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"Background. Systemic Lupus Erythematosus (SLE) is an Autoimmune inflammatory disease that is systemic and chronic inflammation with heterogeneous of history, clinical manifestations, and prognosis. The disease activity of SLE has been proven as a predictor of organ damage and death by evidenced of inflammatory markers involved in this disease. Neutrophil to Lymphocyte Ratio (NLR) is useful for estimating the activity of autoimmune disease and inflammation that easily obtained from blood test and low cost and measurable as new biomarker to assess inflammatory response or activity of SLE. This study aimed to determine the relationship between NRL and Disease Activity based on Mex-SLEDAI in patients SLE. Methods. This study is an analytic study with cross sectional design. It started from November 2016 until March 2017. Mex-SLEDAI and blood sampling used in this study. Result. Total sample in this study is 54 patients with median age was 28.5 years, with mostly female (85,2%). Result analysis with positive correlation between NLR with disease activity on SLE (r=0.399 p=0.003 n=54), thus the Scatter plot shows there is a correlation between NRL with Mex-SLEDAI. Conclusion. Positive correlation between NLR and disease activity of the SLE, the higher of the disease activity/Mex-SLEDAI will be followed by the increase of NLR."

"Background. Antibody to complement C1q (Anti-C1q Antibody) can be found in Systemic Lupus Erythematosus (SLE) patients. Complement C1q plays a role in the clearance of apoptotic cells and immune complexes. Anti-C1q causes complement C1q become inactive so that the clearance decreases, which induces self antigen and inflammatory response. Many tissue inflammation are associated with disease activity and lupus manifestations. The aim of this study is to find out the correlation of anti-C1q level with disease activity, so that anti-C1q can be used as an objective indicator of inflammation along with SELENA-SLEDAI. Method. This is an analytic descriptive study with cross sectional design. Anti-C1q antibody levels were measured in 52 SLE patients who are hospitalized or treated routinely in outpatient clinic of Rheumatology Dr.Hasan Sadikin Hospital Bandung Indonesia from October to December 2015. Result. Most of the study subjects were women (94%), with a median age of 33 years. There were 13 new patients (25%), and the rest 42 patients were treated routinely. The median SELENA-SLEDAI was 6 (0-32). Subject were divided into no activity (11.5%), low disease activity (34.6%), medium disease activity (25%) high disease activity (15.4%) and very high disease activity (13.5%). Median anti-C1q level was 3.92 U/mL (range 0.6-100.2 U/mL). Anti-C1q antibody levels were positively correlated with SLE disease activity based on SELENA-SLEDAI scores (r=+0.304; p=0.014) Conclusion. Anti-C1q antibody levels has mild correlated with lupus disease activity based on SELENA-SLEDAI score"

"Background Patients with systemic lupus erythematosus (SLE) and systemic sclerosis (SSc), have to cope with lifelong disease manifestation and impaired physical function. Limited physical activities along the disease will affect their quality of life (QoL). The QoL is recognized as an important factor of treatment strategy. This study aims to compare the quality of life of patient with SLE and SSc. Method This study was a cross-sectional study and conducted in rheumatology outpatient clinic of Hasan Sadikin Hospital Bandung, Indonesia from January 2015 until March 2017. The respondents were patients diagnosed as SLE and SSc who regularly visit rheumatology outpatient clinic. Respondents were asked to complete the Short Form-36 (SF-36). Baseline characteristics, including age, gender, and duration of disease, were collected during the visit. The Mann-Whitney U test was used to analyze the comparison. Result There were 242 patients who completed the SF-36 questionnaires, consisted of 193 SLE patients and 49 SSc patients. SLE patients were slightly younger and had a longer duration of disease compared to SSc. The SF-36 Physical Component Summary (PCS) score was significantly higher on SLE patients (40.6 vs 40.4, p = 0.0001), but the mean of Mental Component Summary (MCS) score was similar among both diseases. Conclusion Physical functioning aspect on quality of life is better in SLE patients compared to SSc patients. However, mental aspect for both diseases are relatively similar."

