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"Latar belakang: Artritis idiopatik juvenil (AIJ) adalah penyakit autoimun yang ditandai dengan peradangan sendi kronis. Anak dengan AIJ akan mengalami hambatan pertumbuhan tulang yang disebabkan beberapa mekanisme langsung maupun tidak langsung. Sebanyak 40-50 % pasien AIJ memiliki densitas mineral tulang yang rendah pada tulang belakang lumbal dan panggul. Densitas mineral tulang yang rendah dipengaruhi beberapa faktor yaitu klasifikasi penyakit, lama sakit, indeks masa tubuh, status pubertas, aktivitas penyakit, aktivitas fisik, kadar 25(OH)D, dosis kumulatif kortikosteroid, dan dosis metotreksat.Tujuan: Penelitian ini dilakukan untuk mengetahui densitas mineral tulang pada pasien AIJ dan faktor-faktor yang berhubungan.Metode: Penelitian ini merupakan studi potong lintang dengan melibatkan 32 pasien AIJ. Pemilihan subjek dilakukan berdasarkan data registri pasien AIJ di poliklinik Alergi-Imunologi RSCM dan RSAB Harapan Kita tahun 2014-2019. Densitas mineral tulang diperiksa dengan Dual X-ray Absorbtiometry (DEXA) dengan melihat skor Z. Dilakukan analisis bivariat untuk mencari hubungan antara variabel terhadap densitas mineral tulang.Hasil: Densitas mineral tulang total rerata adalah 0,86 g/cm2. Sebanyak 22 subjek mempunyai densitas mineral tulang rendah (osteopenia) dengan nilai skor-Z L1-L4 ≤-2 sedangkan 10 subjek menunjukkan hasil normal. Tidak ditemukan fraktur tulang belakang pada seluruh subjek. Osteopenia banyak ditemukan pada anak dengan dosis kumulatif metotreksat yang lebih banyak (p=0,016). Faktor-faktor lainnya tidak terbukti berhubungan dengan densitas mineral tulang yang rendah.Simpulan: Sebagian besar pasien AIJ mengalami gangguan densitas mineral tulang. Dosis metotreksat yang dihubungkan dengan aktivitas penyakit merupakan faktor yang berperan untuk terjadinya osteopenia.

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Background: Juvenile Idiopathic Arthritis (JIA) is an autoimmune disease characterized by chronic inflammatory arthritis. The disease will affect bone development in children with JIA through direct and indirect mechanisms. About 40-50 % patient with JIA have low bone mineral density in the spine. The low bone mineral density is associated with disease classification, disease duration, body mass index, puberty status, disease activity, physical activity, 25(OH)D level, cumulative doses of corticosteroid and methotrexate.

Objective: This study aimed to investigate bone mineral density in children with JIA and its associated factors.

Method: A cross-sectional study involving 32 children with JIA. Patients were selected based on registry data in the outpatient clinic, subdivision of Allergy and Immunology, Department of Child Health, Dr. Cipto Mangunkusumo General Hospital and Harapan Kita Women and Children Hospital between 2014-2019. Bone mineral density was measured using Dual X-ray Absorbtiometry (DEXA) and reported using Z score. Bivariate analysis was used to identify factors associated with bone mineral density.

Result: The mean bone mineral density was 0,86 g/cm2. Low bone mineral density (osteopenia) occurred among 22 patients (Z score ≤-2 at L1-L4). 10 patients have normal bone mineral density. No vertebral fracture was seen on x-ray. Osteopenia was mainly found in patients with higher cumulative doses of methotrexate (p=0,016). The other factors were not associated with low bone mineral density.

Conclusion: Most patients with JIA have low bone mineral density. Low bone mineral density tends to occur among patients with higher cumulative doses of methotrexate treatment."

