Prevalence of Carotid Artery Atherosclerosis Plaque in Systemic Lupus Erythematosus in Hasan Sadikin Hospital Bandung in 2017-2018

Background. Systemic Lupus Erythematosus (SLE) is an autoimmune disease involving many organs including the cardiovascular system such as accelerated atherosclerosis or premature atherosclerosis. Atherosclerotic plaque can cause coronary heart disease, ischemic stroke and peripheral arterial disease, which are the main causes of death in the world. The purpose of this study was to determine the prevalence of carotid artery atherosclerosis plaques in patients with SLE. Method. This research is a descriptive study with a cross-sectional design. Carotid artery atherosclerosis plaques in SLE patients were assessed by analysing results of carotid ultrasound examinations that were conducted in 2017-2018. The inclusion criteria of this study were SLE patients who had undergone carotid doppler ultrasound B mode examination on the carotid artery for the period of 2017-2018. The exclusion criteria in this study were SLE patients with a history of stroke, peripheral arterial disease, and significant coronary artery disease. Result. This study involved 88 SLE patients who met the inclusion criteria. Results showed that there were 10 SLE patients (11.4%) who had atherosclerotic plaques. SLE patients with atherosclerosis plaque were mostly in the age range of 35-44 years (16%) and 45-54 years (22.2%). There were 2 patients (15.3%) with atherosclerotic plaque from a total of 11 patients had high triglyceride levels (≥150 mg/dL). Chi square analysis of lipid profiles (cholesterol, LDL, HDL, triglycerides) in patients with atheroclerotic plaque revealed not significant (p>0.05). These findings could be caused by several factors, such as the small number of samples in this study and the non-traditional factors in the formation of atherosclerotic plaque as well as other traditional factors Conclusion. The prevalence of carotid artery atherosclerosis plaques in patients with SLE in Dr. Hasan Sadikin General Hospital in 2017-2018 is 11.4%

Association between Serum Uric Acid and Non-Alcoholic Fatty Liver Disease: A Meta-Analysis

Background: non-alcoholic fatty liver disease (NAFLD) is known to be associated with some metabolic disorders. Recent studies suggested the role of uric acid in NAFLD through oxidative stress and inflammatory process. This study is aimed to evaluate the association between serum uric acid and NAFLD. Methods: a systematic literature review was conducted using Pubmed and Cochrane library. The quality of all studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). All data were analyzed using REVIEW MANAGER 5.3. Results: eleven studies from America and Asia involving 100,275 subjects were included. The pooled adjusted OR for NAFLD was 1.92 (95% CI: 1.66-2.23; p<0.00001). Subgroup analyses were done based on study design, gender, non-diabetic subjects, non-obese subjects. All subgroup analyses showed statistically significant adjusted OR and most of which having low to moderate heterogeneity. Two studies revealed relationship between increased serum uric acid levels and severity of NAFLD. No publication bias was observed. Conclusion: our study demonstrated association between serum uric acid level and NAFLD. This finding brings a new insight of uric acid in clinical practice. Increased in serum uric acid levels might serve as a trigger for physician to screen for NAFLD

The Correlation Between Disease Activity Assessed by DAS28-ESR and Quality of Life Assessed by SF-36 in Rheumatoid Arthritis Patients

