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"Artritis reumatoid (AR) dapat menyebabkan penurunan massa tulang sistemik akibat adanya peningkatan osteoklastogenesis dan penghambatan osteoblastogenesis melalui peningkatan sklerostin yang menyebabkan penghambatan jalur Wingless(Wnt)-bcatenin canonicaldan bone morphogenetic proteins(BMP). Sampai saat ini masih belum ada penelitian tentang korelasi TNF-adan sklerostin terhadap penanda turnovertulang (CTX dan P1NP) pada pasien AR perempuan premenopause.Penelitian ini bertujuan untuk menjelaskan patogenesis hilangnya massa tulang pada pasien artritis rheumatoid perempuan premenopause dengan menilai hubungan antara kadar sitokin proinflamasi TNF-α, penghambat Wnt signalingsklerostin, dan penanda resorpsi tulang P1NP dan CTX.Studi potong lintang ini melibatkan 38 perempuan AR premenopause. Pengambilan sampel dilakukan secara konsekutif. Pemeriksaan dilakukan dengan ELISA.Penelitian ini didapatkan kadar CTX (rerata 2,74 ng/ml) yang lebih tinggi dan P1NP (median 34,04 pg/ml) yang lebih rendahdibandingkan dengan sampel sehat pada penelitian sebelumnya. Terdapat korelasi negatif (r = -0,388) antara kadar TNF-α dengan kadar sklerostin yang bermakna secara statistik (p = 0,016). Terdapat pula korelasi positif (r = 0,362) antara kadar TNF-α dengan kadar P1NP yang bermakna secara statistik (p = 0,026). didapatkan adanya peningkatan CTX dan penurunan P1NP, adanya korelasi negatif bermakna antara kadar TNF-α dan sklerostin serta adanya korelasi positif bermakna antara kadar TNF-α dan P1NP.

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Rheumatoid arthritis is associated with systemic bone mass loss due tostimulation of osteoclastogenesis and inhibition of osteoblastogenesis through inhibition of Wingless(Wnt) -bcatenin canonical and bone morphogenetic proteins(BMP) pathway by sclerostin. There are currently no studies that assess the correlation of TNF-α and sclerostin with bone resorption markers CTX and P1NPin premenopause rheumatoid arthritis patients. This study aims to explainthe pathogenesis of bone mass decrease by assessing the correlation between TNF-α, sclerostin, P1NP and CTX. This cross-sectional study involves 38 premenopausal women with AR. Sampling is done consecutively. Examination is done by ELISA.

This study found higher level of serum CTX (mean 2,74ng/mL) and lower level of P1NP (median 34,04 pg/mL) than normal population in previous studies. There was a negative correlation (r = -0,388) between TNF-α levels and sclerostin levels which was significant (p = 0,016). There wasalso a positive correlation (r = 0,362) between TNF-α levels and P1NP levels which was also significant (p = 0,026). This study found an increase in CTX and decrease in P1NP. There was a significant negative correlation between TNF-α and sclerostin levels and also a significant positive correlation between TNF-α and P1NP levels."

"Latar Belakang: Pada artritis reumatoid diketahui terjadi kehilangan massa tulang, baik secara lokal maupun sistemik. TNF-a adalah sitokin utama yang berperan pada proses resorpsi tulang, namun perannya pada formasi tulang belum diketahui. Penelitian ini akan menilai korelasi TNF-adengan proses formasi tulang yang dinilai dengan P1NP, terutama berhubungan dengan SFRP-1 yang merupakan inhibitor alami osteoblas. Sampai saat ini belum ada penelitian yang menilai hubungan sitokin proinflamasi TNF-a, SFRP1 terhadap kedua penanda turnover tulang(CTX dan P1NP) secara sistemik pada pasien artritis reumatoid.Tujuan: Penelitian ini bertujuan untuk mendapat gambaran aktivitas turnovertulang pada pasien AR dengan melihat korelasi antara TNF-adengan SFRP-1, CTX dan P1NP, dan korelasi SFRP1 dengan P1NP. Metode: Penelitian ini merupakan studi potong lintang dengan 38 subjek perempuan premenopause dengan AR. Pengambilan sampel dilakukan secara konsekutif di poliklinik reumatologi Rumah Sakit Cipto Mangunkusumo. Pemeriksaan TNF-a, SFRP-1, CTX, dan P1NP dilakukan dengan metode ELISA.Hasil: Pada penelitian ini didapatkan median durasi menderita AR 5 tahun. 60,6% pasien berada dalam kondisi remisi dan aktivitas rendah. Kadar TNF-amedian 10,6 pg/mL, rerata kadar SFRP-1 9,29 ng/mL, rerata kadar CTX 2,74 ng/mL, serta kadar P1NP 34 pg/mL. Kadar SFRP-1 dan CTX dijumpai meningkat sedangkan P1NP relatif lebih rendah bila dibandingkan dengan kadar populasi normal pada penelitian-penelitian terdahulu. Pada penelitian ini dijumpai adanya korelasi positif lemah antara TNF-a dengan P1NP (r=0,363, p=0,026), begitu juga SFRP-1 dengan P1NP (r=0,341; p=0,036), sedangkan variabel lain tidak menunjukkan korelasi yang bermakna.Simpulan: Pada penelitian ini didapatkan korelasi positif lemah antara TNF-adengan P1NP, dan korelasi positif lemah antara SFRP-1 dengan P1NP. Namun dijumpai kadar CTX yang tinggidan kadar P1NP yang rendah, menunjukkan respon resorpsi meningkat namun tidak diimbangi dengan formasi pada pasien AR perempuan premenopause.

