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Abstrak :
ABSTRAK
Background Rheumatoid arhtirtis is a chronic autoimmune disease that mainly attacks joints. It may causes joint deformities which leads to lower quality of life of RA patients. RA is treated with metothrexate which inhibiting disease progression. MTX is known for its hepatotoxicity side effect, which is described by an elevation of aspartate aminotransferase and/or alanine aminotransferase beyond the upper normal limit. Factors that may enhance hepatotoxicity are gender, age, cummulative dose of MTX, and duration therapy of MTX. Prevalence of hepatotoxicity caused by MTX therapy in RA patients in Indonesia is still unknown. The objective of this research is to know the proportion of hepatotoxicity and its associations with the factors that may enhance hepatotoxicity caused by MTX therapy in RA patients in RSCM.Method Data about gender, age, cummulative dose and duration therapy of MTX are obtained from 115 RA patients medical records.Result Proportion of hepatotoxicity in RA patients treated with MTX in RSCM is 42.60 percent. Gender, age, cummulative dose and duration therapy of MTX do not significantly enhance hepatotoxicity p>0.05. Conclusion In conclusion gender, age, cummulative dose and duration therapy of MTX do not have association with hepatotoxicity in RA patients treated with MTX.

Abstrak :
Background. Rheumatoid Arthritis (RA) is one of the diseases associated with the immune system which causes joint damage and effect to the quality of patients life. DAS28 CRP value describes RA disease activity. The antiCCP titer is a very specific examination which provide an overview prognosis of RA patients illness. The research on the correlation of anti CCP Titers with DAS28 CRP values has never been done in Indonesia. Therefore, this research aims to determine the correlation between anti CCP Titer and DAS28 CRP value in RA patient in Cipto Mangunkusumo hospital with DAS28 CRP value in RSCM. Method. The research design is crosssectional with the sample amounted to 34. anti CCP and DAS28 CRP were obtained through patients medical records. Result. The result of this correlationstudy is (p = 0,582) and r = 0,086. Conclusion. In conclusion, there is no correlation between antiCCP and DAS28 in Cipto Mangunkusumo hospital.

Abstrak :
Background rheumatoid arthritis (RA) is one of the diseases associated with the immune system which causes joint damage and effect to the quality of patients life. DAS28 CRP value describes RA disease activity. The anti ccp titer is a very specific examination which provoide an overview progonosis of RA pantients illness. the research on the corellation of anti ccp titers with DAAS28 CRP values has never been done in Indonesia.

Abstrak :
Sjorgen's syndrome (SS) is a chronic rheumatic autoimmune disease characterized by specific symptoms of sicca keratocon junctivitis (SKC) and xerostomia (called Sicca complex) due to decreased secretion of the lacrimal and salivary glands, with or without enlargement of the parotid gland.1'3 SS is said to be the second most common autoimmune rheumatic disease after Rheumatoid Arthritis (RA), and is even more common than SLE. However, SS is a disease that is very hard to diagnose.3 The average time between the onset and diagnosis is approximately 8-9 years. As with other autoimmune diseases, it is most commonly found among women, with a ratio of approximately 9:1.3A Treatment of SS will always involve many experts, such as neurologists, ophthalmologists, pulmonologists, dermatologists, ENT specialists, gynecologists, and of course, rheumatologists.4*5

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Non-steroid anti-inflammatory drugs (NSAID) can cause gastropathy and gastric mucosa, especially the mucous may play an important prevention role. This cross-sectional, single group study was conducted to evaluated the difference of mucous thickness in antrum or corpus mucosa and the correlation of gastric mucous thickness to gastropathy. Patients who received NSAID from the rheumatology clinic were studied. Healthy subjects of 14 - 65 years old who never received NSAID were included as normal controls. Piroxicam 20 mg daily was given to the patients for 7 days, then gastroscopy and gastric mucosa biopsy with frozen section were performed. Specimens were stained with haematoxyline eosin and thickness of the mucous layer was measured using ocular micrometer. Thirty-two out of 70 patients participated in the study. All cases had hyperemia on gastroscopy with erosions and ulcer in 32 and 9 cases, respectively. The mean thickness of mucosa in distal antrum, proximal antrum and corpus was 28.5 ± 9, 37.4 ± 13.1 and 43.3 ± 13.1 microns, respectively. There was significant relationship between gastric mucosa mucous thickness with gastroscopic findings. In conclusion, this study confirmed that thickness of gastric mucosa mucous has an important role in preventing NSAID gastropathy and dyspeptic complaints in this kind of patients does not suggest abnormalities of gastric mucosa.