"Latar Belakang. Depresi sering ditemukan pada pasien lupus eritematosus sistemik (LES) dan berhubungan dengan aktivitas penyakit LES. Kurangnya perhatian klinisi terhadap penapisan hingga tatalaksana depresi pada LES sangat berperan. Hospital Anxiety and Depression Scal (HADS) merupakan salah satu skala pengukuran depresi berbentuk kuesioner yang sering dan mudah digunakan serta memiliki banyak terjemahan yang tervalidasi sedangkan Mexican- Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI) merupakan sistem skoring untuk menilai aktivitas penyakit LES dengan biaya minimal namun mempunyai reliabilitas dan validitas yang baik. Rasio neutrofil-limfosit (RNL) merupakan penanda inflamasi sistemik sedangan anti-dsDNA merupakan autoantibodi spesifik pada LES yang kadarnya meningkat seiring dengan aktivitas penyakit. Saat ini di Indonesia, belum ada penelitian yang mengkorelasikan antara skor HADS-D dengan RNL, kadar anti-dsDNA dan skor Mex-SLEDAI pada LES.Tujuan. Mengetahui korelasi antara skor HADS-D dengan RNL, kadar anti-dsDNA dan skor Mex-SLEDAI pada pasien LES.Metode. Studi ini menggunakan desain potong lintang, dilakukan analisis data primer pasien LES usia 18-60 tahun. Dilakukan wawancara dan pemeriksaan fisik serta pengisian kuesioner HADS diikuti dengan pengambilan sampel darah untuk menilai kadar anti-dsDNA dan melengkapi perhitungan skor Mex-SLEDAI. Korelasi antara skor HADS-D dengan RNL, kadar anti-dsDNA, dan skor Mex-SLEDAI didapat dengan uji korelasi Spearman menggunakan SPSS.Hasil. Dilakukan analisis pada 121 subjek. Seluruh sampel adalah perempuan dengan median usia 31 (24-39) tahun. Median skor HADS-D sebesar 6 (4-7), median RNL sebesar 2,64 (1,945-3,91), median anti-dsDNA sebesar 133,5 (29,8-388,5), dan median skor Mex-SLEDAI sebesar 5 (3-10). Terdapat korelasi positif sangat lemah antara skor HADS-D dengan RNL (r 0,18 dan p 0,048). Terdapat korelasi positif lemah antara skor HADS-D dengan Mex-SLEDAI (r 0,244 dan p 0,007). Tidak terdapat korelasi antara skor HADS-D dengan anti-dsDNA.Kesimpulan. Terdapat korelasi positif antara skor HADS-D dengan RNL dan skor Mex-SLEDAI tetapi tidak ada korelasi antara skor HADS-D dengan kadar anti-dsDNA pada pasien dengan LES.

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Background. Depression is common in systemic lupus erythematosus (SLE) and can increase SLE disease activity. Lack of clinical attention to screening until the management of depression play an important role. Hospital Anxiety Depression Scale (HADS) is a depression measurement scales that is often and easy to use while Mexican-Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI) is a scoring system to asses disease activity at lower cost but has good reliability and validity. Neutrophil-lymphocyte ratio (NLR) is a systemic inflammation marker whereas anti-dsDNA is a specific antibody for SLE. In  Indonesia, there are no studies that correlate HADS-D score with NLR, anti-dsDNA level, and Mex-SLEDAI score in SLE patients.

Objective. To determine the correlation between HADS-D score with NLR, anti-dsDNA level, and Mex-SLEDAI score in SLE patients.

Methods. This study used a cross-sectional design that analysed the primary data of SLE patients aged 18-60 years. Interviews and physical examinations were carried out as well as filling out the HADS questionnaire followed by blood sampling to assess anti-dsDNA levels and calculate Mex-SLEDAI score. The correlation between HADS-D score with NLR, anti-dsDNA level, and Mex-SLEDAI score were obtained by using the Spearman correlation test using SPSS.

Results. This study analysed on 121 subjects with a median age of 31 (24-39) years. The median HADS-D score was 6 (4-7), median NLR was 2.64 (1.945-3.91), median anti-dsDNA level was 133.5 (29.8-388.5), and median Mex- SLEDAI score was 5 (3-10). There is a very weak positive correlation between HADS-D and NLR (r 0.18 and p 0.048) and weak positive correlation between HADS-D and Mex-SLEDAI (r 0.244 and p 0.007). There is no correlation between HADS-D and anti-dsDNA.

Conclusion. There are positive correlation between HADS-D score with NLR and Mex-SLEDAI score but there is no correlation between HADS-D score with anti-dsDNA level in SLE patients."

