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Abstrak :
ABSTRAK
Artritis rematoid merupakan penyakit otoimun sistemik yang paling sering ditemukan di dunia pada berbagai populasi dan ras, ditandai oleh inflamasi menetap pada jaringan sendi yang meliputi sendi perifer, distribusi simetris, dengan atau tanpa kerusakan rawan sendi dan erosi tulang. Pemantauan aktivitas penyakit diperlukan untuk menentukan keberhasilan terapi. Selama ini, pemantauan aktivitas penyakit menggunakan Disease Activity Score 28 (DAS28), meskipun terdapat kekurangan berupa parameter klinis yang bersifat subjektif, menggunakan perhitungan yang rumit, dan terdapat ketidakseragaman nilai titik potong derajat aktivitas penyakit pada berbagai penelitian.

Penelitian ini merupakan penelitian potong lintang untuk menilai korelasi antara kadar anti-CCP serum dan cairan sendi dengan aktivitas penyakit (DAS28) pada 30 subjek dengan artritis rematoid. Subjek yang memenuhi kriteria masukan dan tidak ada kriteria tolakan dilakukan penentuan skor DAS28 serta pemeriksaan anti-CCP serum dan cairan sendi.

Median (rentang) kadar anti-CCP serum secara keseluruhan, pada tingkat aktivitas penyakit sedang, dan berat adalah 112.23 (1.02-1853.07), 70.98 (1.02-1224.07), dan 157.59 (1.07-1853.07) RU/mL. Median (rentang) kadar anti-CCP cairan sendi secara keseluruhan, pada tingkat aktivitas penyakit sedang dan berat adalah 85.54 (0.90-4150.58), 58.90 (1.03-2477.81), dan 110.23 (0.90-4150.58) RU/mL. Median (rentang) skor DAS28 pada keseluruhan subjek ditemukan 5.04 (4.04-7.10). Uji korelasi Spearman didapatkan korelasi positif lemah namun tidak bermakna secara statistik antara kadar anti-CCP serum dan DAS28 dengan rs = 0.296, p = 0.056, korelasi positif lemah yang bermakna secara statistik antara anti- CCP cairan sendi dan DAS28 dengan rs = 0.331, p = 0.037, sedangkan korelasi antara anti-CCP serum dengan cairan sendi ditemukan kuat yang bermakna secara statistik dengan rs = 0.907, p <0.01.

Kami menyimpulkan kadar anti-CCP cairan sendi berkorelasi lemah dengan aktivitas penyakit (DAS28). Tidak ditemukan korelasi yang bermakna secara statistik antara kadar anti-CCP serum dengan aktivitas penyakit (DAS28). Terdapat korelasi kuat antara kadar anti-CCP serum dengan kadar anti-CCP dalam cairan sendi.

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ABSTRACT
Rheumatoid arhtritis is the most common chronic systemic autoimmune disease worldwide among many populations and races, characterized by persistent joint inflammation affecting peripheral joints, symmetrical distribution, with or without joint damage or bone erosion. Disease activity monitoring is needed to determine treatment response. Nowadays, Disease Activity Score 28 (DAS28) is used to monitor disease activity, although it uses subjective clinical parameter, complicated calculation, and ununiformity cut-off value for disease activity stages on various researches.

This study was a cross sectional study to assess wheter there was any correlation between anti-CCP serum and synovial fluid concentration with disease activity (DAS28) in 30 rheumatoid arhtritis subject. Blood and synovial fluid specimen collection and DAS28 determination was performed on subjects who fulfill inclusion and exclusion criteria, followed by anti-CCP assay on each specimen.

Median (range) anti-CCP serum concentration in overall, moderate, and severe disease activity were 112.23 (1.02-1853.07), 70.98 (1.02-1224.07), and 157.59 (1.07-1853.07) RU/mL, respectively. Median (range) anti-CCP synovial fluid concentration in overall, moderate, and severe disease activity were 85.54 (0.90-4150.58), 58.90 (1.03-2477.81), and 110.23 (0.90-4150.58) RU/mL, respectively. Median (range) of DAS28 were 5.04 (4.04-7.10). A weak but not statistically significant correlation was found between serum anti-CCP concentration and DAS28 with rs = 0.296 (p = 0.056). A weak and significant correlation was found between synovial fluid anti-CCP concentration and DAS28 with rs = 0.331 (p = 0.037). A strong and significant correlation are found between serum and synovial fluid anti-CCP concentration, with rs = 0.907 (p <0.01) using Spearman correlation test.