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ABSTRAK
Background 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.

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Latar Belakang: Sindrom antifosfolipid (antiphospholipid syndrome = APS) merupakan penyakit autoimun dengan gejala trombosis vena atau arteri, kematian janin berulang, dan peningkatan kadar antibodi antifosfolipid yang persisten. Sindrom antifosfolipid merupakan faktor risiko didapat yang paling sering dihubungkan dengan trombosis. Sampai saat ini efek antibodi anti-?2GP1 pada sistem koagulasi, antikoagulan alamiah dan sistem fibrinolisis masih belum jelas. Tujuan: Menganalisis efek imunoglobulin (Ig)G dan IgM anti-beta-2 glikoprotein-1(?2GP1) terhadap ekspresi messenger RNA (mRNA) tissue factor (TF), mRNA trombomodulin (TM), dan mRNA plasminogen activator inhibitor-1(PAI-1) pada endotel. Metode: Studi eksperimental dengan memajankan antibodi anti-?2GP1 pada human umbilical vein endothelial cells (HUVEC). Penelitian dilakukan di Rumah Sakit Ciptomangunkusumo/ Fakultas Kedokteran Universitas Indonesia. Sampel adalah IgG anti-?2GP1 dan IgM anti-?2GP1 dipurifikasi dari 6 pasien sindrom antifosfolipid. Kontrol adalah IgG dan IgM yang dipurifikasi dari orang sehat. HUVEC dipajan dengan IgG anti-?2GP1, IgM anti-?2GP1, IgG orang sehat, IgM orang sehat selama 4 jam. Pengukuran ekspresi relatif mRNA TF, mRNA TM, dan mRNA PAI-1 dilakukan sebelum dan sesudah pemajanan dengan metode real time reverse transcription polymerase chain reaction. Hasil: Ekspresi relatif mRNA TF, mRNA TM, dan mRNA PAI-1 pada HUVEC yang dipajan dengan IgG anti-?2GP1 adalah (3,14 ± 0,93)-, (0,31 ± 0,13)-, (5,33 ± 2,75)-kali dibandingkan pada HUVEC yang dipajan dengan IgG orang sehat. Ekspresi relatif mRNA TF, mRNA TM, dan mRNA PAI-1 pada HUVEC yang dipajan IgM anti-?2GP1 adalah (4,33 ± 1,98)-, (0,33 ± 0,22)-, (5,47 ± 2.64)-kali dibandingkan pada HUVEC yang dipajan IgM orang sehat. Hasil analisis statistik, sebelum dan sesudah pemajanan HUVEC dengan IgG anti-?2GP1, memperlihatkan perbedaan bermakna ekspresi relatif mRNA TF (1,09 ± 0,76 berbanding 3,14 ± 0,93, p = 0,003), mRNA TM (0,91 ± 0,11 berbanding 0,31 ± 0,13, p = 0,001), dan mRNA PAI-1 (0,93 ± 0,13 berbanding 5,33 ± 2,75, p = 0,013). Hasil analisis statistik, sebelum dan sesudah pemajanan HUVEC dengan IgM anti-?2GP1 memperlihatkan perbedaan bermakna ekspresi relatif mRNA TF (1,03 ± 0,11 berbanding 4,33 ± 1,98, p = 0,008), mRNA TM (0,93 ± 0,08 berbanding 0,33 ± 0,22, p = 0,003), dan mRNA PAI-1 (1,02 ± 0,10 berbanding 5,47 ± 2,64, p = 0,01). Kesimpulan: Pada penelitian ini terbukti bahwa IgG anti-?2GP1 dan IgM anti- ?2GP1 mempunyai efek protrombotik pada sel endotel dengan meningkatkan mRNA TF dan mRNA PAI-1, serta menurunkan mRNA trombomodulin. Hasil penelitian ini menyimpulkan bahwa mekanisme trombosis pada APS dapat terjadi melalui peningkatan aktivasi koagulasi, penurunan aktivitas fibrinolisis dan penurunan aktivitas antikoagulan. ......Background: Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by venous or arterial thrombosis, recurrent pregnancy morbidity and the presence of persistent antiphospholipid antibodies. The antiphospholipid syndrome is the most common acquired risk factor of thrombosis. Until now, the effect of anti-?2GP1 antibodies on coagulation system, natural anticoagulant and fibrinolytic`system has not been completely understood. Objectives: To analyse the effects of IgG and IgM anti-beta-2 glycoprotein-1 (anti-?2GP1) on the expression of tissue factor (TF), thrombomodulin (TM), and plasminogen activator inhibitor-1(PAI-1) of endothelial cells in the messenger RNA level. Methods: Experimental study in human umbilical vein endothelial cells (HUVEC) was done at Cipto Mangunkusumo Hospital/ Faculty of Medicine, Universitas Indonesia. Samples are purified immunoglobulin(Ig)G anti-?2GP1 and IgM anti-?2GP1 from six APS patients serum. For controls, purified IgG and IgM from normal human serum (IgG-NHS and IgM-NHS) were used. HUVEC were treated with purified IgG anti-?2GP1, IgM anti-?2GP1, IgG-NHS, IgM-NHS for four hours of incubation. We measured TF, TM, and PAI-1 of HUVEC in mRNA relative expression levels (before and after treatment) by real time reverse transcription polymerase chain reaction. Results: The mean value of TF, TM, and PAI-1 mRNA levels in HUVEC after treated with IgG anti-?2GP1 compared to Ig-NHS were (3.14 ± 0.93)-, (0.31 ± 0.13)-, (5.33 ± 2.75)-fold respectively. On the other hand, after treated with IgM anti-?2GP1 compared to IgM-NHS, mRNA levels of TF, TM, and PAI-1 were (4.33 ± 1.98)-, (0.33 ± 0.22)-, (5.47 ± 2.64)-fold respectively. Before and after treatment with IgG anti-?2GP1, this study showed significant differences of TF mRNA levels (1.09 ± 0.76 versus 3.14 ± 0.93, p = 0.003), TM mRNA levels (0.91 ± 0.11 versus 0.31 ± 0.13, p = 0.001), and PAI-1 mRNA levels (0.93 ± 0.13 versus 5.33 ± 2.75, p = 0.013). Before and after treatment with IgM anti-?2GP1, this study showed significant differences of TF mRNA levels (1.03 ± 0.11 versus 4.33 ± 1.98, p = 0.008), TM mRNA levels (0.93 ± 0.08 versus 0.33 ± 0.22, p = 0.003), and PAI-1 mRNA levels (1.02 ± 0.10 versus 5.47 ± 2.64, p = 0.01). Conclusion: This study has proven that IgG anti-?2GP1 and IgM anti-?2GP1 increase TF and PAI-1 mRNA levels in endothelial cells. However, IgG anti-?2GP1 and IgM anti-?2GP1 decrease TM mRNA levels in endothelial cells. It has shown that the mechanism of thrombosis in APS occurs through coagulation activation, reduction of fibrinolysis activity, and reduction of anticoagulant activity

