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Background: Osteoporosis is an increasing health problem in Indonesia. Fractures that occur in the spine and pelvis are considered to be the most common fracture sites for osteoporosis. Aim: to determine the differences in bone mineral density values in postmenopausal women with fracture and non-fracture. Methods: Survey was carried out in postmenopausal female patients with fractures and without fractures who were included in the inclusion criteria with a case-control study approach and had bone mass density data. For the group of cases with fracture, the amount of vertebral compression was measured using Gennant's measurement criteria. Interviews were conducted regarding the characteristics of patients with and without fracture. The differences in BMD values ​​were analyzed in postmenpausal female patients with fracture and without fracture by using unpaired T test on normal data distribution and Mann-Whitney test on abnormal data distribution. The measured BMD value is the T-score. The analysis result was considered significant if p 0.5). Conclusion: BMD L4 and femoral neck values ​​differ significantly in female patients with postmenopausal osteopenia with fracture and non-fracture.

Background: The sodium may aggravate synovial inflammation and cartilage thinning. This incidence can cause joint pain and reduce functional activity. Not many people know the effect of sodium on the incidence of OA. Objective: This study aims to determine the relationship between sodium in the body and knee joint pain which results in functional activity. Methods: The quantitative descriptive study used accidental sampling. The study was conducted at three outpatient polyclinic orthopedics of hospitals and was approved by the Health Ethics Committee. All data were collected during the interview. The Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ) and the Nutrisurvey Indonesia 2007 application were used as a tool to collect daily sodium intake (mg). Knee joint pain score was measured using the Visual Analog Scale (VAS) while functional body activity was measured using the Western Ontario McMaster Osteoarthritis Index (WOMAC). The Pearson and Spearman test (p

Background: Many factors can cause changes in bone mass density (BMD) in women with postmenopausal osteopenia. Aim: Determine factors associated with changes in BMD in postmenopausal women with osteopenia with the most influential risk factors within 1 year.Methods: Survey was conducted on 38 patients who were included in the inclusion criteria with a cross-sectional study analysis and had BMD data for the last 2 years, body mass index, and conducted interviews for physical activity, age of menopause, and duration of menopause. Blood samples were also taken to check total calcium levels, vitamin D levels and estrogen levels. Finally, patients are followed for up to 1 week for daily nutrition records. The relationship between these factors and changes in BMD was analyzed using Pearson's or Spearman's test. The analysis result was considered significant if p 0.05. However, there was a significant relationship between menopause onset and changes in ward mass density (r = 0,321, p = 0,04) and lumbal 1 (r = 0,333, p = 0,04), serum vitamin D levels and changes in great trochanter mass density (r = 0,336, p = 0,036), physical activity score and changes in ward mass density (r = -0,522, p < 0,01).Conclusion: Â menopause onset, vitamin D and physical activity are significantly associated with changes in BMD in female patients with postmenopausal osteopenia.

Introduction: Rheumatoid arthritis (RA) is an autoimmune rheumatic disease which often found in daily practice and requires certain considerations in recognizing clinical appearance also managing the disease as it often causes permanent joint damage, disability, even premature death. This recommendation is expected to become the latest reference for diagnosis and management of RA in Indonesia. Methods: The steering committee was formed by the Indonesian Rheumatology Association (IRA) to formulate key questions; conduct literature search, selection, and review; then formulate recommendation statements for diagnosis, therapy, and monitoring of RA. Furthermore, the steering committee determined the level of evidence and grades of the recommendations. After that, the level of agreement (LOA) was determined for each item by panelists including rheumatology consultants who have been appointed by IRA to represent Indonesia regions. Results: The steering committee established 30 recommendations including diagnosis, the role of laboratory and radiology tests, general treatment, the use of glucocorticoids, sDMARD, bDMARD, and tsDMARD. This recommendation also discusses guidelines on monotherapy, combination therapy, treatment strategies (treat-to-target), tapering, and continuous clinical remission. Treatment on co-morbidities and complications are also included in brief. Conclusion: IRA recommendations regarding the diagnosis and management of RA was made by considering various aspects such as the availability of drugs and supporting facilities, socioeconomic and cultural conditions in Indonesia, as well as the latest research that can be applied to Indonesian population.

