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"Pendahuluan. Artritis Reumatoid (AR) adalah suatu penyakit autoimun yang bersifat sistemik dan kronik yang manifestasi utamanya melibatkan persendian. Tatalaksana AR membutuhkan terapi medikamentosa dan pendekatan gaya hidup. Salah satu tatalaksana AR adalah medikamentosa dengan metotreksat (MTX). Ada banyak faktor yang memengaruhi keberhasilan terapi AR namun di Indonesia belum ditemukan studi yang meneliti obesitas terhadap keberhasilan terapi MTX pada pasien AR di Indonesia. Peneliti ingin mengetahui pengaruh obesitas terhadap ketidakberhasilan terapi MTX monoterapi pada pasien dengan AR.Metode. Studi kohort retrospektif menggunakan data rekam medis Poli Reumatologi Penyakit Dalam, Rumah Sakit Cipto Mangunkusumo (RSCM) pada kurun waktu Maret 2017-Desember 2021. Dilakukan analisis deskriptif untuk melihat karakteristik sampel berdasarkan tiap variabel dan analisis regresi Cox yang dimodifikasi untuk melihat hubungan antara obesitas terhadap ketidakberhasilan terapi MTX.Hasil. Dari 72 subyek, proporsi ketidakberhasilan terapi pada pasien obesitas adalah 57.1% (20/35), sementara pada pasien yang tidak obesitas adalah 37.8% (14/37). Risiko ketidakberhasilan terapi MTX pada pasien dengan obesitas adalah 1,45 kali dibandingkan pasien yang tidak obesitas (RR 1,45; 95% CI 0,76-2,78). Faktor jumlah sendi yang terlibat, faktor RF, faktor C-reactive protein, usia, laju endap darah, jenis kelamin, dan onset awal sakit bukan merupakan faktor perancu pada studi ini.Kesimpulan. Pada studi ini, pasien AR dengan obesitas meningkatkan risiko untuk mengalami ketidakberhasilan terapi MTX dibandingkan pasien AR tanpa obesitas, namun diperlukan studi lebih lanjut menggunakan sampel yang lebih besar untuk meningkatkan kekuatan statistik.

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Introduction. Rheumatoid arthritis (RA)) is a systemic and chronic autoimmune disease which main manifestations involve the joints. AR management requires medical therapy and a lifestyle approach. One of the AR treatments is medication with methotrexate (MTX). There are many factors that influence the success of AR therapy but in Indonesia there has not been found a study that examines obesity on the success of MTX therapy in AR patients in Indonesia. Researchers wanted to know the effect of obesity on the failure of MTX monotherapy in patients with AR

Methods. A retrospective cohort study using medical records from the Rheumatology Internal Medicine Polyclinic, Cipto Mangunkusumo Hospital (RSCM) from March 2017 to December 2021. A descriptive analysis was performed to see the sample characteristics based on each variable and a modified Cox regression analysis to see the relationship between obesity and failure of MTX therapy.

Results. Of the 72 subjects, the proportion of treatment failure in obese patients was 57.1% (20/35), while in patients who were not obese it was 37.8% (14/37). The risk of MTX treatment failure in obese subjects was 1.45 times that of non-obese patients (RR 1.45; 95% CI 0.76-2.78). Number of joints involved, RF factor, C-reactive protein factor, age, erythrocyte sedimentation rate, gender, and early onset of illness were not confounding factors in this study.

Conclusion. In this study, RA patients with obesity have an increased risk of MTX treatment failure MTX compared to RA patients without obesity, but further studies using larger samples are needed to increase statistical power."

