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"ABSTRAKPenelitian ini bertujuan untuk mengetahui efek pemberian hidroksiklorokuin 400 mg selama 12 minggu terhadap kadar sVCAM-1 dan sE-Selectin sebagai petanda disfungsi endotel pada pasien artritis reumatoid. Penelitian ini juga melihat peran HOMA-IR, FFA dan ox-LDL terhadap perbaikan disfungsi endotel.Penelitian ini menggunakan dua disain yaitu uji klinis acak tersamar ganda dan kohort prospektif dilakukan pada pasien artritis reumatoid dengan terapi metotreksat di poliklinik Reumatologi RS Cipto Mangunkusumo, Jakarta, pada periode Februari 2016-Mei 2017. Pasien dengan terapi insulin, anti-hipertensi dan terapi lain yang mempengaruhi kadar sVCAM-1 dan sE-Selectin dieksklusi dari penelitian. Subjek yang eligibel dirandomisasi menjadi dua kelompok, kelompok yang mendapat hidroksiklorokuin HCQ 400 mg dan kelompok placebo, dan diikuti selama 12 minggu. Pemeriksaan sVCAM-1, sE-Selectin, HOMA-IR, FFA dan ox-LDL dilakukan pada awal penelitian dan pada minggu ke-12. Perbedaan persentase perubahan kadar sVCAM-1 dan sE-Selectin sebelum dan setelah perlakuan antara kedua kelompok dianalisis dengan uji-t dan uji Mann-Whitney. Persentase perubahan kadar sVCAM-1 dan sE-Selectin dikorelasikan dengan persentase perubahan HOMA-IR, FFA dan ox-LDL, dengan uji Spearman.Sebanyak 37 subjek diikutkan dalam penelitian, dan terdapat 3 subjek yang drop-out pada masing-masing kelompok, sehingga didapatkan 15 subjek pada kelompok HCQ dan 16 subjek pada kelompok placebo. Kadar sVCAM-1 serum minggu ke-12 pada kelompok HCQ menurun sebesar 17,1 median , sementara pada kelompok plasebo meningkat sebesar 9,7 , dan perbedaan tersebut bermakna secara statistik. Kadar E-Selectin pada kelompok terapi HCQ mengalami penurunan dalam persen yang lebih besar dibandingkan pada kelompok plasebo, tapi perbedaan tersebut tidak bermakna. Perubahan kadar sVCAM-1 dan sE-Selectin, juga dibuktikan tidak berkorelasi dengan perubahan HOMA-IR, FFA dan ox-LDL.Terapi hidroksiklorokuin pada pasien artritis reumatoid terbukti memperbaiki disfungsi endotel dengan menurunkan kadar sVCAM-1, namun tidak terbukti menurunkan sE-Selectin. Variable sVCAM-1 dan sE-Selectin tidak berkorelasi dengan HOMA-IR, FFA dan ox-LDL Kata kunci: artritis reumatoid, disfungsi endotel, hidroksiklorokuin, sE-Selectin, sVCAM-1.

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ABSTRACTThis study aims to evaluate the effect of hydroxychloroquine on sVCAM 1 and sE Selectin levels decreasing as endothelial dysfunction marker in rheumatoid arthritis patients. This study also assessed the correlation between changes in sVCAM 1 and sE Selectin levels with other variables of changes in HOMA IR, FFA and ox LDL.Two kinds of methods i.e. double blind randomized controlled trial and prospective cohort, were conducted, on patients with rheumatoid arthritis with methotrexate treatment at Rheumatology Outpatient Clinic of Cipto Mangunkusumo Hospital Faculty of Medicine Universitas Indonesia, Jakarta, during February 2016 July 2017. Patients with insulin, anti hypertension and other treatment which could affect sVCAM 1 and sE Selectin level, were excluded. Eligible subjects were randomly assigned into two groups. Eighteen subjects were administered hydroxychloroquine 400 mg daily and 19 patients were given placebo for 12 weeks. sVCAM 1, sE Selectin, HOMA IR, FFA dan ox LDL were examined in the beginning and in the end week 12. Differences of serum sVCAM 1 and sE Selectin level in percentage, before and after experiment, were evaluated, by T test or alternatively by Mann Whitney test. Differences of serum sVCAM 1 and sE Selectin level in percentage, were correlated with difference of serum HOMA IR, FFA and ox LDL level, by Spearman test.There were 37 subjects enrolled in the study, and there were 3 drop out subjects in each group, finally there were 15 subjects in the HCQ group and 16 in the placebo group. Serum sVCAM 1 level decreased 17.1 median in HCQ treatment group, while in placebo group, it increased 9,7 median compared with pre treatment value. The difference in percentage rate change of sVCAM between two group was significant. On the other hand, the change of E Selectin serum level in HCQ group was found a higher percentage of decrease compared with placebo group, but the difference was not significant. Changes in sVCAM 1 and sE Selectin levels were also proven no correlation with HOMA IR, FFA and ox LDL changes.Treatment of HCQ in patients with rheumatoid arthritis appears beneficial to improve endothelial dysfunction by lowering serum sVCAM 1, but not proven to decrease sE Selectin. The sVCAM 1 and sE Selectin variables were not correlated with HOMA IR, FFA and ox LDL Keywords endothelial dysfunction, hydroxychloroquine, rheumatoid arthritis, sE Selectin, sVCAM 1."