Background: Arthritis rheumatoid (AR) is a chronic inflammatory disease that mainly affects the joints. Decreased bone mass and osteoporosis are its complications. Several factors such as dietary calcium, disease activity, physical activity, vitamin D levels, steroids can affect bone mineral density values. Aim: The purpose of this study was to determine the relationship between disease activity, calcium levels and bone mineral densitometry in patients with arthritis rheumatoid. Methods: 23 AR patients based on the 2010 ACR criteria including the inclusion criteria with a cross sectional study approach that had bone mineral densitometry (BMD) data for the last 1 year. Blood samples were also taken to check the total calcium level, the characteristics of the baseline data were collected, and the disease activity was examined using the DAS 28 LED. The relationship between these factors and the bone mass density was analyzed using the Spearman test. The analysis result was considered significant if p

Osteoporosis adalah penyakit tulang sistemik yang ditandai dengan massa tulang yang rendah dan kerusakan mikroarsitektur jaringan tulang yang mengakibatkan peningkatan kerapuhan tulang. Osteoporosis paling sering terjadi pada bagian femoral neck dan lumbar spine (L1-L4). Terdapat beberapa faktor risiko penyebab osteoporosis seperti usia, body mass index (BMI) dan jenis kelamin. Penelitian ini bertujuan untuk membuktikan kontribusi usia, BMI dan jenis kelamin berhubungan dengan terjadinya osteoporosis pada femoral neck dan lumbar spine (L1-L4). Penelitian ini menggunakan desain potong lintang. Populasi penelitian adalah seluruh pasien yang datang dan diperiksa di Poliklinik Osteoporosis RSUD. Dr. Saiful Anwar Malang berdasarkan rekam medis pada tahun 2012. Sampel diambil secara total sampling yaitu sebanyak 154 pasien. Peneltian ini menunjukkan bahwa faktor usia berhubungan dengan terjadinya osteoporosis pada lumbar spine (L1-L4) (p = 0,018), sedangkan BMI berhubungan dengan osteoporosis pada femoral neck (p = 0,000). Hasil analisis multiple logistic regression menunjukkan bahwa usia, BMI, dan jenis kelamin dapat memprediksi terhadap terjadinya osteoporosis pada femoral neck (R 2 = 0,155), dan osteoporosis pada lumbar spine (L1-L4) (R 2 = 0,112). Dapat disimpulkan bahwa faktor usia berpengaruh terhadap osteoporosis pada lumbar spine (L1-L4) dan BMI berpengaruh terhadap osteoporosis femoral neck. Usia, BMI dan jenis kelamin secara bersama-sama berpengaruh terhadap osteoporosis femoral neck dan lumbar spine (L1-L4).

Artritis reumatoid (AR) adalah penyakit autoimun yang etiologinya belum diketahui. Metotreksat adalah DMARD ( d isease -m odifying a ntirheumatic d rug ) yang paling sering digunakan pada AR, namun respons terhadap metotreksat bervariasi di antara populasi. Data mengenai faktor klinis dan laboratoris yang berhubungan dengan remisi pada AR yang diterapi dengan metotreksat masih tidak konsisten. Penelitian ini bertujuan untuk mengetahui faktor-faktor klinis dan laboratoris yang berhubungan dengan remisi pada pasien AR yang mendapat terapi metotreksat. Data diperoleh dari pasien AR yang memenuhi kriteria ACR-EULAR 2010 dengan desain penelitian observasional dan pendekatan potong lintang. Data meliputi jenis kelamin, usia onset penyakit, durasi penyakit, indeks masa tubuh (IMT), t ender j oint c ount (TJC), s wollen j oint c ount (SJC), v isual a nalog s cale (VAS) nyeri, d isease a ctivity s core (DAS)-28 awal, laju endap darah (LED), anti - c yclic c itrullinated p rotein (CCP), dan r heumatoid f actor (RF). Variabel dianalisis secara statistik dengan uji c hi square dilanjutkan regresi logistik multipel. Penelitian ini melibatkan 88 pasien AR, terdiri dari 85,2% wanita (n = 75) dan 14,8% pria (n = 13), rerata usia 54,78±11,34. Proporsi remisi pasien adalah 26,1%. Dari analisis bivariat dengan uji c hi square didapatkan variabel yang berhubungan bermakna terhadap remisi, yaitu usia onset (p = 0,037), VAS nyeri (p = 0,030) dan LED (p = 0,038). Dapat disimpulkan bahwa usia onset, VAS nyeri, dan LED berhubungan bermakna dengan remisi penyakit pasien AR yang diterapi dengan metotreksat.