"ABSTRACTArtritis Reumatoid AR merupakan penyakit inflamasi kronis sistemik yang ditandai dengan pembengkakan dan nyeri sendi, serta kerusakan dari membran sinovial pada persendian. Dalam memonitor penyakit ini, digunakan Disease Activity Score-28 DAS28 yang dapat menunjukkan aktivitas penyakit AR dari waktu ke waktu. DAS28 bermanfaat untuk mengevaluasi pengobatan serta menentukan keputusan klinis lainnya. DAS28 dapat dihitung menggunakan beberapa komponen seperti jumlah sendi yang nyeri, bengkak, nilai Visual Analogue Scale VAS , serta penanda inflamasi berupa nilai Laju Endap Darah LED atau C-Reactive Protein CRP . DAS28-LED dan DAS28-CRP digunakan secara luas dan keduanya ekuivalen. Namun, nilai LED dapat dipengaruhi berbagai faktor lain, seperti kejadian infeksi, yang angkanya cukup tinggi di Indonesia. Oleh karena itu, penelitian ini bertujuan untuk melihat apakah terdapat perbedaan antara nilai DAS28-CRP dengan DAS28-LED di Indonesia. Data ini belum diketahui sebelumnya. Data mengenai jenis kelamin, usia, jumlah sendi nyeri dan bengkak, nilai VAS, LED, dan CRP diperoleh dari 40 rekam medis pasien AR yang berobat di RSCM pada tahun 2015. Dari hasil penelitian, didapatkan bahwa terdapat perbedaan bermakna rerata antara nilai DAS28-CRP dan DAS28-LED sebesar 1,0107.

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ABSTRACTRheumatoid Arthritis RA is a systemic chronic inflammation disease marked by swollen and tender joint, also destruction of joint rsquo s synovial membrane. To monitoring this disease, Disease Activity Score 28 DAS28 used to show disease activity of RA in times to times. DAS28 is useful to evaluate disease rsquo s treatment and guide clinician to take a decision for the treatment itself. There are some component needed to count DAS28 score, they are number of tender and swollen joint, Visual Analogue Scale, and inflammatory marker such as Erythrocyte Sedimentation Rate ESR or C Reactive Protein CRP . Either DAS28 ESR or DAS28 CRP are used widely and are said to be equivalent to each other. Otherwise, ESR influenced by many other factors, one of them is infection disease, whose the incident number in Indonesia is relatively high. Therefore, the objective of this stuy is to know the comparison between DAS28 ESR and DAS28 CRP in Indonesia, which is still unknown. Data about gnder, age, number of tender and swollen joint, VAS, ESR, and CRP are obtained from 40 RSCM RA patients rsquo medical record in 2015. From this research known that there are significant mean difference between DAS28 CRP and DAS28 ESR which is 1,0107."

"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."

"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."

"Artritis Reumatoid (AR) merupakan penyakit autoimun yang menyerang sendi. Di Indonesia, AR 0,5 – 1% penduduk Indonesia menderita AR pada tahun 2020. Penelitian Rotte, et al. menunjukkan adanya hubungan antara jumlah sendi dengan respons terapi tunggal MTX. Penelitian ini dilakukan untuk mengetahui apakah ada hubungan antara jumlah sendi dengan keberhasilan terapi MTX pada pasien AR di RSCM. Penelitian ini menggunakan data rekam medis pasien AR di RSCM sejak tahun 2020 hingga 2022. Penelitian ini dilakukan denga desain kohort retrospektif Data dianalisis menggunakan SPSS Versi 25 dan dilakukan uji normalitas distribusi data menggunakan Uji Saphiro-Wilk. Setelah dilakukan uji normalitas, data dianalisis dengan Uji Mann-Whitney untuk mengetahui hubungan jumlah sendi dengan keberhasilan terapi MTX pada pasien AR di RSCM. Hasil Uji normalitas menunjukkan bahwa data jumlah sendi dengan keberhasilan terapi tidak terdistribusi secara normal. Berdasarkan hasil Uji Komparatif Mann-Whitney menunjukkan adanya perbedaan yang bermakna antara kelompok berhasil dan tidak berhasil terapi (p < 0.05). Terdapat hubungan antara jumlah sendi yang terlibat dengan keberhasilan terapi MTX pada pasien Artritis Reumatoid.

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Rheumatoid arthritis (RA) is an autoimmune disease that affects the joints. In Indonesia, the prevalence of RA is 0.5 - 1% in 2020. Research by Rotte, et al. showed a relationship between the number of joints with the response to MTX monotherapy. This study was conducted to determine whether there is a relationship between the affected joints count and the success of MTX therapy in RA patients at RSCM. This study used medical records of RA patients at RSCM from 2020 until 2022. This study was conducted with a retrospective cohort design. Data were analyzed using SPSS Version 25 and normality test was carried out using the Shapiro-Wilk test. After the normality test was performed, the data were analyzed using the Mann-Whitney test to determine the relationship between the affected joints count and the success of MTX therapy in RA patients at RSCM. The results of the normality test showed that the data on the affected joints count are not normally distributed. Based on the results of the Mann-Whitney Test, there was a significant difference between the successful and unsuccessful treatment groups (p < 0.05). There is a relationship between the number of affected joints count and the success of MTX therapy in Rheumatoid Arthritis 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."

