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"Rheumatoid arthritis and proteus explores the idea that Rheumatoid arthritis is caused by a urinary tract infection as a result of Proteus bacteria. Rheumatoid arthritis is a severe, painful and crippling disease affecting millions of people throughout the world, especially women. Genetic studies over the last 30 years have shown that individuals who possess the white cell blood groups HLA-DR1/4 carry a susceptibility sequence and are more likely to develop the disease. This book uses the methods of Sir Karl Popper, the philosopher of science, to present 12 “Popper sequences” which have been identified to indicate that proteus is the causative agent of rheumatoid arthritis. Rheumatoid arthritis and proteus proposes that Anti-Proteus therapies should be followed as early as possible to prevent the crippling and irreversible joint deformities that occur in rheumatoid arthritis."

"Artritis Reumatoid merupakan suatu penyakit autoimun sistemik kronisyang menyerang sendi dan sekitarnya, seperti jaringan ikat, otot, tendon, dan jaringanfibrosa. Tujuan dari penelitian ini adalah untuk mengetahui pengaruh Faktor Reumatoidterhadap keberhasilan terapi Metotreksat pada pasien Artritis Reumatoid hinggamencapai remisi di RS Cipto Mangunkusumo tahun 2020 – 2022 ditinjau dari aktivitaspenyakit pasien setelah ≥ 6 bulan pemakaian terapi tunggal metotreksat menurut kriteriaDAS28.Metode: Penelitian ini termasuk penelitian jenis obserbasional, pengambilan data secarakohort retrospektif dengan melihat data rekam medik pasien AR dan dianalisis secaradeskriptif. Pengambilan subjek sebanyak 54 pasien dengan metode Chi Square Test.Kriteria inklusi dari penelitian ini adalah pasien AR usia ≥18 tahun, pasien terdiagnosaAR menurut kriteria ACR/EULAR 2010, dan menerima terapi tunggal MTX ≥6 bulandengan data rekam medik lengkap. Kriteria ekslusi dari penelitian ini adalah pasien ARyang memiliki penyakit autoimun lain, pasien AR dengan terapi kombinasi DMARD,pasien dengan kontraindikasi MTX, pasien yang tidak control rutin, serta data rekammedik tidak lengkap. Standar acuan evaluasi yang digunakan adalah PerhimpunanRheumatologi Indonesia 2021.Hasil: Hasil penelitian evaluasi keberhasilan terapi MTX pada 54 pasien AR di RS CiptoMangunkusumo tahun 2020 – 2022 yaitu 53,6% pasien RF Negatif berhasil terapi MTX,23,1% pasien RF Positif berhasil terapi MTX, dan sisanya tidak mencapai remisi.Kesimpulan: Terdapat hubungan yang signifikan antara faktor reumatoid terhadap efekkeberhasilan terapi metotreksat pada pasien artritis reumatoid.

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Rheumatoid arthritis is a chronic systemic autoimmune disease that attacks

the joints and surrounding areas, such as connective tissue, muscles, tendons, and fibrous

tissue. The purpose of this study is to determine the effect of Rheumatoid Factors on the

success of Methotrexate therapy in Rheumatoid Arthritis patients to achieve remission at

Cipto Mangunkusumo Hospital in 2020-2022 based on parameters of patient disease

activity after 6 months of using methotrexate single therapy according to DAS28 criteria.

Method: This study is observational research. Data was obtained cohort retrospectively

from medical records of patients with RA. Data was descriptively analyzed 54 patients

were included as sample by Chi Square method The inclusion criteria of this study were

RA patients aged ≥18 years, patients diagnosed with RA according to the 2010

ACR/EULAR criteria, and receiving MTX single therapy ≥6 months with complete

medical record. The exclusion criteria of this study were RA patients who had other

autoimmune diseases, AR patients on DMARD combination therapy, patients with MTX

contraindications, patients who were not routinely controlled, and incomplete medical

record. The standard evaluation used is the Rheumatology Association of Indonesian

2021

Result: The results of the study evaluating the success of MTX therapy in 54 AR patients

at Cipto Mangunkusumo Hospital in 2020-2022 are 53,6% of RF Negative patients

achieved remission, 23,1% of RF Positive patients achieved remission, and the remaining

patients did not achieve remission.

Conclusion: There is a significant relationship between rheumatoid factors and the

success effect of methotrexate therapy in rheumatoid arthritis patients"

