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Abstrak :
Kepatuhan pasien Lupus Eritematosus Sistemik (LES) berperan penting dalam mencapai aktivitas penyakit yang terkontrol. Penelitian ini bertujuan untuk mengetahui prevalensi ketidakpatuhan, faktor-faktor yang berhubungan dengan ketidakpatuhan, dan hambatan minum obat pada pasien LES. Data potong lintang diperoleh dari pasien Poliklinik Alergi-Imunologi RSUPN Dr. Cipto Mangunkusumo secara konsekutif pada Juli–Agustus 2023. Dilakukan evaluasi terhadap ketidakpatuhan pengobatan (self-report medication-taking behaviour measure for thai patients scale; MTB-Thai), komorbiditas, jumlah obat, aktivitas penyakit (skor MEX-SLEDAI), depresi (Hospital Anxiety and Depression Scale; HADS), dan hambatan lain dalam pengobatan (Identification of Medication Adherence Barriers Questionnaire; IMAB-Q 30). Data kategorik dianalisis dengan uji Chi-square atau Fisher, sedangkan data numerik dianalisis dengan uji Mann-Whitney. Dari 100 pasien LES dewasa, mayoritas merupakan perempuan (97%), dewasa muda (61%), menamatkan pendidikan tinggi (48%), dan memiliki aktivitas penyakit remisi˗ringan (90%). Median (IQR) jumlah obat yang dikonsumsi 6 (5–8). Prevalensi ketidakpatuhan minum obat mencapai 27%. Tingkat pendidikan pasien ditemukan berhubungan dengan ketidakpatuhan (pendidikan menengah vs. pendidikan tinggi, 59,3% vs. 40,7%; p=0,035). Pasien yang tidak patuh memiliki skor hambatan minum obat yang lebih tinggi secara signifikan (p<0,001). Hambatan yang paling banyak dialami pasien yang tidak patuh adalah kekhawatiran terhadap efek samping dan mudah terdistraksi dari mengonsumsi obat-obatan. ......Medication adherence among patients with systemic lupus erythematosus (SLE) is essential to achieve controlled disease activity. This study aimed to investigate the prevalence of non-adherence, associated factors, and medication adherence barriers among patients with SLE. Cross-sectional data were obtained from consecutive patients at Allergy-Immunology Clinic Cipto Mangunkusumo Hospital between July–August 2023. Evaluation was conducted on medication non-adherence (self-report medication-taking behavior measure for thai patients scale), comorbidities, number of medications, disease activity (MEX-SLEDAI score), depression (Hospital Anxiety and Depression Scale), and other adherence barriers (Identification of Medication Adherence Barriers Questionnaire-30). Categorical data were analyzed with Chi-square or Fisher test, while numerical data were analyzed with Mann-Whitney test. Of 100 adult SLE patients, most were female (97%), young adult (61%), completed higher education (48%), and had remission˗mild disease activity (90%). The median (IQR) number of medications consumed was 6 (5–8). The prevalence of medication non-adherence was 27%. Patient's educational level was found to be associated with non-adherence (secondary education vs. higher education, 59.3% vs. 40.7%; p=0.035). Non-adherent patients had significantly higher medication adherence barrier scores (p<0.001). The most common barriers experienced by non-adherent patients were concerns about harmful side effects and easily distracted from taking medications.

Abstrak :
Latar belakang: Limfopenia merupakan manifestasi klinis yang sering terjadi pada pasien dengan LES serta mempunyai arti patologis yang bermakna. Patogenesis limfopenia saat ini masih belum jelas, namun beberapa penyebab yang diketahui adalah terdapatnya antibodi antilimfosit, penurunan CD 55 dan 59 dan apoptosis yang tidak terkontrol. Beberapa penelitian menunjukkan limfopenia berhubungan dengan aktivitas penyakit. Hal lain yang menjadi perhatian adalah pemberian terapi imunosupresan pada pasien LES dalam keadaan limfopenia dapat memperburuk limfopenia. Tujuan: Untuk mengetahui hubungan antara limfosit total dan aktivitas penyakit serta terapi imunosupresan pada pasien LES. Metode: Studi kohort retrospektif dengan penelusuran rekam medis pasien LES yang berobat ke RSUPN Cipto Mangunkusumo periode Januari 2020 – Desember 2020. Analisa bivariat menggunakan chi square dan fisher exact dilakukan untuk mengetahui hubungan limfopenia dengan aktivitas penyakit, serta analisa bivariat mann whitney dan wilcoxon digunakan untuk perbedaan rerata hitung limfosit dan terapi imunosupresan serta hubungan antara terapi imunosupresan terhadap limfosit total. Hasil: Sebanyak 214 subjek memenuhi kriteri inklusi. Didapatkan hubungan bermakna antara limfopenia terhadap Mex SLEDAI pada subjek LES dalam keadaan remisi di bulan ke-3 (RR: 0,490; 95% IK: 0,320-0,751; p = 0,001) dan bulan ke-6 (RR: 0,490; 95% IK: 0,322-0,769; p = 0,001). Pada subjek LES dalam keadaan aktif terdapat hubungan bermakna antara limfopenia terhadap Mex SLEDAI pada bulan ke-3 (RR: 2,46; 