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ABSTRACT
Background: MiR-21 is known to play a role in osteoclast proliferation and differentiation, but the role of serum miR-21 expression in osteoporosis remains unclear. Previous research found that serum miR-21 expression was positively correlated with bone mineral density in postmenopausal osteoporosis patients, but other factors involved in postmenopausal osteoporosis still unknown. This study aimed to determine the role of serum miR-21 expression, concentration of RANKL, OPG, TGF-β1, sclerostin and serum calcium, RANKL/OPG ratio, and physical activity on bone mineral density of spine in hypoestrogenic postmenopausal women with osteoporosis (PMOP) compared with no osteoporosis (PMNOP), with point of interest on the expression of serum miR-21. Methods: this study was conducted by comparative cross-sectional design. The subjects were divided into 2 groups of PMOP and PMNOP. We used an absolute quantification real-time PCR method to determine serum miR-21 expressions level. Results: Median of serum miR-21 expression at the PMOP group was significantly higher compared to PMNOP group (p = 0,001). Serum miR-21 expression, RANKL, RANKL/OPG ratio, and physical activity were significantly correlated with BMD values in the PMOP group. Moderate physical activity was significantly negatively correlated with serum miR-21 expression. We also obtained a linear regression equation BMD = 1,373-0,085*Ln.miR-21-0,176*Log10.RANKL (R2 = 52,5%). Conclusion: serum miR-21 expression in PMOP was higher compared with PMNOP. Serum miR-21 expression proved to have a negative effect on spinal BMD values in hypoestrogenic postmenopausal women with osteoporosis of 8,5%. Obtained equation of BMD = 1,373-0,085*Ln.miR-21-0,176*Log10.RANKL can explain the value of spinal BMD by 52,5%.