"Artritis reumatoid ialah penyakit poliartritis kronik progresif yang menimbulkan deformasi, meliputi multisistem dan disertai morbiditas yang nyata. Obat-obatan imunosupresif telah digunakan untuk mengurangi/menghambat progresi penyakit. Penelitian ini diadakan untuk membandingkan keberhasilan azatioprin dan siklosporin pada penderita artritis reumatoid. Penelitian meliputi 100 penderita artritis reumatoid (sesuai kriteria American Rheumatism Association, 1987) yang dibagi atas dua kelompok: kelompok I mendapat azatioprin 1 mg/kg/h dan kelompok II mendapat siklosporin 2,5-3,0 mg/kg/h selama 16 minggu. Penilaian keberhasilan berdasarkan parameter klinis, biokimiawi dan radiologis. Semua penderita menunjukkan perbaikan nyata (nilai p < 0.001) pada semua parameter klinis, yaitu hilangnya nyeri, berkurangnya kekakuan pagi hari, sendi yang nyeri/membengkak dan waktu yang diperlukan untuk berjalan sejauh 50 kaki serta menguatnya kekuatan genggaman. Semua penderita menunjukkan penurunan LED (p < .001) tanpa perubahan apapun pada titer faktor reumatoid. Kedua obat menunjukkan keberhasilan yang sama (nilai p tidak bermakna) dalam hal perbaikan parameter klinis dan biokimiawi. Tetapi dengan siklosporin erosi tulang dan osteoporosis yukstaartikular lebih banyak berkurang. Sepuluh penderita menunjukkan nefrotoksisitas dengan siklosporin. Siklosporin lebih baik dari azatioprin dalam hal mengurangi derajat progresi kelainan sendi pada artritis reumatoid, tetapi insidens efek samping lebih tinggi, yang pada umumnya dapat diatasi. (Med J Indones 2002; 11: 153-7)

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Rheumatoid Arthritis (RA) is a chronic progressive deforming polyarthritic disease involving multisystems and associated with considerable morbidity. Immunosuppressive drugs have been used to reduce/arrest the progression of the disease. The present study was undertaken to compare the efficacy of Azathioprine and cyclosporin in Rheumatoid Arthritis patients. Study consisted of 100 patients of Rheumatoid Arthritis (as per criteria of American Rheumatism Association, 1987) divided into two groups : group I received Azathioprine 1 mg/kg/d and group II received cyclosporin 2.5-3.0 mg/kg/d for 16 weeks. Assessment of efficacy was based on clinical, biochemical and radiological parameters. All patients showed marked improvemen (p value < 0.001) in all clinical parameters i.e. relief in pain, reduction in morning stiffness, painful/swollen joint along with walking time for 50 feet and increase in grip strength. All patients showed reduction (p < 0.001) in ESR without any change in rheumatoid factor titres. Both drugs showed equal efficacy (p value = NS) in improvement of clinical and biochemical parameters. But cyclosporin showed more reduction in bony erosions and juxtaarticular osteoporosis. Ten patients showed nephrotoxicity with cyclosporin. Cyclosporin has an edge over azathioprine in reducing the rate of progression of joint change in Rheumatoid Arthritis but is associated with increased incidence of side effects that are generally manageable. (Med J Indones 2002; 11: 153-7)"

"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)

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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)."

"Tujuan : Mengetahui pengaruh LASER tenaga rendah, latihan isometrik tangan dan that rutin pada pasien artritis rematoid (AR) tangan untuk mengurangi nyeri dan meningkatkan lingkup gerak sendi metacarpofalangeal.Desain : Pra dan parka perlakuan.Tempat : Polildinik Rehabilitasi Medik Bagian Ilmu Kedokteran Fisik dan Rehabilitasi Perjan RS dr Ciptomangunkusumo JakartaSubyek : Dua puluh lima pasien wanita yang menderita artritis rematoid tangan di RS dr Cipto Mangunkusumo.Enam orang tidak termasuk dalam kriteria inklusi,dua orang mengundurkan diri dari penelitian.Intervensi : Antara bulan Juli-November 2004, tujuhbelas wanita dengan artritis reumatoid tangan yang masuk dalam kriteria inklusi dilakukan terapi LASER tenaga rendah, latihan penguatan isometrik pads otot tangan dan obat rutin selama empat minggu.Hasil : Hasil penelitian selama empat minggu adanya penurunan nyeri sendi MCP diukur dengan Visual Analog Seale ( VAS) yang bermakna (p<0,001 )dan peningkatan lingkup gerak sendi metacarpofalangeal yang bermakna (p< 0,00 I)Kesimpulan : Terapi LASER tenaga rendah dengan latihan penguatan isometrik otot tangan dan obat rutin dapat mengurangi nyeri dan meningkatkan lingkup gerak sendi metacarpofalangeal pads pasien dengan artritis rematoid tangan.

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Objective : To evaluate the influence of low level LASER therapy,isomertric hand strengthening and routine medications in patient with hand rheumatoid arthritis (RA) to reduce pain and increase the range of motion of the metacarpophalanges ( MCP ).

Design : Pre and post treatment.

Setting : Medical Rehabilitation policlinic, Physical Medicine and Rehabilitation Departement Cipto Mangunkusumo Hospital, Jakarta.

Participants : Twenty five female patients with hand rheumatoid arthritis in Cipto Mangunkusumo Hospital. Six subjects did not meet the inclusion criteria, two subjects dropped out from the study.

Intervention : Between July and November 2004, seventeen female patients with hand rheumatoid arthritis, who were classified in the inclusion criteria were given low laser LASER therapy, isometric hand srengthening exercise and routine medications for four weeks.

Results : After four weeks of intervention there was significant decrease on MCP joint pain, marked by decrease in Visual Analog Scale ( VAS ) (p<0,001) and significant increase of MCP range of motions (p< 0,001 )

Conclusion : Low level LASER therapy combine with isometric hand strenghthening exercise can reduce pain and increase the MCP range of motions in patients with hand rheumatoid arthritis."

"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. "