Validity and Reliability Fatigue Severity Scale in Patients with Systemic Lupus Erythematosus (SLE) in Indonesia

Background: Fatigue is one symptom of Systemic Lupus Erythematosus (SLE), which has an important effect on the quality of life. Fatigue Severity Scale (FSS)is one parameter fatigue symptom in SLE. The purpose of this study was to determine the validity and reliabilitybetween FSS with duration of ilness and disease activity of SLE patients in Indonesia.Methods: FSS performed on 40 patients with SLE. FSS original English version has been converted-translated into Indonesian version by a team of RheumatologyImmunology Medical Faculty of Brawijaya University. Reliability determined by Cronbach's Alpha values (>0.6). Validity was determined by the value of Corrected Item-Total Correlation which each item was a valid question if below value of Cronbach's Alpha.Results: The reliability value was determined by Cronbach's Alpha values (>0.6) in which the SLE patients in this study had a Cronbach's Alpha value of 0.946. Value of Corrected Item-Total Correlation overall under Cronbach's Alpha value (range = 0.684-0.859) which indicates that each item was a valid question. There were correlation between the FSS Indonesian version with disease duration (p = 0.000) as well as the value of r = 0.581, with SLEDAI (p = 0.000) with a value of r = 0.833. Conclusion: FSS in Indonesian version has a good reliability and validity and can be used by clinicians andother researchers to assess the condition of fatigue in SLE patients in Indonesia

The Correlation Between Serum Concentration of Vitamin D with Vitamin D Receptor Expression and Disease Activity in Indonesian Patients with Systemic Lupus Erythematosus: Preliminary Study

The vitamin D role on the immune response of systemic lupus erythematosus (SLE) patient is mediated by vitamin D receptor (VDR). Low level of vitamin D correlated with disease activity in SLE patients, and circulating levels of activated vitamin D (1,25(OH)2D) contribute to VDR protein levels and its function. The objective of this study was to determine the correlation between vitamin D status with expression of VDR in peripheral blood mononuclear cell (PBMC) and the disease activity in SLE patients. The Research Subjects were 15 SLE patients (ACR 1997 criteria) from the Rheumato-Immunology Division, dr. Saiful Anwar Hospital, Malang and 5 healthy controls. Serum vitamin D (25(OH)D3) level was assessed using ELISA method. VDR expression in PBMC was assessed using immunocytochemistry technique. The disease activity was measured by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score. This study showed no difference on VDR expression in PBMC between patient and healthy control group, but patient with vitamin D deficiency had lower VDR expression in PBMC than the other group. No difference on SLEDAI score between the group. Vitamin D status correlated positively with VDR expression in PBMC (p < 0,035, r = 0,473). However vitamin D status did not correlate with disease activity scores (p = 0,686)

Kadar Autoantibodi dan Manifestasi Klinis pada Pasien Nefritis Lupus Silent dan Nefritis Lupus Overt

Autoantibodies level and clinical manifestation differences between patients with silent nephritis lupus and overt nephritis lupusBackground: One of the serious clinical manifestations of SLE is the occurrence of lupus nephritis (LN). The pathogenesis of LN is still unclear. Glomerular inflammation has been associated with high levels of autoantibodies. The purpose of this study was to assess the difference of ANA, anti ds-DNA, anti-Sm antibodies and the clinical manifestations between silent lupus nephritis (SLN) and overt lupus nephritis (OLN).Subject and Methods: Subjects were forty SLE patients (diagnosed according to ARA criteria of 1997). Autoantibodies ANA was assayed with IFA, anti-dsDNA and anti-Sm levels were assayed with ELISA. The diagnosis of LN was established using clinical signs, urinary sediments pattern and kidney biopsy, and then patients classified as a silent lupus nephritis (SLN) or overt lupus nephritis (ONL). Classification of NL histopathologic pattern was established according to WHO criteria. Differences in clinical manifestations, presence of ANA, anti-dsDNA and anti-Sm levels in the SLN and OLN and NL classes were analyzed by Chi squaretest and T test. Statistical significance determined when p<0.05.Results: OLN patients showed a edema, hypertension, anemia and autoantibodies more higher than in SLN patients. The mean level of anti-dsDNA was significantly higher in patients with OLN than in SLN (285.75±41.85 vs 179.01±61.81, p<0.000). Renal biopsy on 20 OLN patients showed: 6 patients with NL grade I/II, 9 patients with NL class III/IV and 5 patients with NL class V. Moreover on 11 SLN patients there were 7 patients with NL class I/II, 3 patients with NL class III/IV and 1 patient with NL class V. The NL classIII/IV NL patients showed anti-dsDNA level higher than the class V NL (p<0.05).Conclusion: OLN patients had clinical manifestations more severe than SLN patients. NL patients with class III/IV showed the presence of anti-dsDNA more frequently and with higher levels than the class V NL. Diagnosing NL based solely on clinical signs and laboratory often is inappropriate