"ABSTRAKMiR-21 diketahui berperan dalam proliferasi dan diferensiasi osteoklas, namun peran ekspresi miR-21 serum pada osteoporosis masih belum jelas. Penelitian sebelumnya mendapatkan bahwa ekspresi miR-21 serum berkorelasi positif dengan densitas mineral tulang pada penderita osteoporosis pascamenopause, tetapi penelitian tersebut tidak menganalisis faktor-faktor lainnya yang terlibat dalam osteoporosis pascamenopause.Penelitian ini bertujuan untuk mengetahui peran ekspresi miR-21 serum, konsentrasi RANKL, OPG, TGF- ? 1, sklerostin, rasio RANKL/OPG, kalsium serum dan aktivitas fisis terhadap densitas mineral tulang belakang pada perempuan pascamenopause hipoestrogenik dengan osteoporosis dibandingkan dengan tanpa osteoporosis, dengan point of interest pada ekspresi miR-21 serum.Penelitian ini dilakukan dengan disain uji potong lintang komparatif, di RSUD Ulin Banjarmasin, pada bulan Agustus 2015 sampai Juli 2016. Subjek dibagi menjadi 2 kelompok yaitu perempuan pascamenopause hipoestrogenik dengan osteoporosis dan tanpa osteoporosis. Pengambilan sampel dilakukan dengan metode consecutive. Pemeriksaan ekspresi miR-21 serum menggunakan metode absolute quantification real-time PCR. Analisis statistik menggunakan uji korelasi Spearman, Mann-Whitney U test dan regresi linear berganda.Subjek dibagi menjadi 2 kelompok yaitu perempuan pascamenopause hipoestrogenik dengan osteoporosis PMOP dan tanpa osteoporosis PMNOP masing-masing sebanyak 60 subjek. Median ekspresi miR-21 serum pada PMOP lebih tinggi secara bermakna dibandingkan dan PMNOP p = 0,001 . Ekspresi miR-21 serum, RANKL, rasio RANKL/OPG dan aktivitas fisis berkorelasi bermakna dengan nilai BMD pada PMOP. Aktivitas fisis sedang berkorelasi negatif bermakna dengan ekspresi miR-21 serum pada PMOP dan PMNOP. Analisis regresi linear berganda menggunakan metode backward stepwise mendapatkan persamaan regresi linear: BMD = 1,373 - 0,085 Ln.miR-21 - 0,176 Log 10.RANKL R2 = 52,5 .Simpulan. Ekspresi miR-21 serum pada perempuan pascamenopsuse hipoestrogenik dengan osteoporosis terbukti lebih tinggi dibandingkan dengan tanpa osteoporosis. Ekspresi miR-21 serum terbukti memberikan pengaruh negatif terhadap nilai BMD tulang belakang pada perempuan pascamenopause hipoestrogenik dengan osteoporosis sebesar 8,5 , dengan persamaan regresi linear BMD = 1,373 - 0,085 Ln.miR-21 - 0,176 Log10.RANKL. Persamaan ini dapat menjelaskan nilai BMD tulang belakang sebesar 52,5 . Kata kunci: BMD, miR-21 serum, Osteoporosis, Pascamenopause

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ABSTRACTMiR-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 the study did not analyze other factors involved in postmenopausal osteoporosis.This study aimed to determine the role of serum miR-21 expression, concentration of RANKL, OPG, TGF- ? 1, sclerostin and serum calcium, RANKL/OPG ratio, and physical activity on bone mineral density of spine in hypoestrogenic postmenopausal women with osteoporosis compared to no osteoporosis, with point of interest on the expression of serum miR-21.This study was conducted by comparative cross sectional design, conducted at Ulin General Hospital Banjarmasin, from August 2015 until July 2016. The subjects were divided into 2 groups of hypoestrogenic postmenopausal women with osteoporosis and without osteoporosis. Sampling was done by consecutive method. Examination of serum miR-21 expression using absolute quantification real-time PCR method. Statistical analysis using Spearman correlation test, Mann-Whitney U test and multiple linear regression.The subjects were divided into 2 groups of hypoestrogenic postmenopausal women with osteoporosis PMOP and without osteoporosis PMNOP each as many as 60 people. Median of serum miR-21 expression at 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 PMOP group. Moderate physical activity was significantly negative correlated with serum miR-21 expression. Multiple linear regression multivariate analysis using backward stepwise method obtained linear regression equation BMD = 1,373 - 0,085 Ln.miR-21 - 0,176 Log10.RANKL R2 = 52,5 .Conclusion. Serum miR-21 expression in hypoestrogenic postmenopausal women with osteoporosis has been shown to be higher compared with no osteoporosis. Serum miR-21 expression proved to have a negative effect on spinal BMD values in hypoestrogenic postmenopausal women with osteoporosis of 8.5 , with linear regression equation BMD = 1.373 - 0.085 Ln.miR-21 - 0.176 Log10.RANKL. This equation can explain the value of spinal BMD by 52.5 . Keywords: BMD, Osteoporosis, postmenopausal, serum miR-21 "