We concluded that synovial fluid anti-CCP concentration weakly correlated with disease activity. No significant correlation was found between serum anti-CCP concentration with disease activity. Strong correlation was found between serum and synovial fluid anti-CCP concentration.

Abstrak :
Artritis Reumatoid AR merupakan salah satu penyakit yang berhubungan dengan sistem imun yang menyebabkan kerusakan sendi dan mengakibatkan terjadi penurunan kualitas hidup pasien. Nilai DAS28 CRP menggambarkan aktivitas penyakit AR. Titer Anti-CCP merupakan pemeriksaan yang sangat spesifik digunakan untuk memberikan gambaran prognosis penyakit pasien AR. Penelitian tentang korelasi titer Anti-CCP dengan nilai DAS28 CRP belum pernah dilakukan di Indonesia. Oleh karena itu, penelitian ini bertujuan untuk mengetahui korelasi antara titer Anti-CCP dengan nilai DAS28 CRP di RSCM. Pada peneltian ini desain penelitian yang digunakan adalah cross-sectional dengan sampel berjumlah 43 data. Data mengenai titer Anti-CCP dan DAS28 CRP didapatkan melalui rekam medis pasien. Hasil menyatakan bahwa tidak terdapat korelasi p=0,582 antara titer Anti-CCP dengan DAS28 CRP dengan nilai r yang menunjukkan korelasi sangat lemah r=0,086.

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Rheumatoid arthritis is one of a disease relating with immunity that causes destruction in joints which affects quality of life of its patients. DAS28 CRP score represents the activity of the disease. Anti CCP titer is a specific test to portray the prognosis for the patients. Study about correlation between DAS28 CRP score and Anti CCP titer has not been done in Indonesia. Therefore, this study rsquo s done to understand the correlation between DAS28 CRP score and Anti CCP titer in RSCM. The design of this study is cross sectional study with 43 samples. Data of Anti CCP score and DAS28 CRP score are collected from patients rsquo medical records. The result of this study shows that there is no correlation between Anti CCP titer and DAS 28 CRP score in Rheumatoid Arthritis patients in RSCM with a very low correlation p 0,582 r 0,086.

Abstrak :
Background. Rheumatoid Arthritis (RA) is one of the diseases associated with the immune system which causes joint damage and effect to the quality of patients life. DAS28 CRP value describes RA disease activity. The antiCCP titer is a very specific examination which provide an overview prognosis of RA patients illness. The research on the correlation of anti CCP Titers with DAS28 CRP values has never been done in Indonesia. Therefore, this research aims to determine the correlation between anti CCP Titer and DAS28 CRP value in RA patient in Cipto Mangunkusumo hospital with DAS28 CRP value in RSCM. Method. The research design is crosssectional with the sample amounted to 34. anti CCP and DAS28 CRP were obtained through patients medical records. Result. The result of this correlationstudy is (p = 0,582) and r = 0,086. Conclusion. In conclusion, there is no correlation between antiCCP and DAS28 in Cipto Mangunkusumo hospital.

Abstrak :
Background rheumatoid arthritis (RA) is one of the diseases associated with the immune system which causes joint damage and effect to the quality of patients life. DAS28 CRP value describes RA disease activity. The anti ccp titer is a very specific examination which provoide an overview progonosis of RA pantients illness. the research on the corellation of anti ccp titers with DAAS28 CRP values has never been done in Indonesia.