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Background: Rheumatoid arthritis is known to have a loss of bone mass, both locally and systemically. TNF-a is the main inflammatory cytokine that can directly increase bone resorption. However, its role in bone formation is still unknown. This study will assess the correlation of TNF-a with the process of bone formation evaluated with P1NP, mainly related to the SFRP-1 pathway which is a natural inhibitor of osteoblasts. However, there are currently no studies that assess the correlation of inflammatory cytokines TNF-a, SFRP-1, with bone turnover marker (CTX and P1NP) in rheumatoid arthritis patients

Objective: This study aims to examine bone turnover in RA patients by analyzing the correlation between TNF-a with SFRP-1 and CTX and P1NP, and correlation SFRP-1 with P1NP

Methods: This is a cross-sectional study in 38 subjects of premenopausal women with RA. The Subjects were collected with consecutive sampling technique in rheumatology outpatient clinic in Rumah SakitCipto Mangunkusumo, Jakarta. Measurement of serum TNF-a, SFRP-1, CTX, and P1NP levels were done using ELISA technique.

Results: In this study, the median duration of RA is 5 years. 60.6% of the patients were in remission and low activity disease. The median value of TNF-a was 10.6 pg/mL, the mean value of SFRP-1 was 9.29 ng/mL, the mean value of CTX was 2.74 ng/mL, and mean value of P1NP was 34 pg/mL. SFRP-1 and CTX levels were increased while P1NP level was relatively lower compared to the normal population value in previous studies. There was a weak positive correlation between TNF-a and P1NP(r=0.363, p=0.026), also SFRP-1 and P1NP(r=0.341; p=0.036),while the other variables showed no significant correlation.

Conclusions: This study demonstrated weak positive correlation between TNF-a and P1NP, and weak positive correlation between SFRP-1 and P1NP. However high value of CTX and low value of P1NP showed that a high resorption response cannot be balanced with bone formation activity in patients with rheumatoid arthritis in premenopausal woman."

"Latar Belakang: Kehilangan massa tulang pada artritis reumatoid (AR) terjadi akibat ketidakseimbangan proses resorpsi dan formasi tulang. Tumor necrosis factor-α (TNF-a) adalah salah satu sitokin proinflamasi utama yang secara langsung dapat menyebabkan peningkatan resorpsi tulang, namun peranannya pada proses formasi tulang belum secara jelas diketahui. Aktivitas formasi tulang dapat dihambat oleh Dickkopf-1 (DKK-1) yang meningkat pada pasien AR. Penilaian turnover tulang dapat dilakukan dengan mengukur kadar C-terminal telopeptide (CTX) dan N-terminal propeptide (PINP) yang saat ini menjadi standar untuk penanda turnover tulang.Tujuan: Penelitian ini bertujuan untuk mendapatkan gambaran aktivitas turnover tulang pada pasien AR dengan melihat korelasi antara TNF-α dengan DKK-1 dan CTX untuk penilaian resorpsi tulang, dan korelasi antaran TNF-α dengan DKK-1 dan P1NP untuk penilaian formasi tulang.Metode: Penelitian ini merupakan studi potong lintang dengan 38 subjek artritis reumatoid perempuan premenopause. Pengambilan sampel dilakukan secara konsekutif di poliklinik reumatologi Rumah Sakit Cipto Mangunkusumo. Pemeriksaan TNF-α, DKK-1, CTX, dan P1NP dilakukan dengan metode ELISA.Hasil: Pada penelitian ini didapatkan median durasi menderita penyakit adalah 5 tahun. 60,5% pasien berada dalam kondisi remisi atau aktivitas penyakit rendah, 36,8% dalam kondisi aktivitas penyakit sedang, dan 2,6% pasien dalam kondisi aktivitas penyakit tinggi. Didapatkan median kadar TNF-a adalah 10.6 pg/mL, rerata kadar DKK-1 adalah 4027 pg/mL, rerata kadar CTX adalah 2,74 ng/mL, serta median nilai P1NP adalah 34 pg/mL. Kadar DKK-1 dan CTX dijumpai lebih tinggi sedangkan kadar P1NP lebih rendah jika dibandingkan dengan kadar pasien AR pada penelitian-penelitian sebelumnya. Penelitian ini menemukan korelasi positif lemah antara TNF-α dengan P1NP, sedangkan variabel lain tidak menunjukkan korelasi yang signifikan.Simpulan: Pada penelitian ini ditemukan korelasi positif lemah antara TNF-α dengan P1NP. Dijumpai kadar TNF-a yang rendah, DKK-1 yang tinggi, dan CTX yang tinggi dengan kadar P1NP yang rendah yang menunjukkan respon perbaikan tulang pada pasien AR tidak dapat mengimbangi tingginya aktivitas resorpsi tulang.

