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All Journal Medical Journal of Indonesia Indonesian Journal of Rheumatology The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia
Bambang Setyohadi
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Medicine & Pharmacology

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Mycophenolate mofetil versus cyclophosphamide for therapy of lupus nephritis: an evidence-based case report from systematic reviews and meta-analyses Pramono, Laurentius A.; Karim, Birry; Rajabto, Wulyo; Siregar, Parlindungan; Sukmana, Nanang; Setyohadi, Bambang
Medical Journal of Indonesia Vol 21, No 1 (2012): February
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (402.305 KB) | DOI: 10.13181/mji.v21i1.474

Abstract

Background: The aim of this case study is to compare the effectiveness between cyclophosphamide and mycophenolate mofetil to achieve remission of lupus nephritis in an evidence-based case report from meta-analyses.Methods: Method in this case study is evidence-based case report using meta-analyses. Clinical question used in this paper is; which immunosuppressant gives better result in achieving remission in lupus nephritis patient: cyclophosphamide or mycophenolate mofetil? To answer this question, we search the evidence from PubMed with the keywords: “lupus nephritis AND mycophenolate mofetil AND cyclophosphamide” with inclusion criteria of meta-analysis, written in English, and focused comparing cyclophosphamide and mycophenolate mofetil.Results: From the searching method, we found 11 articles which is relevant. One has been excluded since it written in Hebrew, 4 articles excluded since are not focus answering the clinical question. At the end, 6 studies were included to the critical appraisal step.Conclusion: Based on the evidences, mycophenolate mofetil is non-inferior to cyclophosphamide in achieving remission in lupus nephritis patients, but with the better safety profile. Patient in our case study get mycophenolate mofetil and shows better clinical condition towards remission as she are evaluated in the outpatient clinic. (Med J Indones 2012;21:44-51)Keywords: Cyclophosphamide, evidence-based case report, lupus nephritis, meta-analysis, mycophenolate mofetil, remission, systematic review
Chronic Osteomyelitis of Wrist Joint in An Immunocompromised Host Utari, Amanda P; Oktavia, Dina; Sumaryono, Sumaryono; Setyohadi, Bambang
Indonesian Journal of Rheumatology Vol 5, No 1 (2014)
Publisher : Indonesian Rheumatology Association

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Abstract

Osteomyelitis is heterogenous in its pathophysiology, clinical presentation, and management. Osteomyelitis is generally categorized as acute or chronic based on histopathologic findings, rather than duration of the infection. Necrotic bone ispresent in chronic osteo-myelitis, and symptoms may not occur until six weeks after the onset of infection.1 Epidemiology of chronic osteomyelitis is less well characterized compared with acute osteomyelitis. Adult osteomyelitis most commonly arisesfrom open fractures, diabetic foot infections, or the surgical treatment of closed injuries. Hematogenous  osteomyelitis accounts for approximately 20% of cases of osteomyelitis in adults. It is more common in males regardless of age. Although rare in adults,it most frequently involves the vertebral bodies.2 S.aureus is the most common isolate in all types of bone infection and is implicated in 50-70% of cases of chronic osteomyelitis.3
Osteomalacia Induced by Renal Tubular Acidosis Type 1 Sihombing, Steven Sutanto; Ariane, Anna; Wibowo, RM Suryo Anggoro Kusumo; Setyohadi, Bambang
Indonesian Journal of Rheumatology Vol 9, No 2 (2017)
Publisher : Indonesian Rheumatology Association

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Abstract

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; Hypophosphatemia
The effect of disease duration on the incidence of peripheral arterial disease in young adults with systemic lupus erythematosus Merlyn, M; Setyohadi, Bambang; Soebardi, S; Harimurti, K
Indonesian Journal of Rheumatology Vol 4, No 1 (2013)
Publisher : Indonesian Rheumatology Association

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Abstract

Background: Peripheral arterial disease is a chronic complication that affects morbidity and mortality in SLE patient. However, there were only a few of researches studying the relationship of disease duration and  peripheral arterial disease event overseas and it hasnever been studied in Indonesia.Objectives: To obtain information about the increased event of peripheral arterial disease in women of 40 years old or younger with SLE’s duration of five years or longer compared with less than five years.Methods: This was a case control study conducted between June - August 2012 at Cipto Mangunkusumo hospital, Jakarta. Subjects were women of 40 years old or younger with SLE who visited Rheumatolgy and Allergy-Immunlogy outpatient clinic. They were assignedto case and control groups and traced retrospectively using interview and medical record. The relationship between disease duration and peripheral arterial disease was estimated using OR and the role of confounding factors was analysed using logistic regression one byone, resulted in fully adjusted OR.Results: A total of 90 subjects were recruited, 18 subjects in case group and 72 subjects in control group.Traditional risk factors were similiar in both groups. In multivariat analysis, there was a relationship between disease duration 5 years or longer and peripheral arterialdisease with fully adjusted OR 1,9 (95%CI 0,575-6,543). Older age and steroid therapy were the confounding factors.Conclusion: There was an increased event of peripheral arterial disease in women of 40 years old or younger with SLE’s duration five years or longer compared withsubjects having the disease duration less than five years, but this increase was not statistically significant.Keywords: Peripheral arterial disease, lupus erythematosus systemic, disease duration
The Use of Tocilizumab in Combination with Methotrexate in Indonesian Rheumatoid Arthritis Patients (PICTURE INA Study) Setyohadi, Bambang; Isbagio, Harry; Wachjudi, Rachmat Gunadi; Soeroso, Joewono; Kalim, Handono; Achadiono, Deddy Nur Wachid
Indonesian Journal of Rheumatology Vol 10, No 1 (2018)
Publisher : Indonesian Rheumatology Association