Abstrak :
Pada awal penyakit diagnosis Artritis reumatoid (AR) sering dikacaukan dengan Lupus eritematosus sistemik (LES). Persendian terutama pada tangan dapat terserang pada kedua penyakit, sehingga pasien LES sering salah diagnosis sebagai AR. Oleh karena hasil-akhir dari kedua penyakit ini sangat berbeda , maka dibutuhkan suatu marker serologik untuk membedakan keduanya pada saat awitan penyakit. Antibodi anti-citrullinated peptide (anti ?CCP) telah dilaporkan sangat spesifik pada AR. Tujuan penelitian ini untuk memastikan spesifitas antibodi anti-CCP pada AR dan kemungkinan antibodi ini dapat membedakan pasien RA dari SLE. Penelitian ini suatu studi potong-lintang pada pasien AR (n=27), LES dengan artritis (n=20). penyakit otoimun lain (non-reumatik, n=8) dan kontrol dewasa (n=20). Anti-CCP diperiksa dengan cara Elisa dan faktor-reumatoid (FR) dengan uji latex. Sensitivitas dan spesifitas anti-CCP untuk diagnosis RA adalah 63.0% dan 97.9%, dibandingkan dengan FR yang hanya sebesar 40.7% dan 85.4%. Hanya 1 dewasa sehat dengan anti-CCP+, tidak satupun pasien LES maupun pasien penyakit otoimun lain yang mempunyai anti-CCP+. Nilai rerata titer anti-CCP pada dewasa sehat, penyakit otoimun lain, LES dan AR berturut-turut sebesar 1.35 ± 2.04, 0.63 ± 0.59, 0.75 ± 0.59, and 38.17 ± 44.22 RU/ml. Terdapat perbedaan sangat bermakna di antara titer anti-CCP pada pasien AR dengan yang lainnya (p<0.001). Disimpulkan bahwa deteksi anti-CCP sangat berguna untuk diagnosis AR, dan untuk membedakan AR dari LES. (Med J Indones 2004; 13: 227-31) ...... Diagnosis of Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) can be confused in their initial stages. The joints, especially the hands, are commonly affected in both disorders, many patients with SLE are initially misdiagnosed as having RA Given that the outcome for the two diseases is diverse, it would be helpful to have serological marker to distinguish between them at onset. Anti-citrullinated peptide antibodies (anti-CCP) have recently been described as highly specific for RA. The objective of this study is to confirm the specificity of anti-CCP antibodies and to determine whether they might distinguish patients with RA from those with SLE. This study is a cross sectional study on a group of patients with RA (n=27), SLE with arthritis (n=20), other autoimmune diseases (non-rheumatic diseases, n = 8), and healthy adults (n=20). Anti-CCP was determined by a commercial Elisa test and Rheumatoid factor (RF) was determined by the standard slide latex test. The sensitivity and specificity of anti-CCP for the diagnosis of RA was 63.0% and 97.9% respectively, comparing with RF for RA that was 40.7 % and 85.4 %. Only 1 healthy adult was anti-CCP+, no anti-CCP was detected from SLE and other autoimmune disease. The mean of titer anti CCP in normal healthy adult, other autoimmune diseases, SLE and RA was 1.35 ± 2.04, 0.63 ± 0.59, 0.75 ± 0.59, and 38.17 ± 44.22 RU/ml, respectively. There was a highly significant difference between the mean of titer anti CCP for RA with others diseases (p<0.001). We conclude that detection of anti-CCP is very useful for the diagnosis of RA and distinguishing RA from SLE. (Med J Indones 2004; 13: 227-31).

Abstrak :
Artritis Reumatoid AR merupakan penyakit inflamasi sistemik kronik yang menyerang dan merusak sendi-sendi pada tungkai atas dan bawah. AR menyebabkan morbiditas dan disabilitas yang dapat menurunkan kualitas hidup Inflamasi kronis seiring dengan progresivitas penyakit menyebabkan penurunan indeks massa tubuh pada pasien AR. Titer Anti-CCP yang bersifat spesifik terhadap AR dapat menggambarkan progresivitas dan prediksi keparahan penyakit. Penelitian mengenai titer anti-CCP dan indeks massa tubuh belum dilakukan di Indonesia. Sehingga penelitian ini dilakukan dengan tujuan mengetahui korelasi antara titer anti-CCP dengan nilai indeks massa tubuh IMT di RSCM. Desain penelitian yang digunakan adalah cross-sectional dengan jumlah sampel sebanyak 42 rekam medis. Data mengenai titer anti-CCP, berat badan, tinggi badan, dan nilai indeks massa tubuh diperoleh dari rekam medis pasien. Hasil penelitian menunjukkan bahwa tidak terdapat korelasi antara titer anti-CCP dengan nilai indeks massa tubuh p>0.05; r-0.03.

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Rheumatoid arthritis is a chronic systemic inflammation that attacks and damages joints of upper and lower extremities. RA causes morbidity and disability, hence, affects the quality of life. Chronic inflammation, as the disease progressing, causes lowering of body mass index in RA patients. Titer of Anti CCP, which is specific for RA, indicates the progressivity and severity of the disease. Study about anti CCP titer and body mass index has not been done in Indonesia. Therefore, this study rsquo s done to understand the correlation between anti CCP titer and body mass index score in Rheumatoid Arthritis patients in RSCM. The design of this study is cross sectional study with 42 samples. The data including anti CCP titer, body weight, height, and body mass index are collected from patients rsquo medical records. The result of this study shows that there is no correlation between anti CCP titer and body mass index score in Rheumatoid Arthritis patients in RSCM p 0.05 r 0.03.