"Latar belakang: Artritis idiopatik juvenil (AIJ) adalah penyakit autoimun yang ditandai dengan peradangan sendi kronis. Anak dengan AIJ akan mengalami hambatan pertumbuhan tulang yang disebabkan beberapa mekanisme langsung maupun tidak langsung. Sebanyak 40-50 % pasien AIJ memiliki densitas mineral tulang yang rendah pada tulang belakang lumbal dan panggul. Densitas mineral tulang yang rendah dipengaruhi beberapa faktor yaitu klasifikasi penyakit, lama sakit, indeks masa tubuh, status pubertas, aktivitas penyakit, aktivitas fisik, kadar 25(OH)D, dosis kumulatif kortikosteroid, dan dosis metotreksat.Tujuan: Penelitian ini dilakukan untuk mengetahui densitas mineral tulang pada pasien AIJ dan faktor-faktor yang berhubungan.Metode: Penelitian ini merupakan studi potong lintang dengan melibatkan 32 pasien AIJ. Pemilihan subjek dilakukan berdasarkan data registri pasien AIJ di poliklinik Alergi-Imunologi RSCM dan RSAB Harapan Kita tahun 2014-2019. Densitas mineral tulang diperiksa dengan Dual X-ray Absorbtiometry (DEXA) dengan melihat skor Z. Dilakukan analisis bivariat untuk mencari hubungan antara variabel terhadap densitas mineral tulang.Hasil: Densitas mineral tulang total rerata adalah 0,86 g/cm2. Sebanyak 22 subjek mempunyai densitas mineral tulang rendah (osteopenia) dengan nilai skor-Z L1-L4 ≤-2 sedangkan 10 subjek menunjukkan hasil normal. Tidak ditemukan fraktur tulang belakang pada seluruh subjek. Osteopenia banyak ditemukan pada anak dengan dosis kumulatif metotreksat yang lebih banyak (p=0,016). Faktor-faktor lainnya tidak terbukti berhubungan dengan densitas mineral tulang yang rendah.Simpulan: Sebagian besar pasien AIJ mengalami gangguan densitas mineral tulang. Dosis metotreksat yang dihubungkan dengan aktivitas penyakit merupakan faktor yang berperan untuk terjadinya osteopenia.

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Background: Juvenile Idiopathic Arthritis (JIA) is an autoimmune disease characterized by chronic inflammatory arthritis. The disease will affect bone development in children with JIA through direct and indirect mechanisms. About 40-50 % patient with JIA have low bone mineral density in the spine. The low bone mineral density is associated with disease classification, disease duration, body mass index, puberty status, disease activity, physical activity, 25(OH)D level, cumulative doses of corticosteroid and methotrexate.

Objective: This study aimed to investigate bone mineral density in children with JIA and its associated factors.

Method: A cross-sectional study involving 32 children with JIA. Patients were selected based on registry data in the outpatient clinic, subdivision of Allergy and Immunology, Department of Child Health, Dr. Cipto Mangunkusumo General Hospital and Harapan Kita Women and Children Hospital between 2014-2019. Bone mineral density was measured using Dual X-ray Absorbtiometry (DEXA) and reported using Z score. Bivariate analysis was used to identify factors associated with bone mineral density.

Result: The mean bone mineral density was 0,86 g/cm2. Low bone mineral density (osteopenia) occurred among 22 patients (Z score ≤-2 at L1-L4). 10 patients have normal bone mineral density. No vertebral fracture was seen on x-ray. Osteopenia was mainly found in patients with higher cumulative doses of methotrexate (p=0,016). The other factors were not associated with low bone mineral density.

Conclusion: Most patients with JIA have low bone mineral density. Low bone mineral density tends to occur among patients with higher cumulative doses of methotrexate treatment."

