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"Background systemic sclerosis (SSc) is a chronic autoimmune disease which presents immunological, endothelilal dysfunction, skin and organs fibrosis. The inflammatory process is an important pathopshsiology of systemic sclerosis. Disease activity assessment using clinical parameters of c creative protein (CRP), erytrocyte sedimentation rate (ESR) and soluble CD40 lingand."

"Background Rheumatoid arthritis is the most prevalent from of inflammatory arthritis. One of the key components for its multidimensional outcome is the disease activity, measured by DAS28 ESR. The phsycal, emotional, and social aspect of RA contribute to the quality of life, and SF 36 questionaire can be used to measure it. This study aims to ascertain the correlation between the disease activity (DAS28 ESR) and the quality of life (SF 36) in RA pantients."

"ABSTRACTRheumatoid arthritis (RA) is an autoimmune disease which has recently been recognized to manifest as not only intraarticular events, presented either subclinically or clinically, were discovered more in AR patients. Atherogenic inflammatory mediator in AR including interleukin-6 (IL 6) was thought tobe one of nontraditional cardiovascular risk factor contributing to increase the endothelial dysfunction biomarker such as e selectin."

"ABSTRAKBackground Aim of this research is to assess the efficacy and safety of tocilizumab in combination with methotrexate in Indonesian patients with moderate to severe active rheumatoid arthritis who have an inadequate response to non biologic DMARDs.Methods This was a interventional, prospective, single arm, multicenter, study in Indonesian male or female patients aged > 18 years old, with a diagnosis of RA for > 6 months based on ACR 1987 revised criteria with moderate to severe disease activity DAS28 score > 3.2 after > 12 weeks of non biologic DMARDs treatment. The treatment consisted of tocilizumab, 8 mg/kg, intravenous, every 4 weeks for a total of 6 infusion in combination with oral MTX 10 until 25 mg every week. Efficacy was assessed based on the percentage of patients achieving low disease activity state DAS28 < 3.2, percentage of patients achieving reduction > 1.2 point of DAS28, percentage of patients achieving remission DAS28 < 2.6, and percentage of patients with ACR20, ACR50, and ACR70 responses. Descriptive statistics will be used for presentation of results.Results 100 percent patients reached low disease activity DAS28 < 3.2 at last study visit week 24 and clinically significant improvement reduction at least 1.2 units at every visit in DAS28, both for ITT or PP patients. Remission DAS28 < 2.6 was observed in 82.1 percent ITT patients and 93.1 percent PP patients on last study visit. ACR20, ACR50, and ACR70 were achieved in 20 percent, 34 percent, and 34 percent ITT patients, and 7 percent, 24 percent, and 62 percent PP patients on week 24. There were 3 out of 39 patients 7.69 percent with adverse events and serious adverse events that resulted in discontinuation of TCZ treatment, consisting of 1 patient with SAE of sepsis ec acquired community pneumonia, 1 patient with SAE of pneumonia tuberculosis, and 1 patient with AE of candidiasis. Most common adverse events were hepatic dysfunction 30.7 percent, hypercholesterolemia 23.1 percent, followed by arthralgia 20.5 percent Twelve percent of patients needed dose modification due to elevated liver enzyme elevated ALT/SGPT level. Conclusion Tocilizumab seems to be efficacious and likely to have good safety profile in non biologic DMARD nonresponsive RA patients of PICTURE INA study. "

"ABSTRAKBackground Rheumatoid arhtirtis is a chronic autoimmune disease that mainly attacks joints. It may causes joint deformities which leads to lower quality of life of RA patients. RA is treated with metothrexate which inhibiting disease progression. MTX is known for its hepatotoxicity side effect, which is described by an elevation of aspartate aminotransferase and/or alanine aminotransferase beyond the upper normal limit. Factors that may enhance hepatotoxicity are gender, age, cummulative dose of MTX, and duration therapy of MTX. Prevalence of hepatotoxicity caused by MTX therapy in RA patients in Indonesia is still unknown. The objective of this research is to know the proportion of hepatotoxicity and its associations with the factors that may enhance hepatotoxicity caused by MTX therapy in RA patients in RSCM.Method Data about gender, age, cummulative dose and duration therapy of MTX are obtained from 115 RA patients medical records.Result Proportion of hepatotoxicity in RA patients treated with MTX in RSCM is 42.60 percent. Gender, age, cummulative dose and duration therapy of MTX do not significantly enhance hepatotoxicity p>0.05. Conclusion In conclusion gender, age, cummulative dose and duration therapy of MTX do not have association with hepatotoxicity in RA patients treated with MTX."

