Neuropsychiatric Manifestation Screening Among Systemic Lupus Erythematosus Patients in Hasan Sadikin General Hospital Bandung

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune diseases caused by deposition of immune complex with the involvement of various organ system and certain autoantibodies production. One of the most significant manifestation is neuropsychiatricsymptoms, known as NPSLE (Neuropsychiatric Systemic Lupus Erythematosus). This study aims to portray the distribution of neuropsychiatric manifestation of SLE patients using a screening method in Hasan Sadikin General Hospital.Method: An observative, descriptive categoric study, with consecutive sampling were done. Data were collected by spreading the questionnaire to subjects diagnosed as SLE who visiting Hasan Sadikin General Hospital during August-October 2016 and by tracingtheir medical records. Data analyzed included age, sex, education background, duration of lupus, diagnosis criteria, ongoing therapy, and neuropsychiatric manifestation.Result: Samples volunteered in this study were 97 patients. Of them 94 patients (96.9%) were women and 47 patients (48.5%) were senior high school graduated. Most common diagnosis criteria found was positive ANA test (91.8%). Most necessary ongoing therapygiven was methylprednisolone (96.9%). Common neuropsychiatric manifestations were mood disorders (73,2%), headache (57,7%), and mononeuropathy (51,5%).Conclusion: The common psychiatric, central nervous, and peripheral nervous manifestations were mood disorder, headache, and mononeuropathy, respectively

Systemic Sclerosis in Two Generations Family: a Mother and Offspring

Systemic sclerosis (SSc) is uncommon connective tissue disease characterized by a pathological thickening and tethering of the skin and involvement of internal organ (i.e gastrointestinal tract, heart, lungs, and kidneys). Systemic sclerosis seems to result from a multifactorial process (alteration of the immune system, genetic, and environmental factors) but its pathogenesis remains unclear. A familial history of SSc represents an important risk factor for developing the disease.1 We describe two generations family who developed SSc

Overview of Anemia Among Systemic Lupus Erythematosus Patients in Reproductive Age Women Based on Reticulocyte Hemoglobin Equivalent (RET-He) Level and Reticulocyte Count

Background: Anemia is a common manifestation found among patients with Systemic Lupus Erythematosus (SLE). It may be caused by iron-deficiency, autoimmune hemolytic, and chronic inflammation. Each anemia has different therapy approachments. Without adequatemanagement, anemia may lead to poor prognosis. By identifying the etiology of anemia, appropriate management could be conducted. Reticulocyte Hemoglobin Equivalent (RET-He) and reticulocyte count test may distinguish anemia based on its etiology. This study aimed to give scientific portrayed of the proportion of anemia based on its etiology among patients with SLE using RET-He and reticulocyte count.Method: This study involved women diagnosed with SLE underwent outpatient treatment in Rheumatology Clinic, Dr. Hasan Sadikin General Hospital during SeptemberOctober 2016. Data were collected from blood exam using 35-parameters hematology Sysmex by calculating levels of hemoglobin, RET-He, and reticulocyte count.Results: Seventy four female patients were volunteered as subject in this study with median of age was 29.5 (16-70) years old. Thirty four (46%) of 74 subjects weresuffering from anemia and 12 (35%) of them were between 25-34 years old. Proportion of iron-deficiency anemia, autoimmune hemolytic anemia, and chronic inflammatory anemia were 14 ( 41%), 13 (38%), and 7 (21%), respectively.Conclusion: Based on hemoglobin, RET-He, and reticulocyte count, iron-deficiency anemia is the most common anemia among patients with SLE in repoductive age

Most Frequent Musculoskeletal Manifestation of Systemic Lupus Erythematosus Patients in Dr. Hasan Sadikin General Hospital Bandung

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease with wide range of clinical symptoms. The patients frequently complain musculoskeletal involvement during the active state of the disease. Musculoskeletal manifestation in SLE patients is an important sign in making early diagnosis and monitoring treatment response. This study aims to determine the presentation of musculoskeletal involvement of SLE patients in Dr. Hasan Sadikin General Hospital Bandung.Methods: a descriptive cross-sectional quantitative study done by interviewing SLE patients concerning musculoskeletal manifestation as the primary data and tracking their medical record as the secondary data. Study was conducted between September to November 2016 in Rheumatology Clinic Dr. Hasan Sadikin General Hospital Bandung.Result: Ninety-seven SLE patients, 91 females (93,81%) and 6 males (6,19%), were enrolled in this study with mean age 35.12 (±10.91) years. The three highest proportions of muskuloskeltal manifestations were arthritis of the knee (84,5%), myalgia of upper back(40,2%), and muscle weakness (15,5%). We did not find any Jaccoud's Arthropathy (JA) and tendinitis manifestation. Osteoporosis were occured in 4 patients (4,12%), whereas gout arthritis, spondytlitis, osteoarthritis, rotator cuff syndrome, and rhupus wereonly occured in one patient (1,03%), respectively.Conclusion: The common musculoskeletal manifestation in SLE patients were arthritis of knee, myalgia of upper back, and muscle weakness. Only small portion of patients suffered from osteoporosis, gout arthritis, spondytlitis, osteoarthritis, rotator cuff syndrome, and rhupus