"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. Flat fool adalah salah satu kelainan kaki yang sering dijumpai pada penderita artritis reumatoid. Selain nyeri yang disebabkan oleh penyakitnya, penderita AR juga dapat mengalami nyeri akibat flat foot. Selama ini kita selalu menganggap nyeri kaki dan gangguan berjalan pada penderita AR selalu disebabkan oleh AR, padahal mungkin juga akibat flat fool. Di Amerika prevalensi flat foot sebesar 50%. Untuk itu ingin diketahui proporsi kelainan ini pada penderita AR yang mengunjungi poliklinik reumatologi RSCM, serta gambaran dan faktor-faktor yang mempengaruhinya.Tujuan. (1) Mengetahui proporsi flat foot pada penderita AR. (2) Mengetahui rasio odds faktor-faktor lama menderita penyakit (LMP), Disease Activity Score (DAS), dan Indeks Massa Tubuh (IMT) terhadap kejadianflat foot pada penderita AR.Metodologi. Dilakukan studi potong lintang pada penderita AR dengan keluhan kaki yang berobat ke poliklinik reumatologi RSCM untuk mengamati gambaran cetak kaki, dan kelainan kaki yang diderita, IMT, DAS, dan LMP. Gambaran kelainan kaki pada penderita AR disajikan dalam bentuk statistik deskriptif. Faktor-faktor yang mempengaruhi flat foot dianalisa dengan uji chi square serta perhitungan rasio odds.Hasil. Selama periode Juli - September 2005 terkumpul sebanyak 52 orang penderita AR di Poliklinik Reumatologi Rumah Sakit Dr. Cipto Mangunkusumo, Jakarta. Dua orang tidak sesuai dengan kriteria inklusi, sehingga hanya 50 orang yang dapat dianalisa. Ditemukan proporsi kelainan ini sebesar 40% (11(95% 26% - 53%). Pengujian bivariat menggunakan uji chi square menemukan faktor-faktor yang mempengaruhi kejadian flat foot ialah IMT (P = 0,03; 012 = 3,7; IK95% 1,1 - 12,2) dan DAS (P = 0,047; OR = 0,2; IK 95% 0,03 - 0,9). Untuk mengetahui faktor-faktor yang paling berperan, dilakukan uji multivariat terhadap faktor-faktor dengan P < 0,25 (LMP, DAS, dan IMT). Ditemukan faktor yang paling berperan ialah IMT (P = 0,05; OR = 3,5;IK95% 0,99 - 12,2).Kesimpulan. Proporsi kelainan flat foot pada penderita AR yang berobat di Poliklinik Reumatologi RSCM tidak berbeda dengan penelitian di Amerika. Faktor risiko yang berhubungan ialah IMT. Penelitian ini tidak menemukan hubungan LMP dan DAS terhadap kejadian. Flat foot pada penderita AR.

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Background. Flat foot, as one of the deformities found on Rheumatoid Arthritis (RA) patients, also causes pain. In the case of RA patients, we often thought foot pain or gait disturbances were caused by pain from RA, on the other hand they might be caused by flat foot. Study in United States of America (USA) revealed the prevalence of flat foot were 50%. For this reason we would like to know the proportion of these deformities among RA patients visiting the rheumatology outpatient unit in dr. Cipto Mangunkusumo hospital, and factors which influenced it.

Objectives. To find : (1) the proportion of flat foot on RA patient, (2) the odds ratios of Body Mass Index, disease duration, and Disease Activity Score on the prevalence of flat foot in RA patients.

Methods. A cross sectional study was done on RA patients with lower extremity complaints who came to Rheumatology outpatient unit at Cipto Mangunkusumo General Hospital, Jakarta. The study was done by observing foot print, foot deformities, Body Mass Index (BMI), Disease Activity Score (DAS), and disease duration. The description of flat foot was presented in the form of descriptive statistics. Factors which influenced flat foot were analyzed using chi square method and odds ratios measurements.

Results. We observed 52 patients with RA during July - September 2005 in rheumatology outpatient unit Dr. Cipto Mangunkusumo Hospital, Jakarta. Two patients did not conform inclusion criteria, thus excluded from this study. We found the proportion of flat foot in those patients was 40% (95% CI = 26% to 53%). Bivariate analysis using chi square method revealed BMI (P = 0.03, OR = 3.7 95% CI = 1.1 to 12.2) and DAS (P = 0.047, OR = 0.2, 95% CI = 0.03 to 0.9) as factors related to flat foot in RA patients. Further analysis on variables which had P value <0.25 (BMI, DAS, and disease duration) using multivariate method revealed BMI as the factor related to flat foot in RA patients.

Conclusion. The flat foot proportion on RA patients visiting Rheumatology outpatient Unit RSCM did not differ from that in USA. Factor related to this deformity was BMI. This study did not find relations of disease duration and DAS to flat foot in RA patients."

"[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.]"

