of functional capacity and length of stay."

"Penyakit autoimun berisiko mengalami komplikasi yang berujung pada sakit kritis. Hal ini dapat menyebabkan peningkatan morbiditas dan mortalitas. Tata laksana nutrisi dapat membantu mencegah malnutrisi, meningkatkan status nutrisi, dan memperbaiki status metabolik, sehingga dapat memperbaiki luaran klinis, mempersingkat fase sakit kritis, dan lama rawat rumah sakit (RS). Pasien dalam serial kasus ini mengalami komplikasi penyakit autoimun yang menyebabkan pasien mengalami sakit kritis, danmembutuhkan perawatan intensif. Keempat pasien adalah perempuan, dengan rentang usia 19−37 tahun, dengan status gizi obes 1 pada dua pasien, dan malnutrisi berat pada pasien lainnya. Dua dari empat pasien mendapatkan tata laksana nutrisi sejak awal fase sakit kritis, sedangkan sisanya setelah lebih dari tujuh hari perawatan intensif. Terapi medik gizi diberikan selama berada di ruang perawatan intensif, meliputi pemenuhanenergi, makronutrien, dan mikronutrien, sesuai kondisi klinis dan toleransi pasien. Asupan energi pada keempat pasien saat perawatan intensif mencapai 25−47 kkal/kg BB/hari, dengan asupan protein tertinggi sebesar 1,4−2,7 g/kg BB/hari. Durasi pemakaian ventilator mekanik, hari perawatan intensif dan RS terpanjang, terdapat pada pasien yang mengalami malnutrisi berat. Tiga dari empat pasien dengan toleransi asupan yang baik mengalami perbaikan luaran klinis, peningkatan kapasitas fungsional,dan diizinkan untuk rawat jalan. Satu pasien pulang atas permintaan sendiri sebelum perbaikan kondisi klinis. Tingkat keparahan penyakit, komplikasi, dan status gizi pada pasien autoimun yang mengalami sakit kritis, mempengaruhi luaran klinis. Tata laksana nutrisi dapat meningkatkan status gizi, sehingga membantu memperbaiki kondisi klinis, menurunkan morbiditas dan mortalitas pasien

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Autoimmune diseases pose risks for complications, leading to critical illnesses, thus increase the morbidity and mortality rate. Nutritional management can prevent malnutrition, improve metabolic and nutritional status, thereby, improve clinical outcomes, shorten critical illness phase, and reduce hospital length of stay. In these case series, all patients had autoimmune diseases with complications, leading to critically ill conditions that required intensive care. All patients were women, aged of 19−37 years. There were two patients with obesity and others with severe malnutrition. Two patients received nutritional management starting from the acute phase, while the rest were at the late period. Medical nutrition therapy was given while in the intensive care unit (ICU), including the energy fulfillment, macro- and micro-nutrients, according to the clinical condition and patient’s tolerance. The energy intake of patients during the critical ilness was 25−47 kcal/kg BW/day, with the protein intake was 1.4−2.7 g/kg BW/day. The longest duration of mechanical ventilator use, length of ICU and hospital stay, were found in patients who were severely malnourished. Three patients with good nutritional intake, had better improvement in clinical conditions, complications, and functional capacity. They were allowed to be discharged and followed up at outpatient unit, while one patient returned home on her own request, before required improvement of clinical conditions. Severity of the diseases, complications, and the nutritional status of autoimmune patients with critical illnesses affected overall clinical outcomes. Medical nutrition therapy can improve metabolic and nutritional status, thereby improve clinical conditions, reduce morbidity and mortality of the patient"

"Latar belakang: Artritis idiopatik juvenil (AIJ) adalah penyakit autoimun yang ditandai dengan peradangan sendi kronis. Anak dengan AIJ akan mengalami hambatan pertumbuhan tulang yang disebabkan beberapa mekanisme langsung maupun tidak langsung. Sebanyak 40-50 % pasien AIJ memiliki densitas mineral tulang yang rendah pada tulang belakang lumbal dan panggul. Densitas mineral tulang yang rendah dipengaruhi beberapa faktor yaitu klasifikasi penyakit, lama sakit, indeks masa tubuh, status pubertas, aktivitas penyakit, aktivitas fisik, kadar 25(OH)D, dosis kumulatif kortikosteroid, dan dosis metotreksat.Tujuan: Penelitian ini dilakukan untuk mengetahui densitas mineral tulang pada pasien AIJ dan faktor-faktor yang berhubungan.Metode: Penelitian ini merupakan studi potong lintang dengan melibatkan 32 pasien AIJ. Pemilihan subjek dilakukan berdasarkan data registri pasien AIJ di poliklinik Alergi-Imunologi RSCM dan RSAB Harapan Kita tahun 2014-2019. Densitas mineral tulang diperiksa dengan Dual X-ray Absorbtiometry (DEXA) dengan melihat skor Z. Dilakukan analisis bivariat untuk mencari hubungan antara variabel terhadap densitas mineral tulang.Hasil: Densitas mineral tulang total rerata adalah 0,86 g/cm2. Sebanyak 22 subjek mempunyai densitas mineral tulang rendah (osteopenia) dengan nilai skor-Z L1-L4 ≤-2 sedangkan 10 subjek menunjukkan hasil normal. Tidak ditemukan fraktur tulang belakang pada seluruh subjek. Osteopenia banyak ditemukan pada anak dengan dosis kumulatif metotreksat yang lebih banyak (p=0,016). Faktor-faktor lainnya tidak terbukti berhubungan dengan densitas mineral tulang yang rendah.Simpulan: Sebagian besar pasien AIJ mengalami gangguan densitas mineral tulang. Dosis metotreksat yang dihubungkan dengan aktivitas penyakit merupakan faktor yang berperan untuk terjadinya osteopenia.