Chronic Polyarthritis Mimicking Rheumatoid Arthritis in a Patient with Leprosy

Currently leprosy is now still a global threat in the world even after the introduction of multidrug therapy (MDT), including in Indonesia.1 World Health Organization (WHO) data revealed that in 2002 there were 597,000 cases worldwide and the prevalence is only less than 1 every 10,000 populations.2 Nevertheless, the latest data showedthat 83% of leprosy cases concentrated in only 6 countries: Indonesia, India, Brazil, Madagascar, Myanmar, and Nepal.3 The most common manifestations of leprosyare cutaneous and neuritic manifestation. Rheumatologic manifestation is another common manifestation of leprosy.4-7 Prevalence of rheumatologic manifestation of leprosy is range from 1% to 77% of all leprosy patients.4-11 Study conducted by Mandal et al in India revealed that the prevalence of rheumatologic manifestation was 5.9%, in Brazil,6 another study by Pereira revealed the prevalence of 9.1%.5 Hadi, in Indonesia,showed the prevalence of arthritic manifestation was 7.5%.8 Rheumatologic manifestations that can be found in leprosy are polyarthritis or oligoarthritis, soft tissue rheumatism, noninflammatory arthritis, and also enthesitis.4-7 We report a patient presenting with polyarthritis as the primary manifestation of leprosy

Proteinuria Severity in Lupus Nephritis is Associated with Anti-dsDNA Level and Immune Complex Deposit Location in Kidney

Lupus nephritis (LN) is one of the manifestations of Systemic Lupus Erythematosus (SLE), with proteinuria being one of the clinical manifestations. The proteinuria pathogenesis is associated with anti-dsDNA antibody and the location of immune complex deposits within the kidney. This study aims to investigate the correlation of the severity of proteinuria with the location of immune complex deposits and the level of anti-dsDNA antibody in LN. Data were collected in cross-section. Fifty-three patients with LN in Saiful Anwar Hospital Malang, who underwent renal biopsy, were included. Hematoxylin-eosin staining and immunofluorescence analysis were used to assign subjects to different histopathological classes and determine the immune complex deposits. The spot urine samples were evaluated using the dipstick method for semi-quantitative proteinuria. The anti-dsDNA antibody levels were evaluated using the enzyme-linked immunosorbent assay (ELISA). Turbidity and enzymatic tests were conducted to elucidate urine protein and creatinine content, respectively. The level of proteinuria is significantly different among the different locations of immune complex based on the dipstick and protein/creatinine methods (p = 0.021 and p = 0.005, respectively). There was a significant correlation between anti-dsDNA antibody level and the severity of proteinuria (r = 0.326 based on dipstick and r = 0.28 based on protein/creatinine method). Thus, proteinuria in LN is determined by anti-dsDNA level and the location of immune complex deposits in the kidney

Correlation Between Anti-cyclic Citrullinated Peptide Antibodies and the Severity of Clinical Manifestation, Laboratory Manifestation, and Radiological Joint Destruction in Rheumatoid Arthritis Patients

Background. The second generation anti-cyclic citrullinated peptide test (CCP2) displays sensitivity comparable to that of rheumatoid factor (RF) (approximately 80%) but with superior specificity (98%) . Several observations have indicated that early rheumatoid arthritis (RA) patients with positive anti-CCP may develop a more erosive disease than those without anti-CCP.Objective. The purpose of this cross-sectional study was to investigate the correlation between anti-CCP antibodies and clinical and laboratory parameters and radiological joint destruction in RA patients.Methods. We studied 31 patients with RA fulfilling the 1987 revised criteria of American College of Rheumatology in Rheumatology Clinic of Saiful Anwar General Hospital, Malang, Indonesia. Clinical parameters were collected such as age, sex, visual analog scale,disease duration and diseases activity score (DAS28-3(CRP)). Laboratory parameters were WBC, hemoglobin, platelet count, erythrocyte sedimentation rate, and Creactive protein. Analyzed autoantibody profiles were RF and anti-CCP (ELISA methode). Radiological jointdestruction was evaluated from bilateral postero-anterior manus x ray (Sharp score).Results. Anti-CCP antibodies were detected in 48.4% of RA patients with mean antibody concentration was 291.24±143.67 (range 16-523.8) units. Anti CCP level was significantly correlated with duration of RA (month) (p=0.04, r=0.371), RF level (p=0.002, r=0.542) andSharp score (p=0.048, r=0.358), but was not significantly correlated with other clinical and laboratory parameters.Conclusion. Anti-CCP level was correlated with duration of disease, RF, and Sharp score

