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All Journal Indonesian Journal of Rheumatology Indonesia Journal of Physical Medicine and Rehabilitation Indonesia Journal Physical Medicine and Rehabilitation
Rachmat Gunadi Wachjudi
Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Padjadjaran Rumah Sakit Umum Pusat Hasan Sadikin Bandung
Decision Sciences, Operations Research & Management Medicine & Pharmacology Neuroscience Physics

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Correlation Between Serum Procollagen Type 1 N-Terminal Propeptide Level With Modified Rodnan Skin Score In Systemic Sclerosis Patients. Vincent, Vincent; Dewi, Sumartini; Wachjudi, Rachmat Gunadi
Indonesian Journal of Rheumatology Vol 9, No 2 (2017)
Publisher : Indonesian Rheumatology Association

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Abstract

Introduction: Systemic Sclerosis (SSc) is a chronic autoimmune disease, characterized by vasculopathy, specific autoimmune, and fibrosis. Assesment of skin fibrosis by modified Rodnan Skin Score (mRSS) can not detect the minimal changes of skin fibrosis within lessthan 3 months. A biomarker is needed to assess the minimal changes of skin fibrosis progressivity with a more objective, quantitative, and rapid way. Procollagen type-1 N-Terminal Propeptide (P1NP), a degradation product of collagen type-1, may become a potential biomarker for skin fibrosis. This study aims to evaluate the correlation between skin fibrosis by mRSS with P1NP serum in systemic sclerosis.Methods: This was a cross-sectional study performed among systemic sclerosis patients at Rheumatology outpatient clinic, Dr.Hasan Sadikin Hospital Bandung, from May 2016 to July 2016. Skin fibrosis was measured by mRSS. P1NP level was determined by ELISA. Data were analyzed using Rank-Spearman Correlation.Result: There were thirty-seven subjects, with mean age 37 (SD ±7) years old. Most of subjects were female (91.9%). Subjects consisted of 23 (62.2%) limited SSc and 14 (37.8%) diffuse SSc. Six subjects (16.2%) were DMARD naïve. We found median (range) P1NP serum was 43.85 (9.81-127.90) ng/dL, while the median of MRSS was 14 (3-36). There is a moderate correlation between MRSS and P1NP serum (r=0.443, p=0.003)Conclusion: There was a significant correlation between mRSS and P1NP serum in systemic sclerosis patient at Dr. Hasan Sadikin Hospital Bandung.Keywords: systemic sclerosis, P1NP, modified rodnan skin score
Calcinosis and myocarditis in systemic lupus erythematosus patient Dewi, Sumartini; Wachjudi, Rachmat Gunadi
Indonesian Journal of Rheumatology Vol 2, No 1 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Systemic lupus erythematosus (SLE) patients have multi-organ involvement related to their chronic inflammatory, autoimmune disease. Calcinosis can be clinical manifestations of SLE. Tissue calcinosis is reported in approximately 17% patients and myocarditis in 20-55% patients. Thus, both manifestations are not unusual in SLE. Tachypnea, tachycardia, pericardial effusion, and wheezing are often present and can be misleading in SLE patient.1,2 Calcinosis is less common in SLE, sometimesit is found as an incidental radiological finding. Calcification in SLE maybe periarticular, within joints or muscles, or in the subcutis (calcinosis universalis).1 Calcinosis is classified into four subsets: dystrophic, metastatic, idiopathic, or calciphylaxis/iatrogenic. When calcinosis cutis is isolated to a small area in extremities and joints, it is called calcinosis circumscripta; whereas its diffuse form, refers to calcinosis universalis, affects subcutaneous and fibrous structures of muscles and tendons. The pathophysiology of this condition is unknown and no effective therapy is currently available.3,4,5 Systemic lupus erythematosus can involve the myocardium, pericardium, cardiac valves,and coronary arteries. Myocarditis in SLE is not likely to produce major regional wall motion abnormalities but may contribute to global left ventricular dysfunction.7,8We report a young woman with SLE who developed calcinosis and myocarditis.
Correlation of sCD40L Level with Force Vital Capacity Value in Restrictive Lung Disease of Systemic Sclerosis Patients Salim, Susanto; Wachjudi, Rachmat Gunadi; Dewi, Sumartini
Indonesian Journal of Rheumatology Vol 10, No 1 (2018)
Publisher : Indonesian Rheumatology Association