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Background: Juvenile Idiopathic Arthritis (JIA) is an autoimmune disease characterized by chronic inflammatory arthritis. The disease will affect bone development in children with JIA through direct and indirect mechanisms. About 40-50 % patient with JIA have low bone mineral density in the spine. The low bone mineral density is associated with disease classification, disease duration, body mass index, puberty status, disease activity, physical activity, 25(OH)D level, cumulative doses of corticosteroid and methotrexate.

Objective: This study aimed to investigate bone mineral density in children with JIA and its associated factors.

Method: A cross-sectional study involving 32 children with JIA. Patients were selected based on registry data in the outpatient clinic, subdivision of Allergy and Immunology, Department of Child Health, Dr. Cipto Mangunkusumo General Hospital and Harapan Kita Women and Children Hospital between 2014-2019. Bone mineral density was measured using Dual X-ray Absorbtiometry (DEXA) and reported using Z score. Bivariate analysis was used to identify factors associated with bone mineral density.

Result: The mean bone mineral density was 0,86 g/cm2. Low bone mineral density (osteopenia) occurred among 22 patients (Z score ≤-2 at L1-L4). 10 patients have normal bone mineral density. No vertebral fracture was seen on x-ray. Osteopenia was mainly found in patients with higher cumulative doses of methotrexate (p=0,016). The other factors were not associated with low bone mineral density.

Conclusion: Most patients with JIA have low bone mineral density. Low bone mineral density tends to occur among patients with higher cumulative doses of methotrexate treatment."

"Latar belakang : Inflamatory Bowel disease (IBD) merupakan penyakit autoimun yang insidens dan prevalensinya meningkat terus setiap tahunnya. Modernisasi dan kemajuan industri suatu wilayah selalu diikuti dengan perubahan pola hidup termasuk pola diet cepat saji (western diet) yang tinggi protein dan karbohidrat serta rendah serat dan buah. Diet, dapat merubah komposisi mikrobiota usus (dysbiosis), suatu bakteri komensal yang menjaga homeostasis dan sistim imun mukosa usus sehingga dapat memicu timbulnya IBD serta peningkatan aktifitas penyakitnya (flare).IgG yang meningkat setelah makan, merupakan suatu antibody neutralisasi sebagai bagian toleransi imun pada orang sehat dimana pada IBD makanan dapat dikenali sebagai antigen yang melalui ikatan antigen-antibodi reaksi hypersensitivitas tipe III, kemungkinan dapat menyebabkan inflamasi usus terus menerus dan mempengaruhi aktifitas penyakit.Tujuan : Untuk mengetahui hubungan antara IgG antibodi spesifik makanan dan aktivitas penyakit klinis pada pasien IBDMetode: Studi potong lintang, melibatkan 113 pasien IBD yang diagnosisnya telah dikonfirmasi dengan kolonoskopi. Pada pasien yang setuju dilakukan pemeriksaan serum IgG spesifik makanan untuk 220 jenis makanan menggunakan teknik Elisa dan Immunoarray. Aktivitas klinis pada Kolitis Ulseratif (KU) dinilai menggunakan Indeks Mayo sedangkan pada Penyakit Crohn dinilai menggunakan Indeks Aktivitas Penyakit Chrons (Crohn Disease Activity Index)Hasil: Proporsi antibodi IgG spesifik makanan tertinggi pada kelompok penyakit Crohn adalah kacang polong (100%), barley (97,9%), telur (95,9%), susu (81,6%), jagung (75,5%), agar-agar (69,4). %), kacang mede (69,4%) gandum (67,3%), oat (61,2%) dan almond (59,2%), sedangkan pada Kolitis Ulseratif adalah jelai (98,4%), kacang polong (96,8%), putih telur (92,2%), jagung (82,8%), plum (78,1%), kacang mede (67,2%), susu sapi (65,6%), gelatin (59,4%), almond (50%), kacang merah (48,4%) dan gandum (46,9%). Dari 220 jenis antigen makanan, pada KU didapatkan korelasi negatif yang cukup kuat pada jenis kacang mede dengan r = -0,347 (p=0,041) dan kacang Arab dengan r = -0.473 ( p=0.017); sementara di kelompok PC didapatkan korelasi positif yang cukup kuat pada jenis jelai dengan r = 0,261 ( p= 0,042).Kesimpulan: Terdapat hubungan korelasi negative lemah antara antibodi IgG spesifik kacang mede, dan kacang Arab dengan aktifitas IBD, serta korelasi positive lemah antara antibody IgG spesifik jelai dengan aktivitas klinis IBD