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Background: Bone mass loss in rheumatoid arthritis (RA) is due to the imbalance of bone resorption and formation process.Tumor necrosis factor-α (TNF-a) is one of the main proinflammatory cytokines that can directly increase bone resorption, but its effect on bone formation is still uncertain. Bone formation could be inhibited by Dickkopf-1 (DKK-1) that is increased in RA patients. Bone turnover could be determined by assessing the level of C-terminal telopeptide (CTX) and N-terminal propeptide (PINP), both are standard measurement for bone turnover markers.Objective: This study aims to examine bone turnover in RA patients by analysing correlation between TNF-α with DKK-1 and CTX for assesment of bone resorption, and correlation between TNF-α with DKK-1 and P1NP for assesment of bone formation.Methods: This is a cross-sectional study with 38 subjects of RA premenopausal women. The subjects were collected with consecutive sampling technique in rheumatology outpatient clinic in Rumah Sakit Cipto Mangunkusumo, Jakarta. Measurement of serum TNF-α, DKK-1, CTX, and P1NP levels were done using ELISA technique.Results: The median duration of RA in this study is 5 years. 60,5% of the patients were in remission or low activity disease, 36,8% were in moderate activity disease, and 2,6% were in high activity disease. The median value of TNF-a was 10.6 pg/mL, mean value of DKK-1 was 4027 pg/mL, mean value of CTX was 2,74 ng/mL, and mean value of P1NP was 34 pg/mL. DKK-1 and CTX levels were increased while P1NP level was lower compared to the RA patients in previous studies. This study found weak positive correlation between TNF-α and P1NP, while the other variables showed no significant correlation.Conclusions: This study demonstrated weak positive correlation between TNF-α and P1NP. We found low level of TNF-α, high level of DKK-1, and high level of CTX with low level of P1NP that indicate that the bone repair response could not keep up to the high bone resorption activity in RA patients."

"ABSTRAKLatar Belakang: Pada artritis reumatoid diketahui terjadi kehilangan masa tulang, baik secara lokal maupun sistemik (osteoporosis). Inflamasi sistemik pada AR menyebabkan kehilangan massa tulang melalui gangguan homeostasis dimana terjadi resorpsi tulang yang lebih besar dibanding formasi tulang. Peran IL-17 sebagai sitokin proinflamasi diketahui dapat menstimulasi terjadinya osteoklastogenesis dan menghambat osteoblastogenesis melalui pembentukan antagonis jalur Wingless (Wnt) Catenin signalling yaitu DKK-1, SFRP dan sklerostin pada hewan coba dan secara lokal pada sinovium. Namun saat ini belum ada penelitian yang menilai hubungan sitokin proinflamsi IL-17 dengan formasi dan resorpsi tulang secara sistemik pada pasien artritis reumatoid.Tujuan: Penelitian ini bertujuan untuk menilai hubungan IL-17 terhadap osteoblastogenesis dengan hambatan jalur Wnt melalui DKK-1, SFRP-1 dan sklerostin dan hubungan IL-17 dengan CTX sebagai penanda resorpsi oleh osteoklas dan P1NP sebagai penanda formasi oleh osteoblas.Metode: Studi potong lintang ini melibatkan 38 perempuan AR premenopause. Pengambilan sampel dilakukan secara konsekutif. Pemeriksaan IL-17, DKK-1, SFRP-1, sklerostin, CTX dan P1NP dilakukan dengan metode ELISA.Hasil: Pada penelitian ini didapatkan rerata kadar serum IL-17 yaitu 10,61 ± 0,68 pg/ml, rerata kadar DKK-1 4027,29 ± 1516,80 pg/ml, rerata kadar SFRP-1 9,28 ± 3,17 ng/ml, median kadar sklerostin 101,72 (38,36-255,18) pg/ml. Penanda resopsi serum CTX meningkat dengan rerata 2,74 ± 1,37 ng/ml dan penanda formasi serum P1NP menurun dengan median 34,04 (3,46-220,61). Korelasi IL-17 dengan DKK-1 (r=0,142; p=0,396), IL-17 dengan SFRP-1 (r=0,169; p=0,309), IL-17 dengan sklerostin (r=0,061; p=0,718), IL-17 dengan CTX (r=-0,252; p=0,128) dan IL-17 dengan P1NP (r=0,116; p=0,487).Kesimpulan: Meskipun terdapat penurunan formasi tulang dan peningkatan resropsi tulang, pada penelitian ini tidak terdapat korelasi yang bermakna antara kadar serum IL-17 dengan penghambat jalur Wnt (DKK-1, SFRP-1 dan sklerostin) dan tidak terdapat korelasi yang bermakna antara kadar serum IL-17 dengan penanda turnover tulang (CTX dan P1NP) pada pasien perempuan premenopause dengan artritis reumatoid

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ABSTRACTBackground: Rheumatoid arthritis is known to have a loss of bone mass, both locally and systemically (osteoporosis). Systemic inflammation in AR causes bone mass loss through interference of homeostasis where bone resorption is greater than bone formation. The role of IL-17 as a proinflammatory cytokine is known to stimulate osteoclastogenesis and inhibit osteoblastogenesis through Wingless (Wnt) pathway antagonists Catenin signalling are DKK-1, SFRP and sclerostin in experimental animals and locally in the synovium. However, there are currently no studies that assess the association of proinflammatory cytokines IL-17 with systemic bone formation and resorption in rheumatoid arthritis patientsObjective: This study aims to assess the relationship of IL-17 to osteoblastogenesis with inhibitor Wnt signalling through DKK-1, SFRP-1 and sclerostin and the association of IL-17 with CTX as a marker of resorption by osteoclasts and P1NP as a marker of formation by osteoblastsMethods: This cross-sectional study involves 38 premenopausal women with AR. Sampling is done consecutively. IL-17, DKK-1, SFRP-1, sclerostin, CTX and P1NP measurement was done using ELISAResults: In this study the mean serum IL-17 level was 10.61 ± 0.68 pg/ml, mean serum levels of DKK-1 4027.29 ± 1516.80 pg / ml, mean serum levels of SFRP-1 9.28 ± 3,17 ng / ml, median sclerostin serum level 101.72 (38.36-255.18) pg / ml. Markers of CTX resorption increased with a mean of 2.74 ± 1.37 ng / ml and markers of serum P1NP formation decreased with a median of 34.04 (3.46-220.61) pg/ml. IL-17 correlation with DKK-1 (r = 0.142; p = 0.396), IL-17 with SFRP-1 (r = 0.169; p = 0.309), IL-17 with sclerostin (r = 0.061; p = 0.718), IL-17 with CTX (r = -0.252; p = 0.128) and IL-17 with P1NP (r = 0.116; p = 0.487).Conclusions: Although there was a decrease in bone formation and increased bone resorption, there was no significant correlation between serum IL-17 levels with Wnt signalling (DKK-1, SFRP-1 and sclerostin) inhibitors and there was no significant correlation between serum IL- 17 with a bone turnover marker (CTX and P1NP) in premenopause AR woman."