"Latar Belakang. Prevalensi gangguan kognitif pada pasien artritis reumatoid (AR) berpotensi menurunkan kapasitas fungsional, kualitas hidup, dan kepatuhan berobat. Tujuan dari penelitian ini adalah untuk mengetahui prevalensi gangguan kognitif pada pasien AR di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo (RSCM) dan faktor-faktor yang memengaruhinya.Metode. Penelitian dengan desain potong-lintang ini mengikutsertakan pasien AR berusia ≥18 tahun yang berobat di Poliklinik Reumatologi RSCM pada periode Oktober-Desember 2021. Data demografik, klinis, terapi, dan laboratorium dikumpulkan. Status fungsi kognitif dinilai dengan kuesioner MoCA-INA. Analisis bivariat dan multivariat regresi logistik dilakukan untuk mengidentifikasi faktor prediktif terjadinya gangguan kognitif pada pasien AR: usia, jenis kelamin, tingkat pendidikan, durasi penyakit, aktivitas penyakit, skor faktor risiko penyakit kardiovaskular, depresi, terapi kortikosteroid, dan methotrexate.Hasil. Dari total 141 subjek yang dianalisis, 91,5% adalah perempuan, dengan rerata usia 49,89±11,73 tahun, sebagian besar tingkat pendidikan menengah (47,5%), median durasi penyakit 3 tahun (0,17-34 tahun), memiliki aktivitas penyakit ringan (median DAS-28 LED 3,16 (0,80-6,32)), dan skor faktor risiko penyakit kardiovaskular rendah (median 4,5% (0,2-30 %)). Sebanyak 50,4% subjek diklasifikasikan mengalami gangguan kognitif, dengan domain kognitif yang terganggu adalah visuospasial/eksekutif, atensi, memori, abstraksi, dan bahasa. Analisis regresi logistik menunjukkan usia tua (OR 1,032 [IK95% 1,001–1,064]; p=0,046) dan tingkat pendidikan rendah (pendidikan dasar) (OR 2,660 [IK95% 1,008–7,016]; p=0,048) berhubungan dengan gangguan kognitif pada pasien AR.Kesimpulan. Prevalensi gangguan kognitif pada pasien AR di RSCM sebesar 50,4%, dengan faktor prediktif terjadinya gangguan kognitif tersebut adalah usia tua dan tingkat pendidikan yang rendah.

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Background. Cognitive impairment in rheumatoid arthritis (RA) patients could decrease functional capacity, quality of life, and medication adherence. The objective of this study was to explore the prevalence and possible predictors of cognitive impairment in RA patients in Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta.

Method. This cross-sectional study included Indonesian RA patients aged ≥18 years old, who visited rheumatology clinic at Dr. Cipto Mangunkusumo Hospital, on October to December 2021. Demographic, clinical, therapeutic, and laboratory data were collected. Cognitive function was assessed using MoCA-INA questionnaire. Bivariate and multivariate logistic regression analysis were performed to identify predictive factors of cognitive impairment in RA patients: age, gender, education level, disease duration, disease activity, cardiovascular disease (CVD) risk factor scores, depression, corticosteroid, and methotrexate therapy.

Results. Of the total 141 subjects analysed, 91.5% were women, mean age 49.89±11.73 years old, mostly had intermediate education level (47.5%), median disease duration 3 (0.17-34) years. They had mild disease activity (median DAS-28 ESR 3.16 (0.80-6.32)), and low CVD risk factor score (median 4.5 (0.2-30) %). In this study, 50.4% of the subjects were classified as having cognitive impairment. The cognitive domains impaired were visuospatial/executive, attention, memory, abstraction, and language. In logistic regression analysis, old age (OR 1.032 [95%CI 1.001–1.064]; p=0.046) and low education level (OR 2.660 [95%CI 1.008–7.016]; p=0.048) were associated with cognitive impairment.

Conclusion. The prevalence of cognitive impairment in RA patients in Dr. Cipto Mangunkusumo Hospital was 50.4%, with the its predictive factors were older age and lower education level."

"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 Perilaku duduk menetap telah menjadi suatu rutinitas yang berkontribusi sebagai penyebab gangguan kesehatan seperti keropos tulang. Namun, untuk beberapa orang seperti pekerja kantoran, hal ini sulit dihindari. Tujuan penelitian ini untuk mengetahui hubungan faktor risiko individu dan pekerjaan terhadap kepadatan mineral tulang (Bone Mineral Density/BMD) pada pekerja kantoran dengan pola kerja sedenter. Metode Penelitian ini merupakan studi potong lintang pada populasi pekerja administratif di RS Olahraga Nasional dan Kemenpora RI pada bulan Januari-Maret 2023. Variabel terikat adalah kepadatan mineral tulang berupa skor T yang diukur menggunakan alat DEXA. Variabel bebas mencakup faktor individu seperti usia, jenis kelamin, riwayat osteoporosis pada keluarga, indeks massa tubuh (IMT), merokok, minum alkohol, asupan kalsium, asupan vitamin D, penyakit DM, aktivitas fisik di luar tempat kerja dan faktor pekerjaan yaitu lama duduk harian di tempat kerja. Hasil Subjek penelitian berjumlah 110 orang pekerja kantoran, 70,9% perempuan, median usia 37 tahun. Skor BMD rendah terdapat pada 29 subjek (26,4%) terdiri dari 3 subjek dengan osteoporosis dan 26 subjek dengan osteopenia. Analisis multivariat dengan regresi logistik mendapatkan faktor yang berhubungan secara independen dengan skor BMD rendah adalah penyakit DM (OR 10,7 dengan IK 95% 1,3-85,2), lama duduk di tempat kerja >6 jam/hari (OR 8,5 dengan IK 95% 2,8-25,5), IMT kurus (OR 7,5 dengan IK 95% 1,2-46,6), dan usia>50 tahun (OR 5,1 dengan IK 95% 1,6-15,9). Tidak ditemukan adanya hubungan yang signifikan antara jenis kelamin, asupan vitamin D, aktivitas fisik, dan merokok terhadap skor BMD yang rendah. Kesimpulan. Satu dari empat pekerja kantoran mengalami skor kepadatan mineral tulang yang rendah yang berhubungan dengan penyakit DM, lama duduk di tempat kerja, status gizi, dan usia. Diperlukan tata laksana okupasi berupa modifikasi posisi bekerja untuk mengurangi waktu duduk harian demi mencegah terjadinya gangguan kesehatan tulang di kemudian hari.