Background Rheumatoid arthritis is the most prevalent form of inflammatory arthritis. One of the key components for its multidimensional outcome is the disease activity, measured by DAS28-ESR. The physical, emotional, and social aspects of RA contribute to the quality of life, and SF-36 questionnaire can be used to measure it. This study aims to ascertain the correlation between the disease activity (DAS28-ESR) and the quality of life (SF-36) in RA patients.&nbsp; Method This study was an analytical, descriptive study with a cross sectional design that took primary data from RA patients undergoing treatment in Rheumatology Clinic of Hasan Sadikin Hospital from February to April 2015. The patient’s data included sex, age, marital status, employment status, educational level, serostatus (RF and Anti-MCV), duration of diagnosis, total number of medications, total number of DMARD, DAS28-ESR scores, and SF-36 scores. The data was analysed with the Shapiro-Wilk normality test, followed by the Rank-Spearman correlation analysis. Result There were 42 subjects, with an average age of 41 ± 12. The ratio between females and males was 20:1, and the majority of subjects (73,8%) had a positive serostatus (RF and/or anti-MCV). The score median of DAS28-ESR was 4,3, with the score median for SF-36 PCS being 39,8 and the score median for SF-36 MCS being 48,2. Based on the the Rank-Spearman analysis (CI of 95%), there was a correlation between DAS28-ESR score and SF-36 PCS score, with the correlation coefficient (r) of -0,577 (p &lt; 0,001), and there was also a correlation between DAS28-ESR score and SF-36 MCS score with r of&nbsp; -0,368 (p = 0,008). Conclusion There was a strong negative correlation between disease activity and physical component of quality of life, and a moderate negative correlation between disease activity and mental component of quality of life, and the two correlations were statistically significant

Correlation of Serum Anti-Clq Antibody Levels and Disease Activity in Patients with Systemic Lupus Erythematosus

Background. Antibody to complement C1q (Anti-C1q Antibody) can be found in Systemic Lupus Erythematosus (SLE) patients. Complement C1q plays a role in the clearance of apoptotic cells and immune complexes. Anti-C1q causes complement C1q become inactive so that the clearance decreases, which induces self antigen and inflammatory response. Many tissue inflammation are associated with disease activity and lupus manifestations. The aim of this study is to find out the correlation of anti-C1q level with disease activity, so that anti-C1q can be used as an objective indicator of inflammation along with SELENA-SLEDAI.&nbsp; Method. This is an analytic descriptive study with cross sectional design. Anti-C1q antibody levels were measured in 52 SLE patients who are hospitalized or treated routinely in outpatient clinic of Rheumatology Dr.Hasan Sadikin Hospital Bandung Indonesia from October to December 2015. Result. Most of the study subjects were women (94%), with a median age of 33 years. There were 13 new patients (25%), and the rest 42 patients were treated routinely. The median SELENA-SLEDAI was 6 (0-32).&nbsp; Subject were divided into no activity (11.5%), low disease activity (34.6%), medium disease activity (25%) high disease activity (15.4%) and very high disease activity (13.5%). Median anti-C1q level was 3.92 U/mL (range 0.6-100.2 U/mL). Anti-C1q antibody levels were positively correlated with SLE disease activity based on SELENA-SLEDAI scores (r=+0.304; p=0.014) Conclusion. Anti-C1q antibody levels has mild correlated with lupus disease activity based on SELENA-SLEDAI score Keywords : Anti-C1q antibody, SLE, SELENA-SLEDAI.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp

Correlation of Anxiety Disorder and Quality of Life in Systemic Lupus Erythematosus Patients

Background: Systemic Lupus Erythematosus (SLE), an autoimmune disease, can cause damage and impairment in the nervous system. Patients who had any manifestation of neurology can be classified as patients with Neuropsychiatric Systemic Lupus Erythematosus (NPSLE). One of the most frequent NPSLE manifestation is anxiety disorder. The presence of anxiety disorder is believed to be correlated with their ability to carry out daily activities. This study aims to see the correlation between anxiety disorder and quality of life (QOL) in patients with SLE. Method: an analitic cross-sectional study was done. The data were collected by distributing validated questionnaires to patients diagnosed with SLE in the outpatient clinic of dr. Hasan Sadikin General Hospital. Quality of life and anxiety disorder was measured using Short From-36 (SF-36) and Zung Self-Rating Anxiety Scale (Zung-SAS), respectively. Normality test was done before correlating the variables using Pearson method. Result: Forty-six SLE patients fitted with the inclusion criteria were participated in the study. The assessment using Zung-SAS showed that 9 (19.56%) correspondents had mild–moderate anxiety, and 1 (2.17%) had severe anxiety. The analysis of SF-36 showed the means of Physical Component Summary (PCS) and Mental Component Summary (MCS) which were 45.18 ± 8.23 and 47.11± 9.78, in order. The correlation test of Zung-SAS with PCS and MCS showed the result of r= -0.651 (p &lt; 0,01) and -0.654 (p &lt; 0,01), respectively. Conclusion: There is a significant negative correlation between anxiety disorder and QOL in patients with SLE. The result of this study showed that the high degree of ones anxiety was in a parallel line with their low level of QOL, so it is important to do an early detection and prevention of anxiety disorder in SLE patients. Keywords: Anxiety disorder, quality of life, Systemic Lupus Erythematosus, Zung Self Rating Anxiety Scale