"Background: Systemic sclerosis is a chronic progressive multisystem autoimmune disease in connective tissue, characterized by its heterogeneous clinical manifestation. The purpose of this study is to give information regarding clinical manifestations and laboratory findings of systemic sclerosis patients to establish diagnosis of disease. Methods: This study was conducted using descriptive quantitative design in September until October 2016. Data was collected from medical records of patients visiting Rheumatology Clinic Dr. Hasan Sadikin General Hospital from 1 July 2015 until 30 June 2016 using total sampling method. The collected data were expected to comprise patients clinical manifestation and laboratory finding. Results: Most of patients had cutaneous 57 100.0 pecent and musculoskeletal 40 70.2 pecent involvement. Some of the disease manifestations were Raynauds phenomenon 38 66.7 pecent , fingertip lesion 33 57.9 pecent, stiffness in skin 34 59.6 pecent, and arthalgia 29 50.9 pecent. Gastrointestinal involvements were present in 29 50.9 pecent patients. Renal involvement were determined from urinalysis result showed proteinuria 10 17.5 pecent and hematuria 8 14.0 pecent, found in 24 42.1 pecent patients, while pulmonary and cardiac involvements were found in 30 52.6 pecent patients, acknowledged from clinical symptoms such as dyspnea 12 21.1 pecent. Identification of autoantibodies was found in 12 21.1 pecent patients, with 10 17.5 pecent patients had reactive ANA and 3 3.5 pecent had positive anti Scl70. Conclusion: Most of systemic sclerosis patients had cutaneous involvement. Renal, pulmonary, and cardiac involvement were concluded based on laboratory findings."

"Background: Interstitial Lung Disease is one of the major cause of morbidity and mortality in Systemic Sclerosis. The gold standard to diagnose ILD is using High Resolution Computed Tomography scan. HRCT scan need a lot of cost and not always available, so another diagnosing test is needed as an alternative modality to diagnose ILD. ILD is a restrictive lung disease caused by lung fibrosis which is proved by the decrease of Forced Vital Capacity in spirometry, and followed by the increase of soluble CD40L level in plasma. This sCD40L may become a potential biomarker to evaluate lung fibrosis in SSc patients. The aim of this study is to analyze the correlation of sCD40L levels with FVC score in SSc patients with restrictive lung disease. Method: This cross sectional study was enrolled by the SSc patient who has restrictive lung disease based on spirometry test, at Rheumatology outpatient clinic dr. Hasan Sadikin Hospital from May 2015 to May 2016. All subject took underwent history, physical examination, spirometry and blood test for sCD40L. Data were analyzed using Pearson correlation.Result There were 38 subjects involved in this study, dominated bywoman 92.1 pecent with mean age 41years. Subjects consist of 22 57,9 pecent with limited SSc, 16 42,1 pecent with diffuse SSc patients and 33 subjects treated with DMARD. Mean sCD40L serum in this study was 6.690,3 pg/mL, with no statistical difference between limited and diffuse type p 0.154. Mean FVC score in this study was 58.2. There was no significant correlation between sCD40L serum with FVC r 0.058, p 0.366. There was weak correlation on DMARD naïve subject between sCD40L serum and FVC r 0.058, p 0.366 but statistically insignificant. There was no significant correlation between sCD40L serum with mRSS r 0,066 p 0,346. Conclusion: This study founds no correlation between sCD40L with FVC in SSc at dr. Hasan Sadikin Hospital."