"Background: Systemic Lupus Erythematosus (SLE), an autoimmune disease, can cause damage and impairment in the nervous system. Patients who had any manifestation of neurology can be classified as patients with Neuropsychiatric Systemic Lupus Erythematosus (NPSLE). One of the most frequent NPSLE manifestation is anxiety disorder. The presence of anxiety disorder is believed to be correlated with their ability to carry out daily activities. This study aims to see the correlation between anxiety disorder and quality of life (QOL) in patients with SLE. Method: an analitic cross-sectional study was done. The data were collected by distributing validated questionnaires to patients diagnosed with SLE in the outpatient clinic of dr. Hasan Sadikin General Hospital. Quality of life and anxiety disorder was measured using Short From-36 (SF-36) and Zung Self-Rating Anxiety Scale (Zung-SAS), respectively. Normality test was done before correlating the variables using Pearson method. Result: Forty-six SLE patients fitted with the inclusion criteria were participated in the study. The assessment using Zung-SAS showed that 9 (19.56%) correspondents had mild–moderate anxiety, and 1 (2.17%) had severe anxiety. The analysis of SF-36 showed the means of Physical Component Summary (PCS) and Mental Component Summary (MCS) which were 45.18 ± 8.23 and 47.11± 9.78, in order. The correlation test of Zung-SAS with PCS and MCS showed the result of r= -0.651 (p < 0,01) and -0.654 (p < 0,01), respectively. Conclusion: There is a significant negative correlation between anxiety disorder and QOL in patients with SLE. The result of this study showed that the high degree of ones anxiety was in a parallel line with their low level of QOL, so it is important to do an early detection and prevention of anxiety disorder in SLE patients."

"Latar belakang: Lupus eritrematosus sistemik (LES) adalah penyakit yang kompleks dengan manifestasi yang bervariasi. Interleukin-6 (IL-6) merupakan sitokin pleitropik yang mempunyai aktivitas biologis dengan rentang luas yang berperan penting pada regulasi imun dan inflamasi. Saat ini belum ada biomarker yang dapat membedakan kondisi remisi total dengan aktivitas penyakit ringan. Interleukin-6 diharapkan dapat digunakan sebagai parameter aktivitas penyakit terutama pada kasus-kasus dimana antara manifestasi klinis dan skor SLEDAI tidak sesuai yaitu pada pasien LES dengan aktivits ringan dan remisi total.Tujuan: Mengetahui karakteristik IL-6 pada LES anak dengan berbagai aktivitas ringan dan remisi total.Metode: Penelitian kasus kontrol dilakukan di poli rawat jalan Alergi-Imunologi Departemen Ilmu Kesehatan Anak RSUPN dr. Cipto Mangunkusumo, Jakarta dan RSUP Dr. Sardjito, Yogyakarta mulai Mei hingga Juni 2019. Pasien anak usia 1-18 tahun dengan diagnosis LES dinilai kadar IL-6 dan aktivitas penyakit yang dinilai dengan skor SLEDAI. Uji korelasi chi square dilakukan untuk mengetahui hubungan variabel bebas dan luaran. Analisis data dilakukan dengan program SPSS for Window ver 20,0Hasil: Dari 60 subjek penelitian yang terdiri dari 30 pasien LES aktivitas ringan dan 30 remisi total. tidak ada perbedaan kadar IL-6 tinggi pada kelompok kasus dibanding kelompok kontrol dengan p=0,500, OR= 0,483 (95% IK: 0,041-5,628). Terdapat 2 subyek dengan kadar IL-6 tinggi menderita infeksi saluran kencing.Simpulan: Tidak ada perbedaan aktivitas penyakit pada pasien LES anak dengan aktivitas ringan dibanding remisi total.

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Background: Systemic Lupus Erythematosus (SLE) is a complex disease with various manifestations. Interleukin-6 (IL-6) is a pleiotropic cytokine with a wide range of biological activities that plays an important role in immune regulation and inflammation. Recently, there is no other biomarker that could differentiate total remission condition and mild disease activity in juvenile SLE. Interleukin-6 may be used as a parameter of disease activity, especially in the cases with different clinical manifestations and SLEDAI scores among SLE patients with mild activities and total remissions.

Aim: To indentify the characterictics of serum IL-6 concentration in juvenile systemic lupus erythematosus with mild activities and total remissions.

Methods: Case control study was performed at outpatient clinic of allergy-immunology, department of child health dr. Cipto Mangunkusumo hospital, Jakarta and dr. Sardjito hospital, Yogyakarta during May-June 2019. Serum IL-6 consentration and disease activity were assessed in all juvenile SLE patients aged 1-18 year. SLE disease activity was assessed with SLEDAI scores and serum level of IL-6 was measured by enzyme linked immunosorbent assay. Chi square correlation analysis was used to determine the correlation of serum IL-6 concentration with disease activity in juvenile SLE patients. Analyses of data were performed using the SPSS statistical software for windows version 20,0.