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Background : Inflammatory Bowel disease (IBD) is an autoimmune disease whose incidence and prevalence is increasing every year. Modernization and industrial progress of a region are always followed by changes in lifestyle, including a fast food diet (western diet) which is high in protein and carbohydrates and low in fiber and fruit. Diet, can change the composition of the gut microbiota (dysbiosis), a commensal bacteria that maintains homeostasis and the intestinal mucosal immune system so that it can trigger IBD and increase its disease activity (flare). IgG which increases after eating, is a neutralizing antibody as part of immune tolerance in humans. In healthy people, food IBD can be recognized as an antigen by triggering the antigen-antibody binding type III hypersensitivity reaction, possibly causing persistent intestinal inflammation and influencing disease activity.

Objective : To determine the relationship between food-specific IgG antibody and clinical disease activity in IBD patients

Methods: Cross-sectional study, involving 113 IBD patients whose diagnosis was confirmed by colonoscopy. In patients who agreed, food-specific IgG serum was examined for 220 types of food using the Elisa and Immunoarray technique. Clinical activity in Ulcerative Colitis (KU) was assessed using the Mayo Index while in Crohn's Disease was assessed using the Crohn Disease Activity Index.

Results: The highest proportion of food-specific IgG antibodies in the Crohn's disease group were peas (100%), barley (97.9%), eggs (95.9%), milk (81.6%), corn (75.5%), agar (69,4). %), cashews (69.4%) wheat (67.3%), oats (61.2%) and almonds (59.2%), while in Ulcerative Colitis were barley (98.4%), peas (96.8%), egg whites (92.2%), corn (82.8%), plums (78.1%), cashews (67.2%), cow's milk (65.6%), gelatin (59.4%), almonds (50%), kidney beans (48.4%) and wheat (46.9%). Of the 220 types of food antigens, the KU showed a strong negative correlation with cashew nuts with r = -0.347 (p=0.041) and chickpeas with r = - 0.473 (p=0.017); while in the PC group, there was a fairly strong positive correlation on the type of barley with r = 0.261 (p = 0.042).

Conclusion: There is a weak negative correlation between cashew and chickpea specific IgG antibodies and IBD activity, and a weak positive correlation between barley specific IgG antibodies and IBD clinical activity"

"Latar Belakang. Pasien autoimun rentan terhadap infeksi COVID-19 dan luaran yang lebih berat, sehingga penting untuk mendapat vaksinasi. Namun, terdapat kekhawatiran efek samping, kekambuhan penyakit, serta efektivitas dan imunogenitas vaksin. Tujuan. Mengetahui cakupan vaksinasi COVID-19 di Poli Alergi Imunologi RSCM dan faktor-faktor yang berhubungan. Metode. Studi potong lintang ini melibatkan 260 pasien autoimun dari Poli Alergi Imunologi RSCM periode Juli-Agustus 2023. Pengambilan data menggunakan kuesioner. Analisis bivariat dengan Uji Chi-Square atau Fischer dan analisis multivariat dengan regresi Poisson. Hasil. Cakupan vaksinasi COVID-19 pasien autoimun untuk dosis pertama 60%, dosis kedua 57.3%, dan dosis ketiga 40%. Melalui analisis bivariat, didapatkan faktor yang berhubungan dengan cakupan berupa pekerjaan tenaga kesehatan (PR 1,68; p < 0,001), rekomendasi dokter yang merawat (PR 6,47; p<0,001), dan skala persepsi pasien terhadap keparahan penyakit (p<0,001). Analisis multivariat menunjukkan hubungan antara rekomendasi dokter yang merawat (PR 4,67; p<0,001), pekerjaan tenaga kesehatan (PR 1,56; p=0,01), diagnosis SLE (PR 0,81; p=0,003) dan skala persepsi pasien terhadap keparahan penyakit (PR 0,88; p<0,001). Simpulan. Cakupan vaksinasi COVID-19 dosis pertama pada pasien autoimun di Poli Alergi-Imunologi RSCM adalah 60%. Studi ini menemukan hubungan cakupan vaksinasi dengan rekomendasi dokter yang merawat, pekerjaan sebagai tenaga kesehatan, diagnosis SLE, dan persepsi pasien terhadap keparahan penyakit.

