Indonesian Journal of Rheumatology
type: channel
description: Indonesian Journal of Rheumatology is a peer-reviewed open access journal on rheumatic diseases and connective tissue disorders. This is an official journal of Indonesian Rheumatology Association (IRA) and published twice a year since 2009. Our mission is to encourage the development of scientific and medical practice in rheumatic diseases and connective tissue disorders. This journal is self-focused on rheumatic disease and connective tissue disorders in the form of original article (extended and/or concise reports), review articles, editorial letters, leaders, lesson from memorable cases, book reviews, and matter arising. Both in clinical and laboratory including animal studies.
publisher: Indonesian Rheumatology Associantion
language: en
publication name: Indonesian Journal of Rheumatology
issn: 2086-1435
items: Hematological Parameters Comparison in Systemic Lupus Erythematosus Patients With and Without Nephritis
items: Intravenous Cyclophosphamide Infusion Effects on Skin Fibrosis, IL-6 and TGF-β1 Responses in Systemic Sclerosis with Interstitial Lung Disease
items: Analysis of Clinical and Demographic Predictors of Anxiety and Depression in Rheumatoid Arthritis Patients
items: Sarcoidosis Manifested as Recurrent Pericardial Effusion with Signs of ImpendingTamponade
items: Progressive Systemic Sclerosis with Interstitial Lung Disease Post Radio Ablationin Graves Disease's Patient: A Case Report
items: Pathogenesis, Clinical Presentations and Diagnosis of IgG4-related Disease: AReview
items: Difference between the Decrease in P1NP Concentration and MRSS Within 3Months Treatment of Systemic Sclerosis
items: Avascular Osteonecrosis in Systemic Sclerosis Patient: Risk Factors and Role ofVasculopathy?
items: Pseudogout Overlapping with Pre-Existing Joint Pathologies: A Case Series
items: Inflammatory Cascade in Aortic Wall: Latent Tuberculosis Complicating Takayasu Arteritis in a Young Bangladeshi Lady- The Silent Duo
items: The Characteristics of Septic Arthritis Patients at Dr. Kariadi Hospital Semarang
items: The Relationship between Disease Activity Level and the Incidence of Depression in Systemic Lupus Erythematosus Patients at Haji Adam Malik Hospital Medan
items: Indonesian Rheumatology Association (IRA) Recommendations for Diagnosis and Management of Hyperuricemia and Gouty Arthritis
items: Indonesian Rheumatology Association (IRA) Recommendations for Diagnosis and Management of Systemic Sclerosis
items: Behcet Disease: When Laryngeal Tuberculosis Unforeseably Strikes
items: Evidence Based Case Report: Secukinumab versus golimumab for Ankylosing Spondylitis Patients
items: Management of Non-Radiographic Axial Spondyloarthritis Cases with IL-17A Inhibitors
items: The The Correlation Between Serum Vitamin D Level and Quality of Life inSystemic Sclerosis Patients
items: Relationship Between Interleukin 6 (IL-6) and Organ Damage Based on SLICCDamage Index -SDI Score in Systemic Lupus Erythematosus Patients
items: Plasmapheresis as a Promising Therapeutic Option to TreatMacrophage Activation Syndrome
items: Correlation Between sCD28 and sCD80 Levels with Disease Actiity of SystemicLupus Erythematosus (SLE) Patients Based on SLEDAI Score
items: Is It Obesity or Metabolic Syndrome Which Has a Greater Prevalence ToCause Muscoloskeletal Complaints? A Cross Sectional Study in theCepokomulyo District, Malang Regency
items: Factors Contributed to a Difficult-To-Treat Juvenile IdiopathicArthritis: A Systematic Review and Meta Analysis
items: Massive Pericardial Effusion – An Uncommon Initial Presentation in aMale Patient With Systemic Lupus Erythematosus
items: Relationship between Knowledge Level and Preventive Behavior of SepticArthritis in Student Batch 2019-2020, Faculty of Medicine, University of NorthSumatra
items: Correlation between sCTLA-4 and sCD86 Levels with Disease Activity of SystemicLupus Erythematosus (SLE) Patients Based on SLEDAI Score
items: The The Role of 25-Hydroxy Vitamin D and Cartilage Oligomeric Matrix Protein(COMP) Serum in Knee Osteoarthritis
items: Initial Clinical Presentation of Systematic Lupus Erythematosus (SLE) Patientsin Cipto Mangunkusumo Hospital
items: Perfect Timing for Canakinumab Use in Gout
items: Acute Lupus Pneumonitis with Cytomegalovirus Co-infection in Patients withLupus Nephritis