Results: Among 60 subjects included in this study, 30 subjects with mild activities in the case group and 30 subjects with total remissions in the control group. There was no differences of serum IL-6 concentration between case and control group (p=0,500, OR= 0,483 (95% IK: 0,041-5,628)). In this study, we found 2 subjects with urinary tract infection have high serum IL-6 concentration.

Conclusion: There was no differences of serum IL-6 concentration between juvenile SLE patients with mild activities compared with total remissions."

"Latar Belakang: Lupus Eritematosus Sistemik (LES) merupakan penyakit autoimundengan penyebab multifaktorial. Ketidakseimbangan sitokin Th17 (Interleukin-17; IL-17) dan T-regulator (Transforming Growth Factor-; TGF- and Interleukin-10; IL-10)diduga terlibat dalam patogenesis LES yang mempengaruhi aktivitas penyakit.Tujuan: Penelitian dilakukan untuk menguji perbedaan rerata IL-17, TGF- dan IL-10dengan aktivitas penyakit LES dan menguji korelasi sitokin Th17/T-regulator.Metode: Penelitian ini merupakan studi potong lintang melibatkan 68 pasien LESberdasarkan kriteria inklusi MEX-SLEDAI <2 untuk LES inaktif dan >=2 untuk LESaktif. Kriteria eksklusi adalah pasien LES dengan riwayat autoimun lain, inflamasikronik; infeksi akut secara klinis; serta asma bronkial, dermatitis atopi dan urtikariadidasarkan pada catatan rekam medis. Serum IL-17, TGF-, IL-10 diperiksa denganmetode ELISA. Data dianalisis dengan perangkat lunak SPSS 20 menggunakan uji-Tindependen untuk data berdistribusi normal dan uji Mann-Whitney untuk data tidaknormal.Hasil: Rerata IL-17 serum adalah 19,67 (1,299) pg/ml. Median TGF- dan IL-10 adalah175,02 (132-396) pg/ml dan 2,96 (0-11) pg/ml. Tidak terdapat perbedaan rerata yangsignifikan dari kadar IL-17, TGF- dan IL-10 serum pasien LES aktif dan tidak aktif.Didapatkan korelasi positif sedang yang signifikan antara IL-17 dan IL-10 (p<0,005;r=0,529) dan korelasi yang tidak signifikan antara IL-17 dan TGF- (p>0,005; r=-0,142).Simpulan: Tidak didapatkan perbedaan rerata yang signifikan sitokin Th17/Treg pasienLES aktif dan inaktif. Terdapat korelasi positif signifikan sedang antara IL-17 dan IL-10, sementara tidak terdapat korelasi signifikan antara IL-17 dan TGF-. Penelitianlanjutan dengan disain kohort prospektif diperlukan untuk mengkonfirmasi peransitokin jalur Th17/Treg ini pada pasien LES aktif dan inaktif.

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"Latar Belakang: Anti dsDNA merupakan salah satu faktor risiko aterosklerosis yang berasal dari LES dan belum ada penelitian yang melihat hubungan antara kadar anti dsDNA dengan ketebalan tunika intima-media arteri karotis. Penelitian ini bertujuan untuk melihat korelasi antara anti dsDNA dengan ketebalan tunik intima-media arteri karotis. Metode: Penelitian ini adalah penelitian potong lintang, melibatkan 84 pasien LES dengan kriteria inklusi adalah pasie LES yang memenuhi kriteria diagnosis sesuai dengan ACR 1997 atau SLICC 2012, dan kriteria eksklusi adalah bila terdapat variasi anatomi pembuluh darah yang tidak dapat dilakukan pengukuran. Anti dsDNA diperiksa dengan menggunakan ELISA dan USG Doppler dilakukan pada pasien untuk mengukur ketebalan maksimal tunika intima media arteri karotis (max-IMT). Analisa statistik dilakukan dengan uji parametrik Pearson dan bila tidak memenuhi syarat dilakukan uji non parametrik Spearman. Hasil: Delapan empat responden (82 perempuan dan 2 laki-laki) dilakukan analisa. Rerata usia pasien 35,5±8,9 tahun dengan 64,3% berusia di bawah 40 tahun, median anti dsDNA 38,9 IU/L(0,9 ? 750 IU/L) dan Median max-IMT adalah 581 μm (385-1800 μm). Terdapat 43 (51,2 %) pasien dengan ketebalan pada tunika intima-media arteri karotis, 36 (42,9%) pasien dengan ketebalan saja, 6 (7,1%) pasien dengan ketebalan pada tunika intimamedia dan plak dan 1 (1,2%) pasien dengan plak di near wall bulbus kiri tanpa disertai dengan ketebalan pada tunika intima-media. Plak terutama ditemukan pada bulbus karotis kanan dan kiri. Berdasarkan uji korelasi speraman's tidak terdapat korelasi antara ati dsDNA dengan ketebalan maksimal tunika intima media arteri karotis. (r = 0,073, p= 0,520). Kesimpulan: Tidak terdapat korelasi antara anti dsDNA dengan ketebalan tunika intima-media arteri karotis pada pasien LES.