Early Detection of Suspected Systemic Lupus Erythematosus in Community-Dwellings in West Java Indonesia

Background: Prevalence of systemic lupus erythematosus (SLE) has been known in almost all countries around the world.  Contrary to this, in Indonesia, neither a national epidemiologic study on SLE nor any direct study on SLE in the general population has been conducted. Early detection of SLE is needed as a first step to determine prevalence of SLE in Indonesia as well as to prevent further complications. This study aimed to obtain the prevalence of suspected SLE in community-dwellings.Methods: This study was conducted in the period September to November 2015 and used the descriptive cross-sectional method. The respondents were people who were at least 18 years old and lived in selected blocks in three different villages in Jatinangor, West Java. Data were obtained from secondary sources of a previous SLE screening study that was incorporated in a study on “Epidemiology of hypertension and albuminuria in Jatinangor” in 2014, using the multistage sampling method. Suspected SLE was based on the Liang screening questionnaire. The collected data were presented in tables.Results: There were 72 respondents (8%) suspected to have SLE. Most of the cases were female (Odds ratio:1.47) and 51–60 years old.  The most clinical manifestation was painful swollen joints >3 months.Conclusions: The existence of suspected SLE cases in Jatinangor’s population, as an example of Indonesian population should be a concern so that examinations could be carried out to make sure that  respondents with SLE can be provided  prompt interventions  to prevent further complications.

Mean Platelet Volume on Systemic Lupus Erythematosus Patients with and without Thrombocytopenia in Dr Hasan Sadikin Hospital Bandung: A Descriptive Study

Abstract Background : The aim of the study is to provide an insight about mean platelet volume (MPV) value in systemic lupus erythematosus (SLE) with and without thrombocytopenia patient. MPV wa expected to be used to determine the cause thrombocytopenia in lupus, so the patient could be treated appropriately. &nbsp; Method : The study design was descriptive categoric, and the data were obtained by using cross-sectional method from patient’s medical record and lab examination result in the period from January 1st 2016 – January 31st 2018. The sampling method are done using total sampling. The inclusion criteria of this study were SLE patients which MPV and platelet count had been examined at the same time, the data used is data that was first discovered in the period of the study. The exclusion criteria were incomplete medical record data, patient with thrombocytosis, and SLE with comorbidity such as thrombotic disease (ischemic stroke and deep vein thrombosis), other high inflammatory overlap diseases (such as rheumatoid arthritis and inflammatory bowel disease), and infection. &nbsp; Result : &nbsp;From 75 patients that match with the inclusion criteria, all patients were female and based on the age of diagnosis, most patients were in age group of 25-34 years old (41,33%). Based on the lab results, group with normal platelet count have 53 data of normal MPV and 12 data of high MPV, while group with thrombocytopenia have 6 data of normal MPV and 4 data of high MPV. &nbsp; Conclusion : Group with normal MPV value and normal platelet count has the largest proportion, while the group with thrombocytopenia in lupus and high MPV value has the lowest proportion

Correlation Between Serum C-Reactive Protein (CRP) and Soluble Cd40 Ligand (sCD40L) with Disease Activity by Modified Rodnan Skin Score (mRSS) in Systemic Sclerosis Patients in Indonesia