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Abstract

Background Aim of this research is to assess the efficacy and safety of tocilizumab (TCZ) in combination with methotrexate (MTX) in Indonesian patients with moderate to severe active rheumatoid arthritis (RA) who have an inadequate response to non-biologic DMARDs.Methods This was a interventional, prospective, single arm, multicenter, study in  Indonesian male or female patients aged ≥ 18 years old, with a diagnosis of RA for > 6 months based on ACR 1987 revised criteria with moderate to severe disease activity (DAS28 score > 3.2) after ≥ 12 weeks of non-biologic DMARDs treatment. The treatment consisted of tocilizumab, 8 mg/kg, intravenous (IV), every 4 weeks for a total of 6 infusion in combination with oral MTX (10−25 mg) every week. Efficacy was assessed based on the percentage of patients achieving low disease activity state (DAS28 < 3.2), percentage of patients achieving reduction > 1.2 point of DAS28, percentage of patients achieving remission (DAS28 < 2.6), and percentage of patients with ACR20, ACR50, and ACR70 responses. Descriptive statistics will be used for presentation of results.Results 100% patients reached low disease activity (DAS28 ≤ 3.2) at last study visit (week 24) and clinically significant improvement (reduction at least 1.2 units) at every visit in DAS28, both for ITT or PP patients. Remission (DAS28 < 2.6) was observed in 82.1% (ITT patients) and 93.1 % (PP patients) on last study visit. ACR20, ACR50, and ACR70 were achieved in 20%, 34%, and 34% (ITT patients), and 7%, 24%, and 62% (PP patients) on week 24. There were 3 out of 39 patients (7.69%) with adverse events (AE) and serious adverse events (SAE) that resulted in discontinuation of TCZ treatment, consisting of 1 patient with SAE of sepsis ec acquired community pneumonia, 1 patient with SAE of pneumonia tuberculosis, and 1 patient with AE of candidiasis. Most common adverse events were hepatic dysfunction (30.7%), hypercholesterolemia (23.1%), followed by arthralgia (20.5%) Twelve percent of patients needed dose modification due to elevated liver enzyme (elevated ALT/SGPT level).Conclusion Tocilizumab seems to be efficacious and likely to have good safety profile in non- biologic DMARD nonresponsive RA patients of PICTURE INA study.   Keywords: Rheumatoid Arthritis, Tocilizumab, DMARD, DAS28
Osteoarticular Tuberculosis: A Secondary Manifestations to Tuberculous Pleural Effusion Singh, Gurmeet; Rumende, Cleopas M; Setyohadi, Bambang
Indonesian Journal of Rheumatology Vol 5, No 1 (2014)
Publisher : Indonesian Rheumatology Association

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Abstract

Tuberculosis appears to be increasing throughout the world after years of continuous decline, despite the introduction of effective chemotherapy. This resurgence is related to the increasing number of patients immunocompromised by chemotherapeutic agents used to treat other diseases or Acquired Immunodeficiency Syndrome (AIDS); the appearance of multiple drug-resistant strains of tuberculosis, and aging population. Musculoskeletal tuberculosis arises from haematogenous seeding of the bacilli soon after the initial pulmonary infection.1 Osteoarticular TB can occur in the knee - one study found of 1074 cases, 8.3 percent - or 90 cases - affected the knee.2 The clinical  symptoms are insidious onset, pain, swelling of the joint and limited range of movements. Investigations for suspected cases include: Mantoux test, radiological imaging, fine needle aspiration biopsy, surgical biopsy, bacteriological examination, histopathological examination, and polymerase chain reaction (PCR) of a suitable specimen. The mainstay of treatment is multidrug antitubercular chemotherapy. The main reason for poor outcome is delayed diagnosis.1 We report a case of osteoarticular manifestation of tuberculosis infection affecting the left knee presenting in a man with a history of tuberculosis pleural effusion. This case highlights, firstly, osteoarticular disease is always secondary to a primary lesion in the lung and, secondly, the diagnosis of tubercular arthritis can be challenging, particularly in the presence of confounding factors such as preexisting arthritis. Ethical approval was not required for this case study.
Management of Salmonella Septic Bursitis in Renal Transplant Recipient Prasetya, Albert; Ariane, Anna; Setyohadi, Bambang
Indonesian Journal of Rheumatology Vol 10, No 1 (2018)
Publisher : Indonesian Rheumatology Association