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Background: Anti dsDNA is considered as one of SLE-related risk factors for atherosclerosis. The evaluation of Carotid intimal-media thickness has recently became one of the surrogate markers for atherosclerosis. Until now, there hasn't been any study relate the level of anti dsDNA antibody with Carotid intimal-media thickness. This study is conducted to determine the correlation between anti dsDNA and Carotid intima-Media Thickness.

Methods: This is a cross sectional study, 84 SLE patients were included. Patients diagnosed as SLE according to ACR 1997 or SLICC 2012 criteria were included in the study, while SLE patients with anatomical variation which difficult to measured were excluded from this study. Doppler ultrasound was carried out for patients and max-IMT was measured. Anti dsDNA was measured with ELISA.

Study results: Eighty four subjects (82 female, 2 male) were included. Mean age was 35,5 ±8,9 years old, 64,3 % between 18-39 years old, median anti dsDNA level 38,9 IU/L (0,9 - 750 IU), and median max-IMT value was 581 μm. There were 43 (51,2 %) patients Carotid intima-media thickness, 36 (42,9%) patients with increased IMT only, 6 (7,1%) patients with increase IMT and Plaque, and 1 (1,2%) patient with plaque in near wall left bulbus without increased IMT. Based on spearman's correlation test there are no correlation between anti dsDNA and max-IMT (r=-0,073, p= 0,520).

Conclusion: There are no correlation between anti dsDNA level and Carotid intimal-media thickness this study."

"Background. Systemic lupus erythematosus (SLE) has diverse clinical manifestations, including renal and non-renal. Renal manifestation is related to significant morbidity and mortality. SLE is also characterized by serological aberrations, including levels of complement C3, C4 and anti-dsDNA, but the association of them with clinical manifestations including renal and non-renal is unclear. This study investigated the associations of C3, C4 and anti-dsDNA levels with renal and non-renal manifestations in SLE patients.Method. A cross-sectional study was conducted in the Polyclinic of Rheumatology, Dr. Saiful Anwar Hospital Malang. A number of 43 subjects fulfilled the 1997 American College of Rheumatology criteria participated in this study, that consisted of 11 patients with renal manifestation and 32 patients with non-renal manifestations. Serum C3 and C4 levels were measured using immunoturbidimetry, and serum anti-dsDNA levels were measured using enzyme-linked immunosorbent assays (ELISA). The independent T-test was used to compare C3 levels and the Mann-Whitney U test was used to compare C4 and anti-dsDNA levels between groups.Result. SLE with renal manifestation had significant lower levels of serum C3 compare to non-renal manifestations (mean ± SD: 71.27 ± 32.65 mg/dL and 94.47 ± 26.29 mg/dL respectively, p=0.022). SLE with renal manifestation also had significantly lower levels of serum C4 compare to non-renal manifestations (mean ± SD: 14.55 ± 8.20 mg/dL and 25.50 ± 11.05 mg/dL respectively, p=0.002). Conversely, SLE with renal manifestation had significantly higher levels of serum anti-dsDNA compare to non-renal manifestations (mean ± SD: 249.27 ± 240.34 IU/mL and 109.91 ± 166.11 IU/mL respectively, p=0.014).Conclusion. SLE patients with renal manifestation have significantly lower levels of serum C3 and C4 and a higher level of serum anti-dsDNA than SLE patients with non-renal manifestations."

"Often considered the prototypic autoimmune disease, Lupus is characterized by protean manifestations and affects a wide range of organ systems. Despite widespread availability of anti nuclear antibody testing and other technological diagnostic advances, the diagnosis of lupus can be elusive, difficult, and inexact. Treatment of the disease can also be challenging. Advances in immunology and biotechnology have led to a burgeoning world of new therapies in development that offer patients the real possibility of new therapies and physicians and scientists novel insights into the pathogenesis of this complicated immunological disease. Lupus erythematosus : clinical evaluation and treatment summarizes the clinical aspects of lupus facing the general clinician in the 21st century. In this invaluable, practical book, the reader will find introductory chapters regarding general diagnostic and treatment principles, followed by chapters addressing the lupus-specific organ manifestations. Special topics regarding pregnancy and comorbidities are also presented. Written by highly experienced physicians with special expertise in lupus."