Osteomalacia Induced by Renal Tubular Acidosis Type 1

Renal Tubular Acidosis, a group of disorders characterized by defective renal acid-base regulation, can impair mineralization of bone matrix in adults known as osteomalacia. RTA is classified into 3 major forms, such as proximal RTA or type 2; distal RTA or type 1; and hyperkalemic RTA or type 4. Among all type of RTA, proximal RTA or type 2 is known have association with Fanconi syndrome and bone involvement. However, distal RTA or type 1 can also cause osteomalacia. Hereby we report a case of 22 years old Asian woman who wasfirstly diagnosed with distal type RTA several years ago then started developing bone involvement recently. She was complaining with low back pain due to fracture on left medial side of inferior pubic ramus and endplate fracture on right side superior L4 and BMD examination showed low mineral density. She was diagnosed with osteomalacia induced by distal type RTA due to the loss of calcium salts from bone and hypophosphatemia.Keywords: Osteomalacia; Renal Tubular Acidosis; Hypokalemia; Hypophosphatemi

Correlation between anti-mutated citrullinated vimentin and bone turnover markers (CTX-1 and P1NP) in patients with rheumatoid arthritis in remission and low-disease activity

Introduction Rheumatoid arthritis is associated with bone loss and the risk of osteoporotic fracture. Bone loss in this disease is mediated by inflammation and autoimmunity. Many studies have shown that anti-citrullinated protein antibody is capable of inducing bone loss through several mechanisms. This study aimed to determine the relationship between autoimmunity, represented by anti-mutated citrullinated vimentin (anti-MCV) in this study, and bone loss, represented by C-terminal cross-linking telopeptide of type I collagen (CTX-1), and N-terminal pro-peptide of type 1 procollagen (P1NP) in this study, in patients with rheumatoid arthritis in remission and low disease activity. Material and methods This study enrolled 38 rheumatoid arthritis patients with disease remission and low disease activity in Cipto Mangunkusumo Hospital between August and September 2019. We collected the patients’ demographic data, Disease Activity Score 28 (DAS28), and treatment history. All participants underwent blood work for anti-MCV, CTX-1, and P1NP. Results Thirty-four of the subjects were women (89.5%), with the mean age of 40 ±7.6 years and the median disease duration of 36 months. Among the subjects, 26 patients (68.4%) were anti-MCV positive. There was no correlation between anti-MCV and CTX-1 levels (r = 0.101, p = 0.274). There was a moderate negative correlation between anti-MCV and P1NP (r = –0.449, p = 0.001). The mean difference of P1NP according to anti-MCV level also showed a significant difference (p = 0.019). Conclusions The anti-MCV levels are not directly correlated with CTX-1 levels, indicating heterogeneity in the disease course even after inflammation has ceased. The anti-MCV and P1NP levels are moderately correlated, indicating that bone formation is resumed during the suppression of autoimmunity

Characteristics and Treatment Responses of Rheumatoid Arthritis Patients at Dr. Cipto Mangunkusumo National General Hospital

Introduction: Rheumatoid arthritis (RA) is a chronic progressive autoimmune rheumatic disease that primarily affects the joints. The goal of RA treatment is to achieve remission or low disease activity, using a treat-to-target approach. This study aims to explore the characteristics of RA patients and evaluate their treatment responses in Dr. Cipto Mangunkusumo National General Hospital (RSCM). Methods: This cross-sectional study is conducted by collecting demographic and clinical data, as well as interviewing adult patients that have been diagnosed with RA at the Rheumatology Clinic of RSCM and have been on disease-modifying antirheumatic drugs (DMARD) treatment for a minimum of 6 months.Results: A total of 94 patients were included in this study. Subjects were predominantly female (93.6%) and had no formal jobs (64.9%). A majority of RA patients exhibited moderate disease activity (48.9%, based on Disease Activity Score-28 with erythrocyte sedimentation rate [DAS-28 ESR]), with a relatively high level of steroid use (86.2%). Notably, most patients started DMARD treatment more than 2 years after the onset of symptoms (45.7%). The proportion of patients achieving therapy target (remission to low disease activity) was 41.5%, with 13.8% attaining remission. Furthermore, Health Assessment Quality (HAQ) scores were found to be significantly lower among the target-achieving group, indicating better quality of life.Conclusion: Therapy target was achieved in 41.5% of RA patients in RSCM, with 13.8% achieving remission. Further research can be conducted to evaluate factors which may affect treatment response among RA patients