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Abstract

Background: Interstitial Lung Disease (ILD) is one of the major cause of morbidity and mortality in Systemic Sclerosis (SSc). The gold standard to diagnose ILD is using High Resolution Computed Tomography (HRCT) scan. HRCT scan need a lot of cost and not always available, so another diagnosing test is needed as an alternative modality to diagnose ILD. ILD is a restrictive lung disease caused by lung fibrosis which is proved by the decrease of Forced Vital Capacity (FVC) in spirometry, and followed by the increase of soluble CD40L (sCD40L) level in plasma. This sCD40L may become a potential biomarker to evaluate lung fibrosis in SSc patients. The aim of this study is to analyze the correlation of sCD40L levels with FVC score in SSc patients with restrictive lung disease.Method:This cross sectional study was enrolled by the SSc patient who has restrictive lung disease based on spirometry test, at Rheumatology outpatient clinic dr. Hasan Sadikin Hospital from May 2015 to May 2016. All subject took underwent history, physical examination, spirometry and blood test for sCD40L. Data were analyzed using Pearson correlation.Result:There were 38 subjects involved in this study, dominated bywoman (92.1%) with mean age 41(±11) years. Subjects consist of 22(57,9%) with limited SSc, 16(42,1%) with diffuse SSc patients and 33 subjects treated with DMARD. Mean sCD40L serum in this study was 6.690,3(±2.377,3) pg/mL, with no statistical difference between limited and diffuse type (p=0.154). Mean FVC score in this study was 58.2(±10,8). There was no significant correlation between sCD40L serum with FVC (r=0.058; p=0.366). There was weak correlation on DMARD naïve subject between sCD40L serum and FVC (r=0.058; p=0.366) but statistically insignificant. There was no significant correlation between sCD40L serum with mRSS (r=0,066; p=0,346).Conclusion: This study founds no correlation between sCD40L with FVC in SSc at dr. Hasan Sadikin Hospital. Keyword : sCD40L, Forced Vital Capacity, Restrictive Lung Disease, Systemic Sclerosis
The Effect of Vitamin D Supplementation on Disease Activity and Neutrophyl-Lymphocyte Count Ratio in Systemic Lupus Erythematosus Patients with Hypovitaminosis D : A Preliminary Study Maslim, Y; Dewi, Sumartini; Oehadian, A; Wachjudi, Rachmat Gunadi
Indonesian Journal of Rheumatology Vol 5, No 1 (2014)
Publisher : Indonesian Rheumatology Association

