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"Background: systemic lupus erythematosus (SLE) is still a challenging autoimmune disease, especially in pregnancy setting. An early risk factors awareness of poor pregnancy outcome is important to optimize the outcome of pregnancy in SLE patients. This study was conducted to describe pregnancy outcome and determine the risk factors associated with poor pregnancy outcome in SLE patients.Methods: a retrospective case-control study of SLE patients with poor and normal pregnancy outcome was performed. Pregnancy histories were reviewed from Dr. Hasan Sadikin General Hospital lupus registry study. The case group was pregnancy with poor outcome, defined as abortion, premature birth, stillbirth, intrauterine growth restriction (IUGR) and neonatal death. The control group was pregnancy with good outcome, defined as live birth and full term.Results: a total of 84 SLE patients were enrolled in this study with 109 pregnancies after SLE diagnosis. The median age of subjects at the time of pregnancy was 28 (25-32) years old. Poor pregnancy outcome comprising 22.9% abortion, 14.7% premature birth, 5.5% stillbirth, 1.8% IUGR and 4.6% neonatal death. There was a significant difference in the number of planned pregnancy (P=0.011) between groups with poor and good outcome. Clinical variables significantly associated with poor pregnancy outcome were lupus nephritis (OR = 4.813, 95% CI 1.709 - 13.557, P = 0.003) and neuropsychiatric SLE (OR = 5.045, 95% CI 1.278 - 19.920, P = 0.021).Conclusion: the pregnancy in SLE patient should be planned to have better outcome. Lupus nephritis and neuropsychiatric (NP) SLE were risk factors for poor pregnancy outcome in SLE patient."

"Lupu Eitematosus Sistemik adalah suatu penyakit autoimun yang melibatkan multi organ yang umumnya menyerang wanita dan bersifat kronik yang perjalanan penyakitnya ditandai dengan relaps dan remisi. Penelitian ini bertujuan mencari faktor risiko perburukan pasien lupus eritematosus sistemik dengan menganalisa beberapa variabel seperti usia, tingkat pendidikan, anemia, obat-obatan dihubungkan dengan perburukan yang diukur dengan skor Systemic Lupus Eythematosus Disease Activity Index. Selain itu, dilakukan juga peneltian deskritptif mengenai sebaran gen Human Leucocyte Antigen pada subpopulasi penelitian.

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Systemic Lupus Erythemattosus is an autoimmune disease which involved multi organs and have chronic course and mostly inflicted woman , the nature of the disease involved relaps and remission This research aim to find risk factor for worsening (flare) of SLE by analysing variables like age, education level, anemia, drugs associated to flare measured by Systemic lupus erythematosus disease activity index and we also conduct Human Leucocyte Antigen genotyping for subpopulation of the study."

"Nekrosis avaskular adalah suatu kondisi di mana sel-sel tulang mati karena kurangnya aliran darah. Kondisi ini sering dijumpai pada pasien yang mengonsumsi kortikosteroid dosis tinggi. Sedangkan kortikosteroid dosis tinggi yang sering diberikan pada pasien Systemic Lupus Erythematosus (SLE) menunjukkan adanya hubungan antara AVN dan SLE karena regimen pengobatan itu sendiri. Hal ini memungkinkan untuk menyelidiki faktor mana pada pasien SLE yang dapat mempengaruhi perkembangan AVN. Metode: Sebanyak 22 rekam medis pasien dari RSUPN Cipto Mangunkusumo dicatat dan dianalisis. Sampel yang diambil terdiri dari pasien yang didiagnosis dengan SLE dan kemudian berkembang menjadi AVN. Setiap faktor risiko kemudian dianalisis untuk mengetahui besarnya signifikansi masing-masing faktor risiko terhadap AVN. Hasil: Dari semua faktor risiko yang dianalisis, hanya kortikosteroid dosis kumulatif (p <0,05) yang bermakna dengan terjadinya AVN. Faktor risiko lain tidak signifikan. SLEDAI dan antibodi antifosfolipid tidak dapat dianalisis karena kurangnya data. Kesimpulan: Kortikosteroid dosis tinggi akan mempengaruhi AVN sekunder pada pasien SLE sedangkan tidak ada hubungan yang pasti antara skor SLEDAI dan antibodi antifosfolipid.

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Avascular necrosis is a condition in which bone cells die due to a lack of blood flow. This condition is often seen in patients taking high doses of corticosteroids. Meanwhile, high doses of corticosteroids that are often given to patients with Systemic Lupus Erythematosus (SLE) indicate a relationship between AVN and SLE because of the treatment regimen itself. This made it possible to investigate which factors in SLE patients might influence AVN development.

Methods: A total of 22 patient medical records from RSUPN Cipto Mangunkusumo were recorded and analyzed. The sample taken consisted of patients who were diagnosed with SLE and later developed an AVN. Each risk factor was then analyzed to determine the significance of each risk factor for AVN.

Results: Of all the risk factors analyzed, only the cumulative dose of corticosteroid (p <0.05) was significant with the occurrence of AVN. Other risk factors are not significant. SLEDAI and antiphospholipid antibodies could not be analyzed due to lack of data.