Objectives One of the treatments for rheumatoid arthritis (RA) was methotrexate which a disease modifying antirheumatic drug therapy. The use of methotrexate required the right dose and length of therapy to achieve remission. The effectivity of methotrexate could be accounted by disease activity score 28 (DAS28) as a tool has been used clinically with a combination number of tender joints, swollen joints, erythrocyte sedimentation rate, and global clinical assessment by the patient. The aim of this study was to determine the effective dose and length of therapy methotrexate was measured by DAS28 score. Methods This research was a cross-sectional study and data was collected from patient medical records in Saiful Anwar Hospital, Malang, from February to July 2018. The research has been given ethical clearance. The inclusion criteria for the 88 subjects were men and women, over 20 years of age, usage of only methotrexate for at least three months, an erythrocyte sedimentation rate score, uncomplicated inflammatory bowel disease, cancer, and systemic lupus erythematosus. All data obtained was entered in formula DAS28. The Statistic analysis used both Pearson and Spearman’s rank correlation. Results Only 16 patients achieved remission. There were not significant correlation in statistical analysis between DAS score and cumulative dose (r=−0.091; p=0.400), average dose (r=0.043; p = 0.692), maximum dose (r=0.074; p=0.492), and length of therapy (r=−0.075; p = 0.489). The initial dose of therapy methotrexate was different and the length of therapy was adjusted to the patient’s health condition. Conclusions The maximum dose and length of therapy methotrexate was required to achieve remission in RA.

Osteoporosis is an important health problem, and the number of patients who suffered from it is increasing. Breast cancer is a condition that has a high risk of osteoporosis. Cancer induced bone disease results from the primary disease, metastatic process, or from therapies against the prime condition, causing bone fragility. Therefore, there are still different opinions regarding the therapeutic effect of breast cancer on bone mineral density. Aim: to determine the effect of chemotherapy and hormonal therapy on bone mineral density in patients with breast cancer in Saiful Anwar Hospital Malang. Method: this is a case-control study conducted in 30 patients with breast cancer who had undergone chemotherapy and hormonal therapy are compared to 30 patients without breast cancer as controls. Bone Mineral Density (BMD) was measured by DEXA. Result: there are 53% of breast carcinoma patients having osteopenia and 13% having osteoporosis, with one patient has osteoporosis located in the femoral neck and three patients in lumbar (L1-L4). We obtain a significant T-score (p=0.02) in the great trochanter. Odds Ratio (OR) 0.233 with p = 0.008 showed a protective effect of chemotherapy and hormonal therapy for breast cancer to the bone density. Conclusion: the incidence of osteoporosis in the study was 13%, with the most location in the lumbar spine. Chemotherapy and hormonal therapy had a protective effect on BMD in patients with breast cancer in Saiful Anwar Hospital Malang.