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Abstract

Background : Previous studies showed a significant role of Vitamin D in modulating inflammation and immune abnormality in SLE. The correlation between vitamin D supplementation and SLE disease activity remains controversy. Neutrophyl-Lymphocyte count Ratio (NLCR) as an inflammation marker was significantly increased in SLE patients.Objective : To evaluate the effect of vitamin D supplementation on disease activity and neutrophyllypmhocyte count ratio (NLCR) in SLE patients with hypovitaminosis D.Methods : This is a pre-post test study without control group using a consecutive sampling method. SLE patients were enrolled from Rheumatology Clinic of HasanSadikin General Hospital from November 2013-March 2014. Subjects received vitamin D3 2000 IU/day for 3 months. Data was analyzed using Wilcoxon test.Results : We analyzed 28 subjects with 89,3% of vitamin D deficiency and 10,7% of vitamin D insufficiency, which converted to 25% of vitamin D deficiency, 32,1% vitamin D insufficiency and 42,9% normal vitamin D plasma level at the end of the study.After supplementation, Mexican Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI) and NLCR was significantly decreased (median 4(3-8) to 2(0-6) and median 2,95(1,17-7,27) to 2,28 (1,07-4,87), p<0,001, respectively). SLE organ involvement such as mucocutan, hematology and renal also high BMI (>23 kg/m2) were risks of hypovitaminosis D. Vitamin D supplementation increased mean 25(OH)D serum level by 164,7%, 46,7% decreased of MEX-SLEDAI, and 24,2% decreased of NLCR (p<0,001). Nine subjects (32,1%) achieved remission, 19 subjects (67,9%) atdisease persistence and no subjects experienced flare up after supplementation.Conclusion : The effects of vitamin D3 2000 IU/day supplementation for 3 months are reduced disease activity and NLCR in SLE patients with hypovitaminosisD. The role of NLCR as a simple inflammation marker in this pilot study needs further investigation.
Comorbidities in patients with gout in rheumatology clinic Dr. Hasan Sadikin general hospital in 2012 - 2013 Limanjaya, W R; Wachjudi, Rachmat Gunadi; Tansah, H
Indonesian Journal of Rheumatology Vol 8, No 1 (2016)
Publisher : Indonesian Rheumatology Association

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Abstract

Background: Gout is a metabolic disease manifested mainly as an intense monoarticular inflammatory reaction which is strongly associated with hyperuricemia. Latest evidence showed that uric acid exerted effects on the development of other diseases. Many studies in developed countries had estimated the frequency of comorbidities associated with gout suchas hypertension, obesity, diabetes mellitus, Chronic Kidney Disease (CKD), and Myocardial Infarct (MCI). However, no data regarding these frequencies have been found in Indonesia up to now to the best of the author’s knowledge. This study aimed to establish thefrequency of these comorbidities in patients with gout in Rheumatology Clinic Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.Methods: All medical records of patients with gout in Rheumatology Clinic Dr. Hasan Sadikin General Hospital from January 2012 to December 2013 were collected. The data on blood pressure; Body Mass Index (BMI); random blood glucose, fasting blood glucose or 2 hourspost prandial blood glucose; history of myocardial infarction; and creatinine were taken and analyzed to determine the presence of comorbidities Results: Among all patients with gout in Rheumatology Clinic Dr. Hasan Sadikin General Hospital, 53.08% had chronic kidney disease, 42.73 % had hypertension, 25.39% had diabetes mellitus, 15.70% had myocardial infarction and 12.22% had obesity.Conclusions: Comorbidities commonly found in patients with gout in order of frequency were chronic kidney disease, hypertension, diabetes mellitus, myocardial infarct, and obesity.Keywords: gout, comorbidities, frequency.
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
Correlation Betweeen Skin Fibrosis Based On Modified Rodnan Skin Score And B-Cell Activating Factor Serum In Systemic Sclerosis Alfarish, M Arzan; Dewi, Sumartini; Hamijoyo, Laniyati; Wachjudi, Rachmat Gunadi
Indonesian Journal of Rheumatology Vol 9, No 1 (2017)
Publisher : Indonesian Rheumatology Association

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Abstract

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.Keywords: mRSS, BAFF, Systemic Sclerosis
Effectivity and safety of mahkota dewa fruit extract compared to meloxicam (phaleria macrocarpa fructus) on osteoarthritis Rahmadi, Andri Reza; Dewi, Sumartini; Nawawi, A; Adnyana, I K; Wachjudi, Rachmat Gunadi
Indonesian Journal of Rheumatology Vol 8, No 1 (2016)
Publisher : Indonesian Rheumatology Association