"[ABSTRAKLatar Belakang:Artritis Reumatoid (AR) merupakan penyakit inflamasi sendi autoimun yang multi-sistemik persisten, eksaserbatif dan progresif. Anti-mutated citrullinated vimentin antibodies (Anti MCV) adalah autoantibodi golongan anti citrullinated protein antibody (ACPA) yang memiliki sensitifitas sama namun lebih spesifik dibandingkan dengan anti cyclic citrullinated protein (Anti CCP). Anti MCV berkaitan erat dengan gen HLA DRB1*04 yang berperan penting dalam patogenesis AR. Studi korelasi anti MCV dengan destruksi sendi dan aktifitas penyakit masih kontroversial dan karakteristik pasien AR di Indonesia yang berbeda, menjadi alasan penting dilakukannya penelitian ini.Tujuan: Mengetahui hubungan antara kadar anti MCV dengan destruksi sendi dan aktifitas penyakit pada pasien artritis reumatoidMetode: Penelitian ini merupakan studi potong lintang pada 37 pasien AR berdasarkan kriteria EULAR/ACR 2010 yang berobat di poliklinik Reumatologi RSCM periode September-Nopember 2014 dengan metode consecutive sampling. Anti MCV diukur dengan metode ELISA. Penilaian destruksi sendi menggunakan skor Sharp yang dimodifikasi Van der Heijde (SSvH) sedangkan aktifitas penyakit dinilai dengan disease activity score (DAS) 28 meliputi DAS 28-CRP dan DAS 28-LED. Korelasi anti MCV dengan destruksi sendi dan aktifitas penyakit dinilai dengan uji korelasi Spearman serta p untuk kemaknaan. Data penyerta lain adalah data demografis, jenis dan dosis terapi, status gizi, faktor reumatoid (FR), CRP, LED, dan darah tepi.Hasil: Sebanyak 37 subjek diikutsertakan pada penelitian ini, dengan 34 (91,9%) adalah perempuan. Anti MCV positif ditemukan 26 subjek (70,3%), sedangkan FR positif ditemukan 21 (56.%). Median anti MCV didapatkan 26 IU/ml (minimal 10 IU/ml, maksimal 151 IU/ml) termasuk titer rendah. Median SSvH yaitu 31 (2-107), dengan nilai median erosi 5(0-49) dan joint space narrowing (JSN) 26 (0-64). Rerata nilai DAS 28-CRP 2,69 (SB 1,34) dan median DAS 28-LED 4,08 (2,10-5,97) yang masing-masing termasuk dalam kelompok aktivitas penyakit rendah dan sedang.Pada analisis bivariat didapatkan korelasi positif yang lemah antara anti MCV dengan SSvH sebesar r = 0,393 (p=0,016) dan korelasi positif yang lemah antara anti MCV dengan skor DAS 28-CRP (r=0,365, p=0,013) namun tidak ada korelasi antara anti MCV dengan skor DAS 28-LED.Simpulan: Terdapat korelasi positif lemah yang bermakna antara titer anti MCV dengan destruksi sendi dan skor aktivitas penyakit DAS 28-CRP, korelasi antara titer anti MCV dengan skor DAS 28-LED tidak ada.;