Metilprednisolon merupakan glukokortikoid yang memiliki efek samping penurunan densitas mineral tulang (DMT). Tingkat kepatuhan berhubungan dengan terjadinya efek. Penelitian ini bertujuan untuk mengetahui hubungan penurunan nilai DMT dengan kepatuhan terapi metilprednisolon pada pasien artritis reumatoid dan lupus eritematosus sistemik. Penelitian ini dilakukan pada 43 pasien di Poliklinik Rheumatologi RSUD dr. Saiful Anwar Malang pada bulan Desember 2016–Januari 2017 dan termasuk penelitian deskriptif noneksperimental dengan analisis kualitatif dan kuantitatif menggunakan metode cross-sectional . Data diambil dari rekam medis pasien dan wawancara. Kriteria inklusi pada penelitian ini adalah perempuan berusia 31–50 tahun, menggunakan terapi metilprednisolon minimal selama 3 bulan serta memiliki data DMT. Kriteria eksklusi adalah menopaus e, riwayat fraktur tulang, merokok, mengonsumsi alkohol, sindrom cushing , hipertiroidisme, hiperparatiroidisme, gangguan kelenjar pituitari, dan osteoartritis serta mengonsumsi obat bifosfonat, heparin, anti-konvulsan, dan thiazid. Analisis data menggunakan uji korelasi Pearso n dan regresi linier. Terdapat hubungan antara kepatuhan dengan area DMT Spine -L1 (r= –0,313; p=0,041), Spine -L2 (r= –0,349; p=0,022), Spine -L3 (r= –0,375; p=0,013), dan total spine (r = -0,380; p = 0,012). Metilprednisolon sensitif pada jaringan tulang trabekular yang menyusun area lumbar spine dibandingkan tulang kortikal. Hubungan rendah (r) antara tingkat kepatuhan dan DMT disebabkan sosial ekonomi, perawatan kesehatan, karakteristik penyakit, dan genetik. Kepatuhan terapi metilprednisolon menurunkan nilai DMT ( lumbar spine ) yang berakibat meningkatkan osteoporosis. Kata kunci: Artritis reumatoid, densitas mineral tulang, eritematosus sistemik, kepatuhan, lupus metilprednisolon The Relationship of Lowering the Values of Bone Mineral Density in Methylprednisolone Medication Adherence on Rheumatoid Arthritis and Systemic Lupus Erythematosus Patients Abstract Methylprednisolone is a glucocorticoid which has a side effect of decreasing bone mineral density (DMT). The degree of compliance relates to the occurrence of effects. The objective of this study was to investigate the association of DMT impairment with adherence to methylprednisolone therapy in patients with rheumatoid arthritis (AR) and systemic lupus erythematosus (LES). The research was conducted to 43 patients in Rheumatology Polyclinic of dr. Saiful Anwar (RSSA) Malang. The study was conducted in December 2016–January 2017 and included nonexperimental description with qualitative and quantitative analysis using cross sectional method. The data were taken from the patient’s medical record and interview. The inclusion criteria in this research were women, aged 31–50 years, using metilprednisolon therapy for at least three months and have mineral bone density data. Exclusion criteria were menopause, history of bone fracture, smoking, alcohol consumption, cushing syndrome, hyperthyroidism, hyperparathyroidism, pituitary gland disorders, and osteoarthritis and taking drugs bisphosphonates, heparin, anti-convulsants, and thiazid. Data analysis used person correlation and linear regression. There was a significant correlation between adherence to the Spine-L1 DMT area (r= –0.313; p=0.041), Spine-L2 (r= –0.349; p=0.022), Spine-L3 (r = –0.375; p=0.013), and total spine (r= –0.380; p=0.012). Methylprednisolone is sensitive to trabecular bone tissue that makes up the lumbar spine area compared to cortical bone. The low association (r) between adherence and DMT is due to socioeconomic, health care, disease characteristics, and genetics. Compliance of methylprednisolone therapy decreases the value of DMT (lumbar spine) which increased in osteoporosis. Keywords: Bone mineral density, medication adherence, methylprednisolone, reumathoid arthritis, systemic lupus eythematosus

Background Clinical remission is an attainable goal for Rheumatoid Arthritis (RA). However, data on RA remission rates from multinational studies in the Asia-Pacific region are limited. We conducted a cross-sectional multicentric study to evaluate the clinical remission status and the related factors in RA patients in the Asia-Pacific region. Methods RA patients receiving standard care were enrolled consecutively from 17 sites in 11 countries from APLAR RA SIG group. Data were collected on-site by rheumatologists with a standardized case-report form. Remission was analyzed by different definitions including disease activity score using 28 joints (DAS28) based on ESR and CRP, clinical disease activity index (CDAI), simplified disease activity index (SDAI), Boolean remission definition, and clinical deep remission (CliDR). Logistic regression was used to determine related factors of remission. Findings A total of 2010 RA patients was included in the study, the overall remission rates were 62•3% (DAS28-CRP), 35•5% (DAS28-ESR), 30•8% (CDAI), 26•5% (SDAI), 24•7% (Boolean), and 17•1% (CliDR), respectively, and varied from countries to countries in the Asia-Pacific region. Biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) prescription rate was low (17•9%). Compared to patients in non-remission, patients in remission had higher rates of b/tsDMARDs usage and lower rates of GC usage. The favorable related factors were male sex, younger age, fewer comorbidities, fewer extra-articular manifestations (EAM), and use of b/tsDMARDs, while treatment with GC was negatively related to remission. Interpretation Remission rates were low and varied in the Asia-Pacific region. Treatment with b/tsDMARDs and less GC usage were related to higher remission rate. There is an unmet need for RA remission in the Asia-Pacific region. Funding Macao science and technology development fund (0094/2018/A3) (partial).