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Abstract

Background: Osteoarthritis (OA) is the most common musculoskeletal disease. World Health Organization (WHO) estimates that 10% of the aged over 60 year population have this disease. The aim of OA treatment is to reduce pain, which is the most OA patients chiefcomplaint. People in Indonesia are very interested in use of herbal therapies from original traditional plant to treat pain now, one of the traditional plants that are known havea benefit is Phaleria macrocarpa or Mahkota Dewa fruit. Phaleria macrocarpa has been shown to decrease the degree of inflammation of OA animal model experiments. In order to know what is the effect of this fruit extract to reduce degrees of pain and change the levels of IL-1, IL-6, TNF-α in the blood as the marker of inflammation of patients with knee OA, and what is the effects to liver, kidney and haematology in the Indonesian population hasnot been investigated Methods: The research method is an experimental study and the research design is PROBE (Prospective Randomized Open End Blinded Evaluation), to evaluate the efficacy of the extract Mahkota Dewa fruit (Phaleria macrocarpa fructus) 330 mg (Super Mahkota POMTR 053 345 491) compared to meloxicam 7.5 mg in patients with knee osteoarthritis. The study population was outpatients with knee OA at Rheumatology Clinic Dr Hasan Sadikin Hospital Bandung. Patients are given Phaleria macrocarpa 330 mg or meloxicam 7.5 mg once a day for 14 days. Observations were made to evaluate the degree of pain as measured by VAS and Lequesne index at day 0, day 14 and measured again at day 28,after they are not taking the extract anymore.Results: Phaleria macrocarpa 330 mg is equal to meloxicam 7.5 mg in reducing the degree of pain as measured by VAS (p=0.78) and the Lequesne index (p=0.51). Our finding, t here is no effect of decreasing the proinflammatory cytokine IL-1 (p=0.72), IL-6(p=0.53) and TNF-α (p=0.07) in the blood of both groups. Safety analysis shown that this extract is safe for consumption.Conclusions: Phaleria macrocarpa 330 mg equal to meloxicam 7.5 mg in reducing the degree of pain however there is no effect on reducing proinflammatory cytokines in the blood of OA patients who had received therapy for 14 days in both groups. There is no adverse effects found on hematological, liver function and kidney function after consumption this plant’s fruit extract.Keywords: osteoarthritis, mahkota dewa, phaleria macrocarpa
Comorbidities in patients with gout in rheumatology clinic Dr. Hasan Sadikin general hospital in 2012 - 2013 W R Limanjaya; Rachmat Gunadi Wachjudi; H Tansah
Indonesian Journal of Rheumatology Vol. 8 No. 1 (2016): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (265.209 KB) | DOI: 10.37275/ijr.v8i1.7

Abstract

Background: Gout is a metabolic disease manifested mainly as an intense monoarticular inflammatory reaction which is strongly associated with hyperuricemia. Latest evidence showed that uric acid exerted effects on the development of other diseases. Many studies in developed countries had estimated the frequency of comorbidities associated with gout suchas hypertension, obesity, diabetes mellitus, Chronic Kidney Disease (CKD), and Myocardial Infarct (MCI). However, no data regarding these frequencies have been found in Indonesia up to now to the best of the author’s knowledge. This study aimed to establish thefrequency of these comorbidities in patients with gout in Rheumatology Clinic Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.Methods: All medical records of patients with gout in Rheumatology Clinic Dr. Hasan Sadikin General Hospital from January 2012 to December 2013 were collected. The data on blood pressure; Body Mass Index (BMI); random blood glucose, fasting blood glucose or 2 hourspost prandial blood glucose; history of myocardial infarction; and creatinine were taken and analyzed to determine the presence of comorbidities Results: Among all patients with gout in Rheumatology Clinic Dr. Hasan Sadikin General Hospital, 53.08% had chronic kidney disease, 42.73 % had hypertension, 25.39% had diabetes mellitus, 15.70% had myocardial infarction and 12.22% had obesity.Conclusions: Comorbidities commonly found in patients with gout in order of frequency were chronic kidney disease, hypertension, diabetes mellitus, myocardial infarct, and obesity.Keywords: gout, comorbidities, frequency.
Effectivity and safety of mahkota dewa fruit extract compared to meloxicam (phaleria macrocarpa fructus) on osteoarthritis Andri Reza Rahmadi; Sumartini Dewi; A Nawawi; I K Adnyana; Rachmat Gunadi Wachjudi
Indonesian Journal of Rheumatology Vol. 8 No. 1 (2016): Indonesian Journal of Rheumatology
Publisher : Indonesian Rheumatology Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (293.214 KB) | DOI: 10.37275/ijr.v8i1.9