Faktor HLA-DRB pada Penderita Tuberkulosis Paru dengan Pengobatan Strategi DOTS

HLA-DRB factor in pulmonal tuberculosis with DOTS strategic treatmentBackground: Tuberculosis remains one of the world's greatest public health problems, especially in developing countries. In Indonesia the results of DOTS strategic treatment and conversion have not been fruitful results. Many factors play important roles in the success of DOTS strategic treatment, but a little attention was given to the immuno genetics aspects. This study was aimed at theassociation between HLA-DRB factors and clinical output on DOTS strategic treatment (after first 2 months of treatment):conversion of sputum smear positive.Method: A nested case control study was carried out. The exposure variables were alleles of HLA-DRB (result of PCR examination), while the independent variables were sputum smear positive and negative (result of laboratories examination with Ziehl Neelsen staining, Niacin test). Body mass index (BMI) and sex were confounding variables. Odds ratio (OR) was calculated using bivariate and logistic regression for multivariate analysis.Result: A total sample of 73 new patients with active tuberculosis (sputum smear positive) in developing treatment with DOTS strategic treatment, consist of 34 cases and 39 controls. The odds ratio (OR) of HLA-DRB1*1502 and HLA-DRB5*01 were 3.2 (95%CI: 1.103-9.287). The OR of HLA-DRB1*1201 was 0.305 (95% CI: 0.117-0.798), OR of HLA-DRB3*01 was 0.214 (95% CI: 0.077- 0.592). The PAR (population attributable rate) of HLA-DRB1*1502 and HLA-DRB%*01 were 42.64%. While confounding variables were analyzed, only allele HLA-DRB1*1502 was significant, OR 4.9 (95% CI: 1.234-15.617), the probability was 70.57%.Conclusion: HLA-DRB1*1502 is an allele is a risk factor for the conversion of sputum smear positive after 2 months of treatment

Imunisasi Intranasal Protein Hemaglutinin Pili Streptococcus pneumoniae 54 KDa Menginduksi Respon Imun Mukosa Melalui Peningkatan Konsentrasi TGF-Β, IL-17 dan IL-22 (Studi Pada Tikus Wistar)

Pneumonia merupakan penyebab utama bagi kematian balita di seluruh dunia yaitu mencapai 18 % dan penyebab kedua kematian balita di Indonesia. Patogen penyebab pneumonia pada balita yang paling banyak adalah Streptococcus pneumoniae. Salah satu upaya pencegahan terhadap Pneumococal pneumonia adalah dengan pemberian vaksin dan vaksin yang sudah digunakan saat ini adalah PPV (pneumococcal polysaccharide vaccine) dan PCV(pneumococcal polysaccharide conjugate vaccine). Kemampuan vaksin tersebut untuk memberikan proteksi terhadap infeksi S. pneumoniae terbatas pada serotipe yang terkandung di dalamnya. Kelemahan vaksin ini dapat diselesaikan dengan mengembangkan vaksin yang dapat melindungi terhadap semua serotipe S. pneumoniae, yaitu dengan menggunakan vaksin berbasis protein yang merupakan faktor virulensi dari S. pneumoniae. Salah satu faktor virulensi yang bersifat imunogen adalah protein adhesin serta enzim yang meningkatkan adhesi dan invasi ke sel epitel respirasi yang terdapat pada bagian pili bakteri. Streptococcus pneumoniae mempunyai dua jenis pili yaitu pili tipe 1 dan pili tipe 2. Pili tipe 1 lebih banyak dijumpai daripada pili tipe 2 dan disusun oleh tiga protein yaitu RrgA, RrgB dan RrgC, sedangkan pili tipe 2 disusun oleh 2 protein yaitu pit A dan pit B. Kedua pili tersebut mempunyai peranan dalam proses adhesi bakteri ke sel pejamu. Proses terjadinya infeksi didahului dengan penempelan S.pneumoniae ke epitel saluran pernapasan. Proses penempelan tersebut diperantarai oleh protein adhesin bakteri dan reseptor yang ada di sel hospes. Setelah bakteri menempel, melakukan kolonisasi, replikasi dan menginisiasi respon dari sel hospes, selanjutnya akan menyebabkan kerusakan. Kemampuan bakteri melakukan kolonisasi berhubungan dengan kemampuan melakukan hemaglutinasi. Tingginya aktivitas hemaglutinasi berhubungan erat dengan tingginya kemampuan bakteri melakukan kolonisasi. Beberapa peneletian menunjukkan bahwa protein hemaglutinin merupakan protein adhesin. Penelitian ini dibagi menjadi dua tahap. Tahap pertama penelitian bertujuan untuk melakukan identifikasi dan karakterisasi protein hemaglutinin pili S. pneumoniae. Untuk mengisolasi pili S. pneumoniae, bakteri dikultur pada media bifasik BHI- TCG yang diperkaya dengan 5% darah domba diinkubasi pada suhu 37oC selama 2x24 jam. Setelah dipanen, pili dipotong menggunakan bacterial pili cutter dan dilanjutkan SDS-PAGE dan uji hemaglutinasi untuk mengidentifikasi protein pili yang merupakan protein hemaglutinin. Protein hemaglutinin pili S. pneumoniae diuji imunogenitas dengan mengimunisasikan ke mencit, selanjutnya serum mencit yang mengandung antibodi dijadikan sebagai antibodi primer untuk uji westernblotting. Disamping itu protein pili 54 kDa dilakukan mass spectrometry untuk mengetahui susunan asam amino. Hasil mass spectrometry dilakukan BLASTP untuk mengetahui similaritasnya dengan S. pneumoniae strain ATCC serta diuji antigenitasnya dan epitop mapping secara insilico