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Background. Autoimmune patients are susceptible to COVID-19 infection and severe outcomes, so it is important to receive vaccination. However, there are concerns about side effects, disease recurrence, and vaccine effectiveness and immunogenicity.

Objective. To explore uptake of COVID-19 vaccination at RSCM Allergy Immunology Clinic and related factors.

Method. This cross-sectional study involved 260 autoimmune patients from the RSCM Allergy Immunology Clinic for July-August 2023. Data was collected with questionnaire. Bivariate analysis with Chi-Square or Fischer Test and multivariate analysis with Poisson regression.

Results. COVID-19 vaccination coverage for autoimmune patients for the first dose is 60%, the second dose is 57.3%, and third dose is 40%. Through bivariate analysis, associated factors were health worker employment (PR 1.68; p < 0.001), recommendation of treating doctor (PR 6.47; p < 0.001), and patients’ perception of their illness (p< 0.001). Multivariate analysis showed association between recommendation of treating doctor (PR 4.67;p<0.001), health worker's occupation (PR 1.56;p=0.01), SLE diagnosis (PR 0.81;p=0.003) and the scale patient perception of disease severity (PR 0.88;p<0.001).

Conclusion. Coverage first dose COVID-19 vaccination in autoimmune patients at RSCM Allergy-Immunology Clinic is 60%. This study found association between recommendation of treating doctor, healthcare workers, SLE diagnosis, and patients’ perception of their illness."

"Penyakit Graves merupakan penyakit autoimun yang melibatkan antibodi TSH-R dalam menstimulasi kelenjar tiroid sehingga terjadi sintesis dan sekresi hormon tiroid yang berlebih. Sebanyak 50% pasien penyakit Graves mengalami kekambuhan setelah terapi obat antitiroid selesai diberikan. Faktor genetik salah satunya polimorfisme gen FCLR3 rs7528684 diketahui berperan terhadap kejadian penyakit Graves. Namun, belum ada studi yang mengidentifikasi keterkaitan polimorfisme gen FCRL3 rs7528684 dengan kekambuhan penyakit Graves. Untuk itu, penelitian ini bertujuan untuk mengetahui hubungan polimorfisme gen FCRL3 rs7528684 terhadap kekambuhan penyakit Graves. Desain penelitian yang digunakan adalah studi cross sectional yang dilakukan pada 80 pasien penyakit Graves. Hasil isolasi DNA pasien dilakukan pemeriksaan genotyping dengan menggunakan metode tetra primer ARMS-PCR. Hasil penelitian menunjukkan terdapat 2 variasi genotip pada pasien penyakit Graves yaitu genotip GG (2,5%) dan genotip GA (97,5%). Pada kelompok kambuh, 100% memiliki genotip GA sehingga frekuensi alotip G dan alotip A masing-masing 50%. Sementara itu, pada kelompok tidak kambuh, didapatkan 6,1% genotip GG dan 93,9% gentoip GA dengan frekuensi alotip G dan alotip A yaitu 53,03% dan 46,97%. Berdasarkan hasil analisis uji statistik, disimpulkan bahwa tidak terdapat hubungan antara genotip dan alotip gen FCRL3 rs7528684 dengan kekambuhan penyakit Graves pada populasi Jakarta.

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Graves' disease is an autoimmune disease in which TSH-R antibodies stimulate the thyroid gland, resulting in excess thyroid hormone synthesis and secretion. 50% patients with graves’ disease relapse after finishing antithyroid drugs treatment. Genetics factor such as FCRL3 rs7528684 SNP contribute to the development of Graves' disease. However no study has yet identified an association of the FCRL3 rs7528684 SNP with Graves' disease recurrence. Therefore, this study aims to determine the association between the genetic polymorphism of FCRL3 rs7528684 and the recurrence of Graves' Disease. This cross-sectional clinical study was performed in 80 Graves' disease patients. DNAs of GD patients were isolated and then genotyped using tetra primer ARMS-PCR method. There are two genotype variations in patients with Graves' Disease, namely GG genotype (2,5%) and GA genotype (97,5%). In the relapsed group, 100% had the GA genotype, so the frequencies of G allotype and A allotype were 50% each. Meanwhile, in the remission group, there are 6,1% GG genotype and 93,9% GA genotype with G and A allotype frquencies were 53,03% and 46,97%, respectively. Based on statistic tests analysis, there is no association between the genotype and allotype of the FCRL3 rs7528684 SNP and Graves' disease recurrence in Jakarta's population."