Munculnya Systemic Lupus Erythematosus (SLE) dan Human Immuno Deficiency Virus (HIV) yang terjadi secara bersamaan merupakan hal yang eksklusif. Tulisan ini melaporkan kasus HIV dan SLE yang terjadi bersamaan pada seorang wanita usia 50 tahun. Pasien mengalami keluhan yang mendukung adanya infeksi HIV dengan ditemukannya gejala diare kronis, penurunan berat badan, batuk-batuk, demam-demam, kelelahan badan, sariawan, nyeri sendi, dan allopesia. Pemeriksaan laboratorium yang mendukung diagnosis HIV pada pasien ini adalah peningkatan LED, tes determinan yang reaktif, dan penurunan CD4+. Pasien juga menderita SLE yang ditunjukkan dengan ditemukannya gejala allopesia (kerontokan rambut), sariawan yang tidak nyeri, sering menderita sakit sendi-sendi, demam yang hilang timbul tanpa penyebab jelas, riwayat trombositopenia (penurunan jumlah trombosit), penurunan berat badan. Hasil pemerikaan laboratorium immunologi yang mendukung diagnosis SLE adalah ANA test yang positif, ds DNA yang positif dan coombs test +2. Pemberian terapi antiretroviral dan chloroquin yang diberikan menunjukkan hasil perbaikan gambaran laboratorium dan gejala klinis pada bulan keempat pengobatan.Kata Kunci: Human Immuno Deficiency Virus (HIV), Systemic Lupus Erythematosus (SLE)

Background. Systemic lupus erythematosus (SLE) has diverse clinical manifestations, including renal and non-renal. Renal manifestation is related to significant morbidity and mortality. SLE is also characterized by serological aberrations, including levels of complement C3, C4 and anti-dsDNA, but the association of them with clinical manifestations including renal and non-renal is unclear. This study investigated the associations of C3, C4 and anti-dsDNA levels with renal and non-renal manifestations in SLE patients. Method. A cross-sectional study was conducted in the Polyclinic of Rheumatology, Dr. Saiful Anwar Hospital Malang. A number of 43 subjects fulfilled the 1997 American College of Rheumatology criteria participated in this study, that consisted of 11 patients with renal manifestation and 32 patients with non-renal manifestations. Serum C3 and C4 levels were measured using immunoturbidimetry, and serum anti-dsDNA levels were measured using enzyme-linked immunosorbent assays (ELISA). The independent T-test was used to compare C3 levels and the Mann-Whitney U test was used to compare C4 and anti-dsDNA levels between groups. Result. SLE with renal manifestation had significant lower levels of serum C3 compare to non-renal manifestations (mean ± SD: 71.27 ± 32.65 mg/dL and 94.47 ± 26.29 mg/dL respectively, p=0.022). SLE with renal manifestation also had significantly lower levels of serum C4 compare to non-renal manifestations (mean ± SD: 14.55 ± 8.20 mg/dL and 25.50 ± 11.05 mg/dL respectively, p=0.002). Conversely, SLE with renal manifestation had significantly higher levels of serum anti-dsDNA compare to non-renal manifestations (mean ± SD: 249.27 ± 240.34 IU/mL and 109.91 ± 166.11 IU/mL respectively, p=0.014). Conclusion. SLE patients with renal manifestation have significantly lower levels of serum C3 and C4 and a higher level of serum anti-dsDNA than SLE patients with non-renal manifestations.