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ABSTRACTBackground:Rheumatoid Arthritis is a multi-systemic, persistent, exasperated and progressive auto immune joint inflamation disease. Anti-mutated citrullinated vimentin antibodies (Anti MCV) is an auto antibody in the category of anti citrullinated protein antibody (ACPA) that has same sensitivity but more specific compared with anti cyclic citrullinated protein (anti CCP). Anti MCV is closely related to gen HLA DRB1*04 which has important role in pathogenesis of rheumatoid arthritis. Study on correlation between anti MCV and joint destruction and disease activity is still controversial and the different characteristics of AR patients in Indonesia become a strong reason for this study.Objective:The aim of this study was to described the correlation between anti-mutated citrullinated vimentin (anti MCV) with joint destruction and disease activity of in rheumatoid arthritis patients.Methods:This is a cross-sectional study on 37 RA patients based on criteria of EULAR/ACR 2010 who came to Rheumatology outpatient clinic Cipto Mangunkusumo Hospital, period of September ? November 2014 with the method of consecutive sampling. Anti MCV is measured with ELISA method, while joint destruction is scored with Sharp score modified with Van der Heijde ( SSvH ). disease activity score (DAS) 28 is used in disease activity covering DAS 28-CRP and DAS 28-LED. Correlation between anti MCV and joint destruction as well as disease activity is measured with Spearman correlation test with p for significance. Other supporting data include demography, type and dose of therapy, nutrition status, rheumathoid factor, CRP, LED, and peripheral blood.Results:37 subjects were taken into this study, with 34 (91,9%) are women. Positive anti MCV was found in 26 subjects (70,3%) while positive FR was found in 21 subjects (56%). Median of anti MCV was obtained 26 IU/ml (minimal 10 IU/ml, maximal 151 IU/ml )which is including in low titer. Median of SSvH was 31 (2 ?107) with erosion median score of 5 (0-49) and joint space narrowing (JSN) of 26 (0-64). Average score of DAS 28-CRP was 2,69 (SD1,34) and median score of DAS 28-LED was 4,08 (2,10-5,97), each of which is included in low and medium disease activity. In bivariate analysis it?s found that there is a weak significant positive correlation between anti MCV and SSvH of r = 0,393 (p=0,016) and between anti MCV and score of DAS 28-CRP (r= 0,365 , p=0,013) but there is no correlation between anti MCV and score of DAS 28-LED.Conclusion:There is a weak significant positive correlation between anti MCV and joint destruction and level of disease activity score DAS 28-CRP. Apart from that, there is no correlation between anti MCV and DAS 28-LED., Background:Rheumatoid Arthritis is a multi-systemic, persistent, exasperated and progressive auto immune joint inflamation disease. Anti-mutated citrullinated vimentin antibodies (Anti MCV) is an auto antibody in the category of anti citrullinated protein antibody (ACPA) that has same sensitivity but more specific compared with anti cyclic citrullinated protein (anti CCP). Anti MCV is closely related to gen HLA DRB1*04 which has important role in pathogenesis of rheumatoid arthritis. Study on correlation between anti MCV and joint destruction and disease activity is still controversial and the different characteristics of AR patients in Indonesia become a strong reason for this study.Objective:The aim of this study was to described the correlation between anti-mutated citrullinated vimentin (anti MCV) with joint destruction and disease activity of in rheumatoid arthritis patients.Methods:This is a cross-sectional study on 37 RA patients based on criteria of EULAR/ACR 2010 who came to Rheumatology outpatient clinic Cipto Mangunkusumo Hospital, period of September – November 2014 with the method of consecutive sampling. Anti MCV is measured with ELISA method, while joint destruction is scored with Sharp score modified with Van der Heijde ( SSvH ). disease activity score (DAS) 28 is used in disease activity covering DAS 28-CRP and DAS 28-LED. Correlation between anti MCV and joint destruction as well as disease activity is measured with Spearman correlation test with p for significance. Other supporting data include demography, type and dose of therapy, nutrition status, rheumathoid factor, CRP, LED, and peripheral blood.Results:37 subjects were taken into this study, with 34 (91,9%) are women. Positive anti MCV was found in 26 subjects (70,3%) while positive FR was found in 21 subjects (56%). Median of anti MCV was obtained 26 IU/ml (minimal 10 IU/ml, maximal 151 IU/ml )which is including in low titer. Median of SSvH was 31 (2 –107) with erosion median score of 5 (0-49) and joint space narrowing (JSN) of 26 (0-64). Average score of DAS 28-CRP was 2,69 (SD1,34) and median score of DAS 28-LED was 4,08 (2,10-5,97), each of which is included in low and medium disease activity. In bivariate analysis it’s found that there is a weak significant positive correlation between anti MCV and SSvH of r = 0,393 (p=0,016) and between anti MCV and score of DAS 28-CRP (r= 0,365 , p=0,013) but there is no correlation between anti MCV and score of DAS 28-LED.Conclusion:There is a weak significant positive correlation between anti MCV and joint destruction and level of disease activity score DAS 28-CRP. Apart from that, there is no correlation between anti MCV and DAS 28-LED.]"

"ABSTRAKBackgrounds : There was a two-fold increase in cardiovascular-related mortality in rheumatoid arthritis (RA). Postprandial triglyceride (PPTG) related to increased risk of ischemic heart disease, myocardial infarction, ischemic stroke, mortality and elevated level of adhesion molecules. Increased endothelial adhesion molecules was a sign of endothelial activation, an early process in the development of atherosclerotic lesion. There was no study evaluating the role of NTG in cardiovascular risk assessment in RA patients. Aim : This study observed the relationship between PPTG and sICAM-1 and sE-selectin, as markers of endothelial activation. Methods : This was a cross-sectional study of fifty consecutively-recruited RA patients. Lipid profiles, sICAM-1, and sE-selectin were measured postprandially. Further analysis using multiple regression was performed. Results : There was no correlation found between PPTG and sICAM-1, nor NTG and sE-selectin. Level of sICAM-1 was influenced by HDL (R2=0,087) while sE-selectin was influenced by DAS-28 (R2=0,174), body mass index (R2=0,125), and postprandial glucose (R2=0,138). Conclusion : PPTG did not correlated with sICAM-1 and sE-selectin in RA patients.

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ABSTRACTBackgrounds : There was a two-fold increase in cardiovascular-related mortality in rheumatoid arthritis (RA). Postprandial triglyceride (PPTG) related to increased risk of ischemic heart disease, myocardial infarction, ischemic stroke, mortality and elevated level of adhesion molecules. Increased endothelial adhesion molecules was a sign of endothelial activation, an early process in the development of atherosclerotic lesion. There was no study evaluating the role of NTG in cardiovascular risk assessment in RA patients. Aim : This study observed the relationship between PPTG and sICAM-1 and sE-selectin, as markers of endothelial activation. Methods : This was a cross-sectional study of fifty consecutively-recruited RA patients. Lipid profiles, sICAM-1, and sE-selectin were measured postprandially. Further analysis using multiple regression was performed. Results : There was no correlation found between PPTG and sICAM-1, nor NTG and sE-selectin. Level of sICAM-1 was influenced by HDL (R2=0,087) while sE-selectin was influenced by DAS-28 (R2=0,174), body mass index (R2=0,125), and postprandial glucose (R2=0,138). Conclusion : PPTG did not correlated with sICAM-1 and sE-selectin in RA patients."