Abstract

Background: Osteoarthritis (OA) is the most common musculoskeletal disease. World Health Organization (WHO) estimates that 10% of the aged over 60 year population have this disease. The aim of OA treatment is to reduce pain, which is the most OA patients chiefcomplaint. People in Indonesia are very interested in use of herbal therapies from original traditional plant to treat pain now, one of the traditional plants that are known havea benefit is Phaleria macrocarpa or Mahkota Dewa fruit. Phaleria macrocarpa has been shown to decrease the degree of inflammation of OA animal model experiments. In order to know what is the effect of this fruit extract to reduce degrees of pain and change the levels of IL-1, IL-6, TNF-α in the blood as the marker of inflammation of patients with knee OA, and what is the effects to liver, kidney and haematology in the Indonesian population hasnot been investigated Methods: The research method is an experimental study and the research design is PROBE (Prospective Randomized Open End Blinded Evaluation), to evaluate the efficacy of the extract Mahkota Dewa fruit (Phaleria macrocarpa fructus) 330 mg (Super Mahkota POMTR 053 345 491) compared to meloxicam 7.5 mg in patients with knee osteoarthritis. The study population was outpatients with knee OA at Rheumatology Clinic Dr Hasan Sadikin Hospital Bandung. Patients are given Phaleria macrocarpa 330 mg or meloxicam 7.5 mg once a day for 14 days. Observations were made to evaluate the degree of pain as measured by VAS and Lequesne index at day 0, day 14 and measured again at day 28,after they are not taking the extract anymore.Results: Phaleria macrocarpa 330 mg is equal to meloxicam 7.5 mg in reducing the degree of pain as measured by VAS (p=0.78) and the Lequesne index (p=0.51). Our finding, t here is no effect of decreasing the proinflammatory cytokine IL-1 (p=0.72), IL-6(p=0.53) and TNF-α (p=0.07) in the blood of both groups. Safety analysis shown that this extract is safe for consumption.Conclusions: Phaleria macrocarpa 330 mg equal to meloxicam 7.5 mg in reducing the degree of pain however there is no effect on reducing proinflammatory cytokines in the blood of OA patients who had received therapy for 14 days in both groups. There is no adverse effects found on hematological, liver function and kidney function after consumption this plant’s fruit extract.Keywords: osteoarthritis, mahkota dewa, phaleria macrocarpa
Co-Authors A Nawawi A Oehadian Achadiono, Deddy Nur Wachid Adnyana, I K Alfarish, M Arzan Andri Reza Rahmadi Andri Reza Rahmadi Andri Reza Rahmadi, Andri Reza Anna Tjandrawati Arie Taufik Bambang Setyohadi Bambang Setyohadi Deddy Nur Wachid Achadiono Dewi, Sumartini Dian Marta Sari Guntur Darmawan H Tansah Habib Burahman Handono Kalim Handono Kalim Harry Isbagio Harry Isbagio I K Adnyana Irma Ruslina Defi Irsan Agung Ramdhani Joewono Soeroso Joewono Soeroso Laniyati Hamijoyo Laniyati Hamijoyo Laniyati Hamijoyo Laniyati Hamijoyo Laniyati Hamijoyo Laniyati Hamijoyo, Laniyati Limanjaya, W R M Arzan Alfarish Maslim, Y Nadia Gita Ghassani Nawawi, A Oehadian, A Putri Vidyaniati Salim, Susanto Stefanie Yuliana Usman Sumartini Dewi Sumartini Dewi Sumartini Dewi Sumartini Dewi Sumartini Dewi Sumartini Dewi Sumartini Dewi Susanto Salim Tansah, H Vincent Vincent Vincent Vincent, Vincent W R Limanjaya Wisynu Tresnadi A.B Y Maslim