Correlation Betweeen Skin Fibrosis Based on Modified Rodnan Skin Score and B-Cell Activating Factor Serum in Systemic Sclerosis

Background: Progression and expansion of skin fibrosis are the most important characteristics in determining clinical responses and prognosis of Systemic Sclerosis(SSc). Using modified Rodnan skin score (mRSS) can not rapidly detect a slight changes of skin fibrosis in SSc patients. Biomarker assessment is needed to make a more objective, quantitative and rapid evaluation of the changes. Suggested potential useful biomarker isB-cell Activating Factor (BAFF), a positive regulator of B cell survival and maturation process. This study aimed to evaluate correlation between skin fibrosis based on mRSS and BAFF serum in SSc patients.Methods: We used cross sectional methods. Enrolled all patients who met ACR EULAR 2013 criteria for SSc in Rheumatology Clinic Hasan Sadikin Hospital, Bandung, from November 2015 to March 2016. Subjects underwent medical record review, physical examination,mRSS measurement by rheumathologist, and blood tests. Data were analized using Rank-Spearman Correlation.Results: Thirty seven subjects, with mean age 40+10 years old. Subjects consisted of 23(62.2%) limited SSc and 14(37.8%) diffuse SSc. Mean BAFF serum was 1160.2+424.7 pg/mL, no statistical difference were found between limited and diffuse type (p=0.662).Median mRSS results was 16 ranged from 2 to 36.Correlation between mRSS and BAFF serum was not significant (r=0.077; p=0.326).Conclusion: There is no correlation between mRSS and BAFF serum in systemic sclerosis at Hasan Sadikin Hospital

Mucocutaneous Manifestation of Systemic Lupus Erythematosus Patients at Rheumatology Outpatient Clinic in Dr. Hasan Sadikin General Hospital

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune systemic disease which symptoms induced by Ultraviolet rays exposure. It commonly affects women and causes wide range of symptoms. One of the organs affected is mucocutaneous. Our study aims to determine mucocutaneous manifestations of SLE patients in Rheumatology Outpatient Clinic in Dr.Hasan Sadikin General Hospital, Bandung.Methods: A descriptive study with prospective crosssectional design conducted. Data were obtained by interviewing SLE patients as primary data and accessing medical record as secondary data. Ninety-six SLE patients met the inclusion and exclusion criteria wereincluded.Results: From ninety-six subjects, 94.8% subjects are working indoors. Mucocutaneous manifestation were found in most patients. Based on American College of Rheumatology (ACR) criteria, we found mucocutaneous manifestations, such as: oral ulcers in 67 patients(69.8%); malar rash in 63 patients (65.6%); photosensitivity rash in 51 patients (53.1%), and discoid rash erythematous in 21 patients (21.9%). Specific SLE cutanoeus manifestation based on Gilliam classification were found in our study subjects, such as papulosquamous/ psoriasisform (19.5%) , morbilliform (17.7%), vesicobullous annular SCLE (13.5%), annular SCLE (6.3%), and TEN-like LE (1%). Non-specific LE cutaneousmanifestations based on Gilliam classification were also found in our study subjects, such as oral ulcers (69.8%), photosensitivity rash (53.1%), alopecia (86.5%), Raynaud's Phenomenon (39.6%), nail abnormalities (24.0%), periungual telangiectasia patients (13.5%), vasculitic lesions (12.5%), thrombophlebitis (44.8%), bullous lesion (5.2%) and erythema multiforme (5.2%).Conclusion: Mucocutaneous manifestations in SLE patients based on ACR criteria found most in this study is oral ulcers. Based on Gilliam classification specific LE cutanoeus manifestation was not found in all SLE patients, while non-specific LE mucocutaneous manifestations mostly found is alopecia