Conclusion: High doses of corticosteroids will affect secondary AVN in SLE patients whereas there is no definite relationship between SLEDAI score and antiphospholipid antibodies."

"Kasus penyakit LES mempunyai prevalensi yang cukup tinggi di Indonesia dan dunia. Prevalensi di berbagai negara sangat bervariasi antara 2.9/100.000 – 400/100.000. Namun, belum terdapat data epidemiologi LES yang mencakup semua wilayah Indonesia. Diagnosis Lupus Eritematosus Sistemik tidak mudah dan sering terlambat akibat dari gejala yang timbul menyerupai gejala berbagai penyakit sehingga Lupus dikenal dengan sebutan penyakit 1000 wajah. Gejala penyakit Lupus sangat beragam, mulai dari gejala ringan hingga yang dapat mengakibatkan kematian. Penelitian berupa kajian kepustakaan (literature review) terhadap 3 jurnal penelitian internasional pada tahun 2000-2020. Penelitian ini bertujuan untuk mengetahui peran faktor risiko paparan silika pada kejadian Lupus Eritematosus Sistemik. Hasil penelitian menunjukan bahwa terdapat hubungan yang signifikan antara paparan silika dengan kejadian Lupus Eritematosus Sistemik dengan rata-rata OR 3,6. Paparan silika yang terhirup tidak mungkin menjadi penyebab utama LES pada populasi umum, namun paparan silika menjadi salah satu faktor risiko yang berperan dalam pengembangan penyakit LES. Memahami mekanisme yang digunakan oleh silika dalam LES dapat membantu kita lebih memahami peran paparan lingkungan terutama paparan silika pada LES.

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Literature Review: The Role of Risk Factors for Silica Exposure in Systemic Lupus Erythematosus. Systematic Lupus Erythematosus have a high prevalence in Indonesia and the world. Prevalence in various countries varies greatly between 2.9 / 100.000 - 400/100,000. However, there are no epidemiological data covering all regions of Indonesia for SLE. Diagnoses of Systemic Lupus Erythematosus is not easy and often late due to symptoms that resemble the symptoms of various diseases, so that Lupus is known as 1000 facial diseases. Symptoms of lupus are very diverse, ranging from mild symptoms to those that can result in death. The research was in the form of a literature review of 8 international research journals in 2000-2020. This study aims to determine the role of risk factors for silica exposure in the incidence of Systemic Lupus Erythematosus.

The results showed that there was a significant relationship between exposure to silica with the incidence of Systemic Lupus Erythematosus with an average OR of 3.6. Exposure to inhaled silica may not be a major cause of SLE in the general population, but silica exposure is one of the risk factors that play a role in the development of LES disease. Understanding the mechanism used by silica in SLE can help us better understand the role of environmental exposure especially silica exposure in SLE."

"Latar belakang : Nefritis lupus (NL) memiliki renal outcome yang buruk meliputi, doubling serum kreatinin, atau penurunan laju filtrasi glomerulus (LFG) ≥ 50% terhadap baseline, atau gagal ginjal terminal. Baik penyakit ginjal kronik maupun gagal ginjal terminal berdampak pada masalah kesehatan global, mortalitas, hospitalisasi, dan beban pembiayaan kesehatan. Identifikasi faktor-faktor yang mempengaruhi renal outcome yang buruk pada nefritis lupus diharapkan meningkatkan pengelolaan pasien NL dan mencegah perburukan fungsi ginjal. Tujuan : Mengetahui faktor-faktor yang memengaruhi renal outcome yang buruk pada pasien NL di RSUPN Cipto Mangunkusumo. Metode : Studi kohort retrospektif dengan penelusuran rekam medis pasien nefritis lupus yang berobat ke RSCM periode Januari 2011-Juni 2019. Analisis bivariat dilakukan pada faktor anemia, proteinuria, fungsi ginjal, aktivitas penyakit LES baseline, rerata mean arterial pressure (MAP), obesitas, histopatologi, remisi, dan relaps terhadap renal outcome yang buruk pada nefritis lupus selama 3 hingga 5 tahun paska terdiagnosis, menggunakan metode Chi-square. Analisis multivariat dilakukan dengan metode binary regresi terhadap variabel dengan nilai p < 0,25 pada analisis bivariat. Hasil : Didapatkan subjek sebanyak 128 pasien untuk diteliti. Renal outcome yang buruk berupa doubling serum kreatinin, atau penurunan LFG ≥ 50% terhadap baseline, atau gagal ginjal terminal selama follow-up didapatkan sebesar 25% dengan status obesitas (31,6%), rerata MAP ≥ 100 mmHg (45,2%), serum kreatinin baseline ≥ 0,9 mg/dl (21,4%), proteinuria baseline ≥ 3,5 g/24 jam (38,5%), anemia baseline (23,7%), gagal remisi (78,3%), relaps (48%), aktivitas penyakit LES derajat berat (25,9%), NL proliferatif (32,1%), indeks aktivitas ≥ 12 (80%), dan indeks kronisitas ≥ 4 (45,5%). Faktor-faktor yang memengaruhi renal outcome yang buruk pada pasien NL di RSCM meliputi rerata MAP ≥ 100 mmHg, proteinuria baseline ≥ 3,5 g/24 jam, dan gagal remisi dengan RR (IK 95%) masing-masing 2,241 (1,468-3,419), p < 0,001, 1,756 (1,283-2,403), p < 0,001, dan 5,438 (3,268-9,047), p < 0,001. Kesimpulan: Persentase renal outcome yang buruk pada pasien NL di RSCM sebesar 25% yang dipengaruhi rerata MAP ≥ 100 mmHg, proteinuria baseline ≥ 3,5 g/24 jam, dan, gagal remisi.