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Background Prolonged sitting has become a routine that contributes to causing health problems, one of which is bone loss. However, for some people, such as office workers, this is difficult to avoid. The aim of this study was to determine the relationship between individual and occupational risk factors on bone mineral density (BMD) in sedentary office workers. Methods This research is a cross-sectional study conducted on a population of office workers at the National Sports Hospital and the Indonesian Ministry of Youth and Sport in January-March 2023. The dependent variable is bone mineral density in the form of a T-score as measured using Dual Energy X-ray Absorptiometry (DEXA). Independent variables include individual factors such as age, gender, family history of osteoporosis, body mass index (BMI), smoking, alcohol consumption, calcium intake, vitamin D intake, history of DM, physical activity, and occupational factors, namely daily sitting time at work. Results The subjects totaled 110 office workers, 70.9% were female, the median age was 37 years old. Low BMD were found in 29 subjects (26.4%) consisting of 3 subjects with osteoporosis and 26 subjects with osteopenia. Multivariate analysis using logistic regresion found factors that were independently associated with a low BMD were history of diabetes mellitus (OR 10.7, 95% CI 1.3-85.2), duration of daily sitting at work > 6 hours (OR 8.5, 95% CI 2.8-25.5), underweight (OR 7.5, 95% CI 1.2-46.6), and age> 50 years old (OR 5.1, 95% CI 1,6-15,9). No significant relationship was found between gender, vitamin D intake, physical activity, and smoking on low BMD. Conclusions One in four office workers experience a low bone mineral density related to DM, prolonged sitting at work, nutritional status, and age. Occupational management is needed in the form of modifying work positions to reduce daily sitting time and to prevent bone loss in the future."

"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."

"Mortalitas penderita artritis reumatoid(AR) yang cukup tinggi disebabkan oleh penyakit kardiovaskular akibat aterosklerosis.Penelitian ini bertujuan untuk mengetahui sensitivitas dan spesifitas skor kalsifikasi arkus aorta di foto polos toraks berdasarkan klasifikasi Ogawa dalam mendeteksi aterosklerosis pada penderita AR. Penelitian ini menggunakan desain potong lintang pada 76 pasien AR di Poliklinik Reumatologi RSUPN Cipto Mangunkusumo. Hasil penelitian menunjukkan sensitivitas 25% dan spesifitas 91,7% pada titik potong skor Ogawa 3,125%, dengan demikian lebih baik untuk mendeteksi pasien AR tanpa aterosklerosis. Pasien AR dengan kalsifikasi arkus aorta kemungkinan memiliki aterosklerosis sebesar 3,7 kali daripada pasien AR tanpa kalsifikasi arkus aorta.

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Mortality of rheumatoid arthritis (RA) patients which is quite high caused by cardiovascular disease due to atherosclerosis. This study aims to determine the sensitivity and specificity of the aortic arch calcification score on plain chest X-ray based on classification Ogawa in detecting atherosclerosis in RA patients. This study used a cross-sectional design in 76 patients at the Rheumatology Division Cipto Mangunkusumo Hospital. The results showed a sensitivity of 25% and specificity of 91.7% at the cut off point Ogawa scores 3.125%, thus it is better to detect RA patients without atherosclerosis. The possibility of arthritis rheumatoid patients with aortic arch calcification having atherosclerosis by 3.7 times than RA patients without aortic arch calcification."