Introduction: Systemic Sclerosis (SSc) is a chronic autoimmune disease which presents immunological, endothelial dysfunction, skin and organs fibrosis. The inflammatory process is an important pathophysiology of systemic sclerosis. Disease activity assessment using clinical parameters of Modified Rodnan Skin Score (mRSS) changes and inflammatory laboratory parameters of C-Reactive Protein (CRP), Erytrocyte Sedimentation Rate (ESR) and soluble CD40 ligand. The European Scleroderma Study Group (EscSG) Activity Index uses CRP. CRP is higher sensitivity and specificity than ESR (80% and 91.2%). The study aims to evaluate the correlation between CRP and sCD40L with disease activity by mRSS.Methods: This research was a cross-sectional study, and data of mRSS and sCD40L were obtained from the study, "Blind Clinical Trials Extract Ciplukan Herbs on Clinical Improvement of Skin Disorders, Inflammatory Process, Immunology and Fibrosis in Scleroderma Patientsâ€. CRP examination was done by using the rest samples of the study, conducted in December 2017. Data analysis with Rank-Spearman and Pearson Correlation..Result: There were fifty-eight subjects with mean age 38 ± 11 years old. Most of subjects were female (94.8%) and with a late disease duration &gt; 2 years (74.1 %). Subjects consisted of 35 (60.3%) diffuse SSc and 23 (39.7 %) limited SSc. CRP was measured by Turbidimetric Immunoassay. Median (range) CRP serum was 2.89 (0.16–17.29) mg/L, while the median of sCD40L was 6457 (1018–17976) pg/mL, and the median of mRSS was 17 (4–36). There was no correlation between CRP and sCD40L with mRSS (r = -0.134, p = 0.167; and r = 0.023, p = 0.433).Conclusion: There was no correlation between CRP and sCD40L serum with mRSS in systemic sclerosis patients

Paraneoplastic Arthritis in a Patient with Non-Hodgkin’s Lymphoma

Paraneoplastic syndromes are a group of disorders associated with benign or malignant tumors but not related to mass effect or invasion directly. Paraneoplastic syndromes may affect any organic system of the human body, such as endocrine, neurologic, dermatologic, hematologic, rheumatologic. Paraneoplastic rheumatic syndromes are not quite common, about 7-10% of paraneoplastic syndromes, and may mimic rheumatic diseases. We present an interesting case of paraneoplastic arthritis in a woman with non-Hodgkin’s lymphoma

Lupus Low Disease Activity State Associated with Lower Fatigue : Preeliminary Study

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease with heterogeneous clinical manifestations including fatigue. Previous studies aimed at proving the relationship between fatigue and SLE disease activity showed conflicting results. In 2015, Asia Pacific Lupus Collaboration (APLC) developed low disease activity criteria, named Lupus Low Disease Activity State (LLDAS). Patients who spend more time in LLDAS have significantly lower morbidity. This study aimed to evaluate the association between disease activity based on LLDAS and fatigue.&nbsp; &nbsp; Methods: This is a analytical cross-sectional study. Subjects were SLE patients at rheumatology clinic in Dr. Hasan Sadikin Hospital, Bandung during June-January 2018. Subjects were evaluated based on LLDAS criteria and divided into 2 groups: LLDAS and non-LLDAS. Fatigue status of the subjects was assessed with Fatigue Severity Scale (FSS). Results: A hundred and thirty-three subjects were included in this study, divided into 63 subjects in LLDAS group and 60 subjects in non-LLDAS group. Nineteen subjects (30.2%) in LLDAS group had fatigue and 39 subjects (65%) in non-LLDAS had fatigue. There was a significant association between LLDAS and fatigue (p&lt; 0.001). Nonetheless, fatigue level in LLDAS group was still high since disease activity was not the only factor related to fatigue. Fatigue may be a distinct clinical manifestation of neuropsychiatric lupus and may be independent of lupus disease activity Conclusions: There was a significant association between LLDAS and fatigue showed by lower fatigue level was found in the LLDAS group than in the non-LLDAS group. &nbsp; Keywords: Systemic lupus erythematosus, disease activity, Lupus Low Disease Activity State, fatigu