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Abstract

Salmonella as a causative agent in septic bursitis is considered rare. We report a case of 56 years old male with history of renal transplantation and using mycophenolate mofetil, cyclosporine and methylprednisolone as maintenance, admitted due to 3-week-fever associated with tenderness and swelling on left shoulder. Upon investigation, a diagnosis of septic bursitis was established. Salmonella enteritidis as the definitive causative agent was revealed. He was treated with meropenem 1g IV three times daily and levofloxacin 500 mg IV once a day for 3 weeks, followed by oral ciprofloxacin 500 mg twice a day for 2 weeks and oral metronidazole 500 mg three times a day for 1 week with a total duration of 5 weeks of antibiotics. On the subsequent follow up there was no recurrence episode of fever and the swelling of the left shoulder subsided, no tenderness noted and the patient has no limitation of range of movement. Since immunocompromised state complicates the management, the duration of therapy may twice longer than the typical management of septic bursitis. Salmonella as etiologic agent should be considered as differential in immunocompromised patient with septic bursitis.Keywords: Immunocompromised state, septic bursitis, deep bursae, Salmonella, duration of therapy.
Effect of Folic Acid Supplementation for Reducing Methotrexate Side Effects in Patients with Rheumatoid Arthritis: an Evidence-based Case Report Athira Presialia; Bambang Setyohadi
Indonesian Journal of Rheumatology Vol. 12 No. 2 (2020): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ijr.v12i2.113

Abstract

Background: Rheumatoid arthritis is a chronic inflammatory joint disease,indicated by a symmetrical erosive synovitis. Disease-modifying anti-rheumaticdrugs (DMARDs) are known to interfere with signs and symptoms of RA, improvephysical function and therefore increase patient productivity. Methotrexate is ananchor drug for rheumatoid arthritis patients, however, its related mechanism ofaction with folate deficiency resulting in some side effects, includinggastrointestinal and liver toxicity. Folic acid supplementation may reduce theseside effects. Method: A search was conducted on Pubmed, Cochrane, EBSCOhost,and ProQuest. After the selection of title and abstract was done using inclusionand exclusion criteria, which led to one relevant article. The selected study wascritically appraised for its validity, importance, and applicability. Result: Inrheumatoid arthritis patient receiving methotrexate, there was a statisticallysignificant reduction in the incidence of abnormal transaminase elevation (RR:0.19, 95% CI: 0.10-0.36), but the reduction in gastrointestinal side effects did notreach statistical significance (RR: 0.76, 95% CI: 0.57-1.01) Conclusion: Folic acidsupplementation has an effect in reducing gastrointestinal and liver toxicity as sideeffects of methotrexate in rheumatoid arthritis patients.
Non-Steroidal Anti-Inflammatory Drugs Prescribing in Patient with Gastrointestinal Risk Aryanto Basuki; Sumaryono Sumaryono; Bambang Setyohadi; Armen Muchtar; Ari Fahrial Syam
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 1, April 2006
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/71200616-20

Abstract

Conventional NSAID treatment has been consistently associated with gastrointestinal complications including dyspepsia syndrome, gastric ulcer, and upper gastrointestinal tract bleeding. There are some risk factors correlated to these complications, i.e. elderly age, previous history of gastric ulcer, concomitant use with steroid, multiple NSAID administration, high-dose NSAID and concomitant use with anticoagulant. NSAID prescribing with consideration of patient’s risk factor is necessary in order to decrease gastrointestinal complications. Combination therapy of NSAID and mucoprotector agent may be considered to prevent or to treat the NSAID- induced gastrointestinal ulcer Keywords: prescribing, NSAID, gastrointestinal risk
Bone Mass Density in HIV/AIDS Patients Mulansari, Nadia Ayu; Sukmana, Nanang; Setyohadi, Bambang; Setiati, Siti
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 4
Publisher : UI Scholars Hub

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Abstract

Co-Authors Achadiono, Deddy Nur Wachid Aldo F Marsetyo, Aldo F Amanda P Utari, Amanda P Andri M.T. Lubis Anna Ariane, Anna Ari Fahrial Syam Ari Fahrial Syam Armen Muchtar Armen Muchtar Aryanto Basuki Athira Presialia Birry Karim Carles Siagian, Carles Cleopas M Rumende, Cleopas M Dina Oktavia E Mudjaddid, E Erick Wonggokusuma, Erick Esthika Dewiasty, Esthika Findy Prasetyawaty, Findy Gurmeet Singh Handono Kalim Harimurti, K Harry Isbagio Ikhwan Rinaldi Joewono Soeroso Laurentius A. Pramono Lugyanti Sukrisman Marcel Prasetyo Merlyn, M Myra Puspitasari, Myra Nabil Mubtadi Falah, Nabil Mubtadi Nadia Ayu Mulansari, Nadia Ayu Nanang Sukmana Parlindungan Siregar Prasetya, Albert Rachmat Gunadi Wachjudi Rudi Putranto Rudy Hidayat Siti Setiati Soebardi, S Steven Sutanto Sihombing Sumaryono Sumaryono Sumaryono Sumaryono Wibowo, RM Suryo Anggoro Kusumo Wulyo Rajabto