95% IK: 1,71-5,188; p = 0,009). Tidak didapatkan perbedaan median limfosit total pada pasien LES dalam terapi MMF dan tanpa terapi MMF baik pada bulan ke-0 (p = 0,822), bulan ke-3 (p = 0,916), dan bulan ke-6 (p = 0,560). Tidak didapatkan juga hubungan dari limfosit total pada pasien dalam terapi MMF selama 6 bulan (p = 0,084). Didapatkan perbedaan median limfosit total pada pasien LES dalam terapi AZA dibandingkan pasien LES tanpa terapi AZA di bulan ke-0 (p = 0,044) dan bulan ke-3 (p = 0,007). Terdapat penurunan limfosit total pada bulan ke-3 pada pasien LES dalam terapi AZA namun tidak signifikan (p = 0,844). Tidak didapatkan perbedaan median limfosit total pada subjek pasien LES dalam terapi MTX baik pada bulan ke-0, bulan ke-3 dan bulan ke-6 (p = 0,510), (p=0,977), (p=0,714). Tidak didapatkan hubungan bermakna antara terapi MTX terhadap limfosit total (p = 0,721). Kesimpulan: Terdapat hubungan bermakna antara limfopenia terhadap aktivitas penyakit pasien LES yang dihitung dengan Mex SLEDAI. Tidak terdapat hubungan bermakna antara terapi imunosupresan selama 6 bulan terhadap limfosit total pasien LES. ......Background: Lymphopenia is a clinical manifestations that frequently develops in SLE patients and has important pathological implications. Although the pathogenesis of lymphopenia is still unknown, antilymphocyte antibodies, diminished CD 55 and 59, and uncontrolled apoptosis are a few of the factors that can develop inside it. Numerous investigations have demonstrated a connection between lymphopenia and disease activity. Another issue is that administering immunosuppressant therapy to SLE patients who are already lymphopenic can make their condition worsen. Objective: To investigate the association between total lymphocytes, disease activity, and immunosuppressive treatment in SLE patients. Methods: Retrospective cohort study by tracing the medical records of SLE patients who visited Cipto Mangunkusumo General Hospital between January 2020 and December 2020. The relationship between lymphopenia and disease activity was investigated using bivariate analysis using chi square and fisher exact, and the relationship between immunosuppressant therapy and total lymphocytes and differences in mean lymphocyte count and immunosuppressant therapy were investigated using bivariate analysis using mann-Whitney and Wilcoxon. Results: 214 subjects fulfilled the criteria for inclusion. Lymphopenia and Mex SLEDAI were shown to be significantly associated in SLE patients in remission at months 3 (RR: 0.490; 95% CI: 0.320-0.751; p = 0.001) and 6 (RR: 0.490; 95% CI: 0.322-0.769; p = 0.001). Lymphopenia and Mex SLEDAI were significantly associated at month 3 in patients with active SLE (RR: 2.46; 95% CI: 1.71-5.188; p = 0.009). At month 0 (p = 0.822), month 3 (p = 0.916), and month 6 (p = 0.560), there was no difference in the median total lymphocyte count between SLE patients receiving MMF therapy and those receiving no MMF medication. In addition, there was no association between total lymphocytes and MMF therapy in individuals treated for 6 months (p = 0.084). At month 0 (p = 0.044) and month 3 (p = 0.007), SLE patients receiving AZA therapy had median differences in total lymphocytes compared to SLE patients not receiving AZA therapy. Patients with SLE receiving AZA medication had a decrease in total lymphocytes in the third month, but it was not statistically significant (p = 0.844). At months 0, 3, and 6, there was no difference in the median total lymphocyte count among SLE patients receiving MTX therapy (p = 0.510), (p = 0.977), and (p = 0.714). Total lymphocytes and MTX treatment had no statistically significant relation (p = 0.721). Conclusion: The lymphopenia and disease activity of SLE patients as determined by the Mex SLEDAI are related. Immunosuppressant therapy administered for six months had no significant impact on the total lymphocyte count in SLE patients.

Abstrak :
Gastrointestinal manifestations are common is systemic lupus erythematosus (SLE). Although the relationship between SLE with ulcerative colitis (UC) rarely obtained, SLE patients with gastrointestinal manifestations should preferably be evaluated for the possibility of an inflammatory bowel disease (IBD). UC prognosis associated with SLE is usually good, whereas by proper diagnosis and management, the clinical output and a good life expectancy of patients will be obtained. A young female, 17 years old, who had previously been diagnoses with SLE for 5 years, come with complaints of abdominal pain and chronic diarrhea. From the result of colonoscopy and biopsy of the intestinal mucosa was noted that in accordance with UC. After receiving treatment for 6 days, she no longer obtained compalints of abdominal pain and diarrhea.