Learning from the COVID-19 pandemic: health care disturbances and telemedicine as an alternative rheumatology practice in Indonesia

Abstract Background Coronavirus disease 2019 (COVID-19) affects health care services. Our aim was to assess health care disruptions, treatment interruptions, and telemedicine reception regarding autoimmune rheumatic diseases (ARDs) in Indonesia. Method A cross-sectional population online-based questionnaire was conducted in Indonesia from September to December 2021. Results A total of 311 ARD patients were included, of whom 81 (26.0%) underwent consultations via telemedicine during the COVID-19 pandemic. The respondents showed increased concern about their susceptibility to COVID-19 (score of 3.9/5). Approximately 81 (26.0%) avoided hospital visits, and 76 (24.4%) stopped taking the medication without medical advice. Respondents’ concerns correlated with their social distancing behaviors (p value 0.000, r 0.458). Respondent concerns, behaviors, and blocked access to the hospital during the pandemic were associated with avoiding hospital visits (p value 0.014; 0.001; 0.045; 0.008). Sex was associated with stopping medication (p value 0.005). In multivariate analysis, blocked access and sex remained significant. Approximately 81 (26%) respondents who used telemedicine services during the COVID-19 pandemic as an alternative medical consultation method showed high satisfaction (3.8/5). Conclusion Health care disruptions and treatment interruptions were affected by patients’ internal and external factors during the COVID-19 pandemic. Telemedicine may be the best option to address barriers to health care access in Indonesia’s rheumatology practice during and after the pandemic situation

Indonesian Rheumatologist Association (IRA) Recommendations for Diagnosis and Management of Peripheral Spondyloarthritis 2021

Objective. Spondyloarthritis recommendations are made to provide guidance in diagnosis, treatment, and monitoring of peripheral spondyloarthritis cases.Method. Literature searches were conducted online. The drafting team determines the levels of evidence (LOE) and grades of recommendation (GOR). After conducting a discussion, each recommendation that has been agreed upon by the drafting team is then classified based on the levels of evidence and grades of recommendation. The final step in the preparation of these recommendations is to determine the level of agreement (LOA) on each recommendation carried out by a team of panelists who have been appointed by IRA.Result. Thirty five recommendations regarding peripheral spondyloarthritis were compiled. There are 6 strong recommendation or GOR A for psoriatic arthritis and 8 recommendations for enteropathic arthritis.Conclusion. These recommendations provide directions for clinicians to diagnose and to manage peripheral spondyloarthritis

Indonesian Rheumatology Association (IRA) Recommendations for Diagnosis and Management of Axial Spondyloarthritis 2021

Objective. Recommendations for spondyloarthritis are made to provide guidelines in diagnosis establishment, therapy, and monitoring of axial spondyloarthritis cases.Method. Literature searches were conducted online. The drafting team determines the levels of evidence (LOE) and grades of recommendation (GOR). After conducting a discussion, each recommendation that has been agreed upon by the drafting team is then classified based on the levels of evidence and grades of recommendation. The final step in the preparation of these recommendations is to determine the level of agreement (LOA) on each recommendation carried out by a team of panelists who have been appointed by IRA.Results. Twenty recommendations regarding axial spondyloarthritis were established. Strong recommendations or GOR A include: Ax-SpA diagnosis can be made according to the 2010 ASAS criteria, or the 1984 modified New York criteria specifically for the US; conventional radiographic examinations and MRI of the sacroiliac joints and vertebrae may be used as evaluators of disease activity and predictors of therapeutic response, as well as patients who do not respond to NSAIDs (within 4 weeks) can be administered a combination of NSAIDs and anti-TNF, and if it is not possible, a combination of NSAIDs and anti-IL-17A (Secukinumab, Ixekizumab).Conclusion. These recommendations provide a direction for clinicians to diagnose and manage spondyloarthritis