"ABSTRAKLatar Belakang: Penyakit kardiovaskular adalah penyebab kematian yang paling sering pada pasien AR dengan laju1,5-1,6 kali lebih tinggi dari populasi non AR. Prevalensi gagal jantung pada AR dua kali lipat dibanding non AR. Karakteristik pasien AR Indonesia berbeda dibanding pasien di Negara Barat. Masih sedikit penelitian yang melihat korelasi faktor resiko non tradisional dengan disfungsi diastolik.Tujuan: Mengetahui apakah ada korelasi faktor resiko non tradisional yaitu lama menderita penyakit, derajat aktivitas penyakit dan skor disabilitas dengan disfungsi diastolik pada wanita penderita ARMetode: Desain penelitian adalah potong lintang pada wanita penderita AR yang berobat ke poli Rematologi RSCM dari Oktober 2015-Januari 2016.Sampel penelitian belum pernah dinyatakan menderita penyakit jantung sebelumnya.Disfungsi diastolik dinilai secara ekhokardiografi. Lama menderita sakit diperoleh dengan wawancara langsung, sementara aktivitas penyakit dan tingkat disabilitas dinilai dengan menghitung skor DAS28 dan skor HAQ-DI.Hasil: Disfungsi diastolik dijumpai pada 30,8 % partisipan ( masing-masing 13,5% tingkat ringan dan sedang, dan berat sebesar 3,8% ). Rerata lama menderita AR 26,5 bulan (rentang 2-240), rerata DAS28-CRP 2,69±1,11 sementara DAS28-LED 3,65 (rentang 1,13-7,5), rerata skor HAQ-DI 0,29 (rentang 0-2,38). Hipertropi LV dijumpai pada 34,6% partisipan, rerata EF 66,7±5,76%. Kelainan katup dijumpai pada 34,6% partisipan. Korelasi antara lama sakit, DAS28-CRP, DAS28-LED and skor HAQDI dengan E/A secara berurutan adalah (r= - 0,065; p=0,89), (r=0,393; p=0,38), (r=0,357; p=0,43), (r=0,630; p=0,12) ; sementara dengan E/E? secara berurutan adalah (r=0,136; p=0,77), (r= - 0,536; p=0,21), (r= - 0,393; p=0,38), (r=0,374; p=0,41)Simpulan: Lama menderita sakit, derajat aktivitas penyakit dan derajat disabilitas, tidak memiliki korelasi yang bermakna secara statistik dengan disfungsi diastolik. Angka hipertropi jantung juga cukup tinggi, dan kelainan katup yang paling sering di jumpai adalah regurgitasi ringan.Dengan tingginya angka proporsi disfungsi diastolik pada penelitian ini maka diusulkan agar dirumuskan strategi penatalaksanaan jantung pada pasien-pasien AR untuk mencegah progresifitasnya.

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ABSTRACTBackground: Cardiovascular is the main cause of death in RA, with the rate of 1.5-1.6 times higher than non RA population .The prevalence of HF in RA is 2 times fold of non RA. RA patients characteristics in Indonesia is different from the ones in western. There are only few studies about correlation between non traditional risk factor and diastolic dysfunction in RA patients.Objective: To study the correlation between each of the non traditional risk factors including disease duration,disease activity and disability score with the diastolic dysfunction in women with RA.Methods: A cross-sectional, consecutive sampling study conducted to 52 RA women without any previous history of cardiovascular disease. All participants underwent an echocardiography to asses the diastolic dysfunction and other findings associated. Duration of disease is assesed by direct interview, while the disease activity by calculating DAS28 and disability sore by HAQ-DI.Results: Diastolic dysfunction was found in 30.8 % of study participants ( 13.5 % for each low and moderate grade, while severe was 3.8% ). Mean of disease duration was 26.5 months (range 2-240), mean DAS28-CRP 2.69±1.11 while mean DAS28-ESR 3.65 (range 1.13-7.5), HAQ-DI score 0.29 (range 0-2.38). LV hypertrophy was found in 34.61% participants. Mean EF 66.7±5.76%. Valve abnormality was found in 34.6% study participants. Correlation between duration of disease, DAS28-CRP, DAS28-ESR and HAQDI score with E/A in sequence was (r= - 0.065; p=0.89), (r=0.393; p=0.38), (r=0.357; p=0.43), (r=0.630; p=0.12) ; while with E/E? in sequence was (r=0.136; p=0.77), (r= - 0.536; p=0.21), (r= - 0.393; p=0.38), (r=0.374; p=0.41)Conclusions; Duration of the disease, the disease activity score and disability score in our RA study participants had no correlation with diastolic dysfunction. The most valvular abnormality findings was mild regurgitation. Since there was a big proportion of participants with diastolic dysfunction, it is encouraged to make a stepwise approach of cardiovascular management in patients with RA."