Rheumatoid arthritis is a chronic inflammatory autoimmune disease associated with articular and systemic effects. This disease affects synovial joints covered by a special tissue called synovium. Curcumin has a potent antioxidant, antiinflammatory agent, antiangiogenic and anticarcinogenic. Curcumin can downregulate the expression of various proinflammatory cytokines and is reported beneficial effects in arthritis, but has a poor solubility dan bioavailability as well. The purpose of this research was to study the potential of liposomes topikal curcumin in reducing athritis score, reducing the expression of TNF-α and histopathological synovium hyperplasia of hind paw on Wistar rats with CFA that had been treated with topical curcumin. In this study, rats were divided into 7 groups: positive control, negative control, rheumatoid arthritis with topical curcumin therapy of 90 mg/kg BW, rheumatoid arthritis with topical curcumin therapy of 110 mg/kg BW, rheumatoid arthritis with topical curcumin therapy of 200 mg/kg BW, rheumatoid arthritis with methotrexate therapy, rheumatoid arthritis with placebo therapy. Results from this experiment indicated that topical curcumin has no significant to the arthritis score, significantly effect to percentase expression of TNF-α (p

Osteoporosis is characterized by compromised bone strength and increase susceptibility to frature. The problem of osteoporosis is increasing in Indonesia. The Indonesian Osteoporosis Guideline was developed to increase the awareness of medical practitioners in detection and management of osteoporosis. Early detection and prevention is of paramount importance. Assessment of risk factors is an integral part of the management of osteoporosis.

Aims: Rheumatoid arthritis is a chronic inflammatory condition that affects approximately 1% of the world's population. There are a wide number of guidelines and recommendations available to support the treatment of rheumatoid arthritis; however, the evidence used for these guidelines is predominantly based on studies in Caucasian subjects and may not be relevant for rheumatoid arthritis patients in the Asia-Pacific region. Therefore, the Asia Pacific League of Associations for Rheumatology established a Steering Committee in 2013 to address this issue. Materials and methods: The AGREE II instrument and the ADAPTE Collaboration framework were applied to systematically identify, appraise, synthesize, and adapt international rheumatoid arthritis guidelines for use in the Asia-Pacific region. Results: Forty rheumatoid arthritis treatment recommendations, based on evidence and expert opinion, were drafted and are presented in this report. Conclusion: The Asia Pacific of Associations for Rheumatology rheumatoid arthritis treatment recommendations are intended to serve as a reference for best practice management of rheumatoid arthritis in Asia-Pacific, focusing on local issues to ensure the delivery of basic care for these patients, and to improve their outcomes. In addition, the document will serve as a reference for national rheumatology associations in Asia-Pacific for developing guidelines in their respective countries. International Journal of Rheumatic Diseases

Objective: To evaluate the bone density and bone metabolism in women with rheumatoid arthritis (RA), focusing on disease activity, joint erosion, and RA-epitope. Methods: Disease activity was assessed using erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, Ritchie articular index (RAI), and disease activity score (DAS). The presence of joint erosion was assessed using wrist-hand and feet X-ray, and wrist-hand magnetc resonance imaging. A fasting metabolic bone study was done including serum calcium, phosphate, 25(OH) vitamin D, parathyroid hormone (PTH), alkaline phosphatase (ALP), osteocalcin, and urine deoxypyridinoline/creatinine (DPD/Cr) ratio. Bone mineral density (BMD) was measured at hip, spine, distal forearm, hand, and total body using dual energy X-ray absorptiometry (DEXA) machine. HLA-DRB1 genes were examined using DNA sequencing based typing. Results: Seventy-six women with RA according to 1987 American College of Rheumatology (ACR) criteria with clinical onset equal to or less than 5 years were examined. Mean (SD) of age was 55.4 (13.7) years, disease duration 34.9 (36.4) months, and 96% with ACR functional criteria class I and II. HLA typing demonstrated that 61.4% of them have the RA shared-epitope (QRRAA or QKRAA or RRRAA) in their HLA-DRB1 alleles. Most of them had been receiving disease-modifying antirheumatic drugs and glucocorticoid. Erosive disease was significantly correlated with intertrochanter BMD (P = 0.044), serum calcium (P = 0.005), and urine DPD/Cr ratio (P