"Lupus eritematosus sistemik merupakan penyakit autoimun sistemik yang menghasilkan berbagai autoantibodi yang ditujukan terhadap komponen sel, seperti inti sel, sitoplasma dan membran sel. Salah satu autoantibodi tersebut yaitu antibodi anti ?2GP-1 dihubungkan dengan kejadian aterosklerosis dan penyakit kardiovaskular yang timbul lebih dini pada pasien SLE. Penelitian ini bertujuan untuk mengetahui hubungan antibodi anti ?2GP-1 dengan disfungsi endotel dan aterosklerosis pada pasien SLE dan disfungsi endotel pada HUVEC. Penelitian potong lintang pada pasien SLE yang memenuhi kriteria inklusi menurut ACR 1997 di poliklinik khusus Reumatologi, Alergi Imunologi RSCM dan poliklinik khusus Reumatologi RSUP Dr. M. Djamil dari Maret 2016 sampai dengan Juli 2017. Subjek secara acak dibagi atas 2 kelompok berdasarkan nilai CIMT. Dilakukan pemeriksaan antibodi anti ?2GP-1, ox-LDL, ADMA, ICAM-1, VCAM-1, ET-1. Dilakukan pemajanan antibodi anti ?2GP-1 yang berasal dari kelompok aterosklerosis positif dan kontrol pada HUVEC. Enam puluh enam orang subjek direkrut pada penelitian ini, terdiri atas 33 orang aterosklerosis positif dan 33 orang aterosklerosis negatif dan 6 orang kontrol dengan rentang umur 20-45 tahun. Ditemukan korelasi positif antara antibodi anti ?2GP-1 dengan CIMT,ADMA, ICAM-1, VCAM-1 dan ET-1 dengan nilai r = 0,409, 0,89, 0,36, 0,43, 0,37 dan dengan p < 0,05. Tidak ditemukan korelasi antibodi anti ?2GP-1 dengan ox-LDL dengan r = 0,025 dan p > 0,05. Ditemukan perbedaan bermakna kadar antibodi anti ?2GP-1, ADMA, ICAM-1, VCAM-1 dan ET-1 pada kelompok aterosklerosis positif dengan kelompok aterosklerosis negatif dengan nilai p < 0,05, sedangkan kadar ox-LDL tidak ada perbedaan bermakna pada kedua kelompok tersebut dengan nilai p > 0,05. Hasil pemajanan antibodi anti ?2GP-1 pada HUVEC mendapatkan perbedaan bermakna peningkatan kadar ICAM-1, VCAM-1 dan ET-1 pada kelompok SLE aterosklerosis positif dari kontrol dengan nilai p < 0,05. Antibodi anti ?2GP-1 menimbulkan disfungsi endotel pada pasien SLE.

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Systemic lupus erythematosus SLE is a multi systemic disease characterized by a wide variety of autoantibodies directed to several self molecules found in the nucleus, cytoplasm and cell membrane. One of variety autoantibodies is Antibody anti 2GP 1 which associated with atherosclerosis and premature cardiovascular disease in SLE patients. The purpose of the study is to know the association of antibody anti 2GP 1 with endothelial dysfunction and atherosclerosis in SLE and endothelial dysfunction in HUVEC. Cross sectional study was performed in SLE patients fulfill inclussion criteria according ACR 1997 out patients in Rheumatology and Alergy Immunology polyclinic of Cipto Mangunkusomo Hospital and Dr. M. Djamil Hospital from March 2016 to July 2017. Patients were divided in 2 groups based on CIMT. Examination of antibody anti 2GP 1, ox LDL, ADMA, ICAM 1, VCAM 1 and ET 1 were performed. Purified antibody anti 2GP 1 from positive atherosclerosis and controls groups were exposed to HUVEC. Sixty six patients were enrolled, consists of 33 patients with positive atherosclerosis, 33 patients with negative atherosclerosis and 6 as healthy control with range of age 20 40 year. In this study we found positive correlation between antibody anti 2GP 1 with CIMT, ADMA, ICAM 1, VCAM 1 and ET 1 with r 0.409, 0.89, 0.36, 0.43, 0.43 respectively and p value 0.05. There was no correlation between antibody anti 2GP 1 with ox LDL, r 0.025 and p 0.05. There were significantly different levels of antibody anti 2GP 1, ADMA, ICAM 1, VCAM 1 and ET 1 in positive atherosclerosis compared to negative atherosclerosis group with p 0.05. Level of ox LDL was not different between the two groups with p 0.05. There were significantly different increase of ICAM 1, VCAM 1 and ET 1 levels in HUVEC which was exposed with purified antibody anti 2GP 1 from positive atherosclerosis compared to control with p 0.05. Antibody anti 2GP 1 cause endothelial dysfunction in SLE patients. "