"ABSTRAKBackground WHO ILAR COPCORD Program is a program that aimed to obtain data on joints pain and musculoskeletal diseases in developing countries, one aspect which has not been studied is the ability of COPCORD questionnaire as a screening tool which standardized for screening joint pain and musculoskeletal diseases. Objective of this study is to assess the validity of modified COPCORD questionnaire Indonesian version in screening joint pain and musculoskeletal disease compared to examination by rheumatologists.Methods The initial phase of the research is determining essential points, translation to Indonesian, and back translation. The second stage is testing questionnaires in communities which 100 respondents involved. Dependent variable is the diagnosis of rheumatic diseases and independent variables are pain in less and more than 7 days, high degree pain in less and more than 7 days, history of NSAIDs/Steroids/DMARDs use, and disabilities. Validation test was assessed by calculating the sensitivity, specificity, PPV, NPV, LR, and ROC curve. Bivariate analysis using Chi Square analysis, and multivariate analysis using logistic regression.Results The sensitivity test results is best obtained on the question history of NSAIDs/steroids/DMARDs use 100 percent and specificity is best obtained on the question about disability 98 percent . ROC curve analysis which the results >85 percent obtained on the question of pain >7 days 90 percent , high degree pain >7 days 93 percent , and history of NSAIDs/steroids/DMARDs use 92 percent . LR to diagnose rheumatic diseases found in all questions. Chi square analysis showed that all questions were significant with p <0.05 and odds ratio obtained most on high degree pain more than 7 days OR 180.167, 95 percent CI 38.196 until 849.834 .Conclusion The modified COPCORD questionnaire Indonesian version has been adapted and can be a good tool in the screening of joint pain and musculoskeletal diseases compared to examination by rheumatologists."

"ABSTRAKBackground Gout arthritis associates with many comorbodities such as hyperuricemia, hypertension, hyperglycemia, obesity, and dyslipidemia, which are also factors for the development of/or predisposition factors of chronic kidney diseases . Albuminuria is a predictor factors for CKD. Screening for albuminuria is needed to be done in patients with high risk of CKD. This research was conducted to examine the prevalence of albuminuria and the associated factors in gout arthritis patients.Methods This research was a cross sectional study from gout arthritis patients medical records in Cipto Mangunkusumo Hospital. We included all gout patients who treated within 2011 until 2015. Subjects with chronic kidney disease, in kidney replacement therapy, hypertension > 10 years, and diabetes > 5 years were excluded. Albuminuria was determined by urine dipstick result of protein > 1. Factors associated were age, sex, hyperuricemia, hypertension, stage of hypertension, hyperglycemia, obesity, dyslipidemia, uric acid level, and body mass index. Data associated with the factors were recorded and the associations were tested with chi square, fisher exact, or independent t test.Results from 54 subjects included in this research, the prevalence of albuminuria was 20.4 percent . There were no significant associations between all factors and albuminuria tested by chi square and fishers exact test. Independent t tests results also showed no significant associations between all the factors and albuminuria Conclusion The prevalence of albuminuria in gout arthritis patient was 20.4 percent. There were no significant associatons between age, sex, hyperuricemia, hypertension, hyperglycemia, obesity, dyslipidemia, uric acid level, and body mass index tested with albuminuria in gout arthritis patients in Cipto Mangunkusumo Hospital from 2011 until 2015."

"ABSTRAKSalmonella as a causative agent in septic bursitis is considered rare. We report a case of 56 years old male with history of renal transplantation and using mycophenolate mofetil, cyclosporine and methylprednisolone as maintenance, admitted due to 3 week fever associated with tenderness and swelling on left shoulder. Upon investigation, a diagnosis of septic bursitis was established. Salmonella enteritidis as the definitive causative agent was revealed. He was treated with meropenem 1g IV three times daily and levofloxacin 500 mg IV once a day for 3 weeks, followed by oral ciprofloxacin 500 mg twice a day for 2 weeks and oral metronidazole 500 mg three times a day for 1 week with a total duration of 5 weeks of antibiotics. On the subsequent follow up there was no recurrence episode of fever and the swelling of the left shoulder subsided, no tenderness noted and the patient has no limitation of range of movement. Since immunocompromised state complicates the management, the duration of therapy may twice longer than the typical management of septic bursitis. Salmonella as etiologic agent should be considered as differential in immunocompromised patient with septic bursitis."