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Background : Lupus nephritis (LN) is associated with poor renal outcomes, such as doubling serum creatinine, or reduced estimated glomerular filration rate (eGFR) ≥ 50% from baseline, or end-stage renal disease. Either chronic kidney disease or end-stage renal disease (ESRD) affect the global health problem, mortality, hospitalization, and medical expenses. Identification of factors that influence poor renal outcome in lupus nephritis might increase the awareness in management of patient with lupus nephritis to reduce health burden due to worsening renal outcome. This study aims to identify factors that influence poor renal outcome in patient with lupus nephritis in an Indonesian tertiary hospital. Methods: Retrospective cohort study tracing medical records in patients with lupus nephritis during January 2011-June 2019. Chi-squared bivariate analysis was conducted among influencing factors; baseline anemia, proteinuria, renal function, disease activity, the time average of mean arterial pressure (MAP), obesity, histopathology, achieving remission, and the occurence of relapse. Binary regression is used in multivariate analysis for variables with p ≤ 0,25 in bivariate analysis. Results: This study consists of 128 patients with lupus nephritis. Poor renal outcome was defined by doubling serum creatinine or reduced eGFR ≥ 50% from baseline or end-stage renal disease. During the follow-up, poor renal outcome was found 25% among obesity (31,6%), the time average of mean arterial pressure (MAP) ≥ 100 mmHg (45,2 %), baseline serum creatinine ≥ 0,9 mg/dl (21,4%), baseline proteinuria ≥ 3,5 g/24 h (38,5%), baseline anemia (23,7%), failure to achieve remission (78,3%), renal relapse (48%), severe disease activity (25,9%), proliferative histopathology (32,1%), activity index ≥ 12 (80%), and chronicity index ≥ 4 (45,5%). The time average of MAP ≥ 100 mmHg, baseline proteinuria 3,5 g/24 h, and failure to achieve remission influenced poor renal outcome in patients with LN consecutively with RR (95% CI) 2,241 (1,468-3,419), p < 0,001, 1,756 (1,283-2,403), p < 0,001, and 5,438 (3,268-9,047), p < 0,001. Conclusion: Poor renal outcome in LN patients in the Indonesian tertiary hospital was 25 % that influenced by the time average of MAP ≥ 100 mmHg, baseline proteinuria ≥ 3,5 g/24 h, and failure to achieve remission. "

"Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with various clinical disorders and frequent exacerbations. Psoriasis vulgaris is a common skin disorder which affect 1-3% of general populations. The pathophysiology regarding the coexistence of these diseases is not fully understood. Therapeutic challenges arise since the treatment one of these diseases may aggravate the other. We reported two cases of SLE with psoriasis vulgaris with clinical manifestations as recurrent erythroderma with photosensitivity. Improvement in clinical condition was observed after treating the patients with methylprednisolone combined with methotrexate. The coexistence SLE and psoriasis are considered very rare. The presence of this overlap syndrome may precede one another or occur simultaneously and is closely related with the presence of anti-Ro/SSA. Thus, it raises new challenge regarding its relationships, diagnosis, therapeutic, and management."

"ABSTRAKBackground: Systemic lupus erythematosus (SLE) is an autoimmune disease that more commonly affects women of childbearing age. It is a multi-organ disease and can involve virtually any organ in the body. Pleural effusion can occurred in 30% of patients with SLE, which may be a result of SLE itself, pulmonary emboli, or end-organ damage such as heart or renal failure. The management of pleural effusions in SLE patient can be challenging because the numerous of potential underlying cause and sometimes effusion recur despite appropriate treatment of primary process. Case Report: We reported 33 years old woman patient admitted to our ED with chief complaint of shortness of breath for last 1 week. Chest X-ray result showed bilateral pleural effusion. Serial pleural fluid analysis consistent with conclusion of transudate fluid. Echochardiograpy showed dilatation of left atrium and ventricle and reduced LVEF 34%. These data suggest congestive heart failure as the cause of pleura effusion. A few days after initial thoracocentesis, the patient become dyspnea again because of reccurent pleural effusion. To relieve the symptom, we did insertion of pigtail catheter connected with mini WSD (Water seal drainage). Conclusion: Pleural effusion is a relatively common clinical presentation of a patient with SLE. Pleural effusions may be a result of SLE itself, pulmonary emboli, or end-organ damage such as heart or renal failure. The management of pleural effusions are mainly to relieve the symptoms and treatment of underlying cause."

"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)."