"Latar Belakang: Artritis Reumatoid (AR) adalah penyakit inflamasi kronik progresif, yang selain menyebabkan peningkatan morbiditas akibat kecacatan sendi, juga menyebabkan peningkatan mortalitas terkait kejadian kardiovaskular. Salah satu prediktor peningkatan risiko mortalitas kardiovaskular adalah kekakuan arteri (KA) lokal. Proses inflamasi pada AR yang dicerminkan oleh derajat aktivitas penyakit berupa disease activity score (DAS) 28, baik yang dinilai dengan c reactive protein (CRP) dan laju endap darah (LED) diduga memiliki hubungan terhadap KA. Penelitian ini dimaksudkan untuk mengetahui korelasi antara derajat aktivitas penyakit dengan kekakuan arteri pada penderita AR. Metode: Penelitian ini merupakan studi potong lintang pada penderita AR yang berobat di poliklinik Reumatologi RSCM dalam periode April-Mei 2014. Dilakukan pengukuran KA lokal dengan USG arteri karotis komunis menggunakan teknik rf-echotracking untuk mendapatkan nilai pulse wave velocity (PWV) serta penilaian DAS 28-CRP dan DAS 28-LED. Data penyerta yang juga dikumpulkan adalah data demografis, durasi dan jenis pengobatan, glukosa darah sewaktu, profil lemak darah, kreatinin, dan faktor risiko tradisional kejadian kardiovaskular. Hasil: Sebanyak 74 subjek diikutsertakan pada penelitian ini, dengan 68 (91,9%) adalah wanita. Rerata nilai KA (PWV) yaitu 7,89 (SB 1,92) m/detik yang termasuk dalam kategori kaku. Rerata nilai DAS 28-CRP 2,46 (SB 0,82) dan DAS 28-LED 3,49 (SB 0,91) yang masing-masing termasuk dalam kelompok aktivitas penyakit rendah dan sedang. Pada analisis bivariat didapatkan korelasi DAS 28-CRP dan DAS 28-LED terhadap KA, masing-masing dengan nilai r = 0,529 (p = 0,001) dan r = 0,493 (p = 0,001). Simpulan: Terdapat korelasi positif sedang yang bermakna antara derajat aktivitas penyakit (DAS 28-CRP dan DAS 28-LED) dengan kekakuan arteri (PWV).

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Background: Rheumatoid arthritis (RA) is a chronic progressive inflammatory disease related to increase in morbidity due to joint deformity and increase in mortality due to cardiovascular event. One of cardiovascular event predictor is local arterial stiffness (AS). Inflammatory process in RA that is reflected on disease activity score (DAS) 28 calculated by c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) suspect to be related with AS. This study was aimed to find correlation between disease activity score and arterial stiffness in RA patients.

Methods: a cross sectional study was conducted in Rheumatology outpatient clinic, Cipto Mangunkusumo Hospital between April-May 2014. Arterial stiffness was measured by carotid artery ultrasound using echotracking technic to get pulse wave velocity (PWV) value, also DAS 28-CRP and DAS 28-ESR measurement was done in every subject. Others data which also collected in this study are demographic profile, duration and drugs of treatment, random blood glucose, lipid profile, creatinin, and others cardiovascular risk factors.

Results: 74 subjects met the inclusion criteria, with 68 (91,9%) are women. Mean of AS (PWV) 7,89 (SD 1,92) m/second, which categorized in stiff artery. Mean of DAS 28-CRP 2,46 (SD 0,82) and DAS 28-ESR 3,49 (SD 0,91), each of them was categorized in low and moderate disease activity. In bivariate analysis we found correlation of DAS 28-CRP and DAS 28 ESR to AS (PWV) r = 0,529 (p= 0,001) and r = 0,493 (p = 0,001).

Conclusion: There was positive and significant correlation between disease activity score (DAS 28-CRP and DAS 28-ESR) with arterial stiffness (PWV)."

"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."