"Latar Belakang: Komplikasi kardiovaskular yang disebabkan oleh disfungsi endotel menjadi salah satu penyebab mortalitas yang cukup tinggi pada pasien Artritis Reumatoid AR. Faktor Reumatoid RF merupakan autoantibodi yang sering dijumpai pada AR dan diduga dapat meningkatkan respon inflamasi dan disfungsi endotel. Sindroma metabolik dapat pula meningkatkan disfungsi endotel. Belum ada studi yang menilai korelasi RF dengan disfungsi endotel pada pasien AR tanpa sindroma metabolik.Tujuan: Mengetahui korelasi antara kadar RF dengan kadar VCAM-1 pada pasien AR tanpa sindroma metabolik.Metode: Penelitian desain potong lintang terhadap pasien AR dewasa yang berobat di Poliklinik Reumatologi RSUPN Cipto Mangunkusumo tanpa sindroma metabolik. Pengumpulan data dilakukan sejak Februari hingga Maret 2018 dari data penelitian sebelumnya yang diambil periode Februari 2016 hingga September 2017. Kadar RF dan VCAM-1 dinilai melalui pemeriksaan serum darah dengan metode ELISA. Analisis korelasi antar kedua variabel dibuat dengan SPSS 20,0.Hasil: Sebanyak 46 subjek diikutsertakan dalam penelitian ini. Sebagian besar 95,7 subjek adalah perempuan dengan rerata usia 44,43 tahun, median lama sakit 36 bulan, dan sebagian besar memiliki derajat aktivitas sedang 52,2. sebagian besar pasien memiliki RF positif 63. Korelasi antara kadar RF dengan kadar VCAM-1 memiliki kekuatan korelasi yang lemah tetapi tidak bermakna secara statistik r = 0,264; p = 0,076 . Subjek dengan RF positif memiliki kadar VCAM-1 yang lebih tinggi 626,89 vs 540,96 ng/mL. Simpulan: Belum terdapat korelasi antara RF dengan VCAM-1 pada pasien Artritis Reumatoid tanpa sindroma metabolik.

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Background: Cardiovascular complications caused by endothelial dysfunction become one of the highest causes of mortality in patients with Rheumatoid Arthritis RA . Rheumatoid Factor RF is an autoantibody that is commonly found in RA and is thought to increase the inflammatory response and endothelial dysfunction. Metabolic syndrome may also increase endothelial dysfunction. There have been no studies assessing correlation between RF and endothelial dysfunction in RA patients without metabolic syndrome.Aim: To determine the correlation between RF levels with VCAM-1 levels in RA patients without metabolic syndrome.Method: Cross sectional design study of adult AR patients treated in Rheumatology Polyclinic of Cipto Mangunkusumo General Hospital without metabolic syndrome. Data collection was conducted from February to March 2018 from the previous research data taken from February 2016 to September 2017. The levels of RF and VCAM-1 were assessed through blood serum testing using the ELISA method. Correlation analysis between the two variables was made with SPSS 20.0 for windows version.Results: A total of 46 subjects were included in the study. Most 95.7 subjects were women with an average age of 44.43 years, median duration of 36 months, and most had moderate activity 52.2. Most patients had a positive RF 63. The correlation between RF levels and VCAM-1 levels had a weak correlation strength but was not statistically significant r = 0.264; p = 0.076. Subjects with RF positive had higher VCAM-1 levels 626.89 vs 540.96 ng/mL.Conclusion: We did not found correlation between RF and VCAM-1 in Rheumatoid Arthritis patients without metabolic syndrome."

"Latar Belakang: Subyek diabetes melitus (DM) tipe 2 mengalami peningkatanrisiko fraktur akibat penurunan kekuatan tulang. Bone mineral density (BMD),sebagai parameter kuantitas tulang, tidak dapat menggambarkan fragilitas tulang pada subyek DM tipe 2 karena menunjukkan hasil yang normal atau meningkat dibandingkan dengan subyek bukan DM, sehingga peningkatan resiko fraktur pada subyek DM tipe 2 lebih disebabkan oleh penurunan kualitas tulang. Salah satu unsur penentu kualitas tulang adalah turnover tulang. Beberapa faktor yang berpengaruh pada turnover tulang, antara lain tumor necrosis factor-α (TNF-α) dan sclerostin. Kajian TNF-α dan sclerostin pada subyek DM perempuan pernah dilaporkan namun melibatkan subyek pascamenopause, sehingga tidak dapat dipisahkan efek TNF-α dan sclerostin terhadap turnover tulang.Tujuan: Penelitian ini bertujuan untuk mendapatkan profil kadar TNF-α dansclerostin serum pada subyek perempuan pramenopause DM tipe 2 dan bukanDM.Metode: Studi potong lintang dilakukan pada 80 subyek perempuanpramenopause yang terdiri dari ini 40 subyek DM Tipe 2 dan 40 subyek bukanDM. Data yang dikumpulkan antara lain: karakteristik subyek, riwayatpenggunaan obat-obatan, HbA1C, SGPT, kreatinin, dan eGFR. PemeriksaanTNF-α dan sclerostin serum dilakukan dengan metode enzyme-linkedimmunosorbent assay (ELISA).Hasil: Median (rentang interkuartil) kadar TNF-α serum pada subyek DM tipe 2[43,0 pg/mL (14,4-101,31)], lebih tinggi dibandingkan subyek bukan DM [23,86pg/mL (11,98-78,54)] namun perbedaan tersebut tidak bermakna (p=0.900).Rerata (simpang baku) kadar sclerostin serum pada subyek DM tipe 2 [132,05pg/mL (SB 41,54)], lebih tinggi bermakna (p<0.001) dibandingkan subyek bukan DM [96,03 pg/mL (SB 43,66)]. Tidak didapatkan hubungan antara kadar TNF-α dan sclerostin serum baik pada subyek DM tipe 2 (p=0,630) maupun subyek bukan DM (p=0,560).Kesimpulan: Subyek perempuan pramenopause DM tipe 2 memiliki kadar TNF-α serum lebih tinggi namun tidak bermakna dibandingkan dengan subyek bukan DM. Subyek perempuan pramenopause DM tipe 2 memiliki kadar sclerostin serum lebih tinggi bermakna dibandingkan dengan subyek bukan DM.

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Background: The subject of type 2 diabetes mellitus (T2DM) has an increased

risk of fracture due to a decrease in bone strength. Bone mineral density (BMD), as a parameter of bone quantity, cannot describe bone fragility in T2DM subjects because it shows normal or increased results compared to non-DM subjects, so an increased risk of fracture in T2DM subjects is due to a decrease in bone quality. One element that determines bone quality is bone turnover. Some factors that influence bone turnover include tumor necrosis factor-α (TNF-α) and sclerostin. TNF-α and sclerostin studies in female DM subjects have been reported but involve postmenopausal subjects, so that the effects of TNF-α and sclerostin cannot be separated from bone turnover.

Objective: This study aims to obtain a profile of serum TNF-α and sclerostin levels in premenopausal women with T2DM and non-DM.

Method: A cross-sectional study was carried out on 80 premenopausal female

subjects consisting of 40 T2DM subjects and 40 non-DM subjects. Data collected included: subject characteristics, history of drug use, HbA1C, SGPT, creatinine, and eGFR. Serum TNF-α and sclerostin examination was carried out by the enzyme-linked immunosorbent assay (ELISA) method.

Results: The median (interquartile range) of serum TNF-α levels in T2DM

subjects [43.0 pg/mL (14.4-101.31)], was higher than non-DM subjects [23.86

pg/mL (11.98 -78.54)] but the difference was not significant (p= 0.900). The mean (standard deviation) of serum sclerostin levels in T2DM subjects [132.05 pg/mL (SD 41.54)], was significantly higher (p< 0.001) than non-DM subjects [96.03 pg/mL (SD 43.66)]. There was no association between serum TNF-α and sclerostin levels in both T2DM subjects (p= 0.630) and non-DM subjects (p= 0.560).

Conclusions: Subjects of premenopausal women with T2DM had higher serum

TNF-α levels but were not significant compared to non-DM subjects. Subjects of premenopausal women with T2DM had significantly higher serum sclerostin

levels compared to non-DM subjects.

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"Artritis reumatoid merupakan penyakit autoimun yang ditandai dengan inflamasi kronik pada daerah persendian. Daun babandotan terbukti memiliki khasiat dalam terapi inflamasi. Tetapi belum ada data terkait efeknya terhadap artritis reumatoid sehingga dapat dijadikan alternatif terapi artritis. Penelitian ini bertujuan untuk mengetahui efek antiartritis ekstrak etanol 70% daun babandotan diamati dari volume edema kaki tikus yang diinduksi complete freund?s adjuvant, serta pengaruh ekstrak terhadap kadar TNF-α dan parameter hematologi darah diamati dari jumlah leukosit, limfosit, granulosit, hemoglobin, eritrosit, dan mean cells volume of RBCs (MCV). Penelitian ini menggunakan 30 tikus putih jantan Sprague-Dawley, dibagi menjadi 6 kelompok. Kelompok kontrol normal dan negatif diberikan CMC 0,5%, kelompok kontrol positif diberikan suspensi metotreksat 0,05 mg/200 g bb, kelompok variasi dosis ekstrak diberikan 6,48 mg; 12,96 mg; dan 25,92 mg/200 g bb. Semua kelompok diinduksi 0,1 ml CFA pada hari ke-1 kecuali kelompok kontrol normal. Bahan uji diberikan satu kali sehari secara oral pada hari ke-29 sampai hari ke-49. Pengukuran volume telapak kaki dilakukan pada hari ke- 1, 29, dan 50. Perhitungan parameter hematologi dilakukan pada hari ke-29 dan 50, serta uji kadar TNF-α dilakukan pada hari ke-50. Hasil yang diperoleh menunjukkan bahwa pemberian ekstrak etanol 70% daun babandotan, mampu menurunkan volume edema, kadar TNF-α, jumlah leukosit, limfosit, dan granulosit pada kelompok dosis 25,92 mg/200 g BB melalui mekanisme penghambatan sitokin inflamasi seperti TNF-α. Namun pemberian bahan uji tidak signifikan dalam mempengaruhi jumlah hemoglobin, eritrosit, dan MCV.

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Rheumatoid arthritis is an autoimmune disease characterized by chronic inflammation in joints. Babandotan leaves is proven to be used in inflammation theraphy, but there is yet any data regarding the effects of the leaves on rheumatoid arthritis. At the same time, the extract can be an alternative arthritis therapy. The aim of this research is to determine the anti-arthritic effect of 70% ethanolic extract of babandotan leaves in terms of reduction in edema volume on rat paw induced by complete freund?s adjuvant (CFA), and the effect of extract to TNF-α and haematological parameters observed the number of leukocytes, lymphocytes, granulocytes, haemoglobin, erythrocytes, and mean cells volume of RBCs (MCV). This research used white male Sprague-Dawley rats which were divided into 6 groups; normal control and negative control groups, both given 0.5% CMC; positive control group, given methotrexate suspension 0.05 mg/200 g bw; the dose variation extract are 6.48 mg; 12.96 mg; 25.92 mg/200 g bw. All the groups were induced with 0.1 ml CFA on day-1, except normal control group. Test material were administered orally once daily on days-29 to 49. Foot-pad volume measurements were performed on days-1, 29, and 50. The number of leukocytes, lymphocytes, granulocytes, haemoglobin, erythrocytes, and mean cells volume of RBCs (MCV) were counted on days-29 and 50, and TNF-α assay were counted on days-50. The results showed that the 70% extract ethanolic of babandotan leaves with a given dose variation have been able decrease edema volume, TNF-α, the number of leukocytes, lymphocytes, granulocytes at 25.92 mg/200 g bw dose groups by inhibit cytokins inflammation. However, administration of the test materials did not significantly influence the number of haemoglobin, erythrocytes, mean cells volume of RBCs (MCV)."