Hematological Parameters Comparison in Systemic Lupus Erythematosus Patients With and Without Nephritis
type: item
description: Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disorder commonly complicated by hematological disorders and lupus nephritis (LN). Kidney impairment and chronic inflammation may affect erythropoiesis and red blood cell parameters. However, there is limited information on the short-term changes of hematological parameters in patients with and without LN. This study aimed to compare the short-term changes of hematological parameters between two clinical visits in patients with SLE with and without LN. Methods: This retrospective observational study used data from the Hasan Sadikin Lupus Registry in 2023. A total of 202 female patients with SLE aged 18 years and older with complete hematological data from two clinical visits were included. Hematological parameters included hemoglobin, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and red cell distribution width coefficient of variation (RDW-CV). Comparison of changes in parameters between the first and second visits was done separately for patients with and without LN using the Wilcoxon Signed Rank Test. Results: In patients with LN, there was a statistically significant reduction in MCHC between the first and second visits, whereas there were no significant changes in hemoglobin, hematocrit, MCV, MCH, and RDW-CV. In patients without LN, small but statistically significant changes were noted in hemoglobin, MCV, and MCHC. The degree of change was small and remained within the normal range. Conclusion: The short-term hematological parameters in patients with SLE are generally stable between two clinical visits. Only MCHC showed a significant change in patients with LN, indicating a selective and subtle hematological change rather than a global effect of LN. These results indicate a cautious interpretation of the short-term hematological changes and suggest that MCHC may be used as an auxiliary parameter for hematological ass…
subject: Articles
  topic: section
subject: Systemic Lupus Erythematosus
  topic: keywords
subject: Lupus Nephritis
  topic: keywords
subject: Anemia
  topic: keywords
subject: mean corpuscular hemoglobin concentration
  topic: keywords
subject: Hasan Sadikin Lupus Registry
  topic: keywords
subject: Systemic lupus erythematosus
  topic: subjects
subject: lupus nephritis
  topic: subjects
subject: anemia
  topic: subjects
subject: mean corpuscular hemoglobin concentration
  topic: subjects
subject: Hasan Sadikin Lupus Registry
  topic: subjects
creator: Alya Marsya Sabrina
creator: Edhyana Sahiratmadja
creator: Laniyati Hamijoyo
rights: Copyright (c) 2026 Indonesian Journal of Rheumatology
date: 2026-07-29
publication date: 2026-07-29
doi: 10.66446/ijr.v18i1.1

Intravenous Cyclophosphamide Infusion Effects on Skin Fibrosis, IL-6 and TGF-β1 Responses in Systemic Sclerosis with Interstitial Lung Disease
type: item
description: Background: Systemic sclerosis (SSc) is a chronic multisystem disease characterized by organ fibrosis, microvascular damage, and immunological dysregulation. This study aimed to evaluate the effects of intravenous cyclophosphamide (CYC) infusion on skin fibrosis severity, interleukin-6 (IL-6), and transforming growth factor-beta 1 (TGF-β1) levels in patients with SSc-associated interstitial lung disease (SSc-ILD), compared to conventional disease-modifying antirheumatic drug (DMARD) therapy. Methods: This study included patients meeting the 2013 ACR/EULAR classification criteria for SSc. Thirty-two patients (47.8%) received intravenous CYC, while 35 patients (52.2%) received conventional DMARDs. Skin fibrosis severity, assessed by the modified Rodnan skin score (mRSS), alongside serum IL-6 and TGF-β1 levels, were measured at baseline and after six months of therapy. Efficacy was evaluated by comparing post-treatment values to baseline measurements. Results: Both CYC and conventional DMARDs significantly reduced mRSS and serum TGF-β1 levels post-therapy. When comparing the two groups, the reduction in IL-6 levels demonstrated a trend toward statistical significance (p=0.051). Conclusion: Intravenous CYC therapy substantially reduces skin fibrosis (mRSS) and serum TGF-β1 levels in patients with SSc-ILD.
subject: Articles
  topic: section
subject: Systemic sclerosis
  topic: keywords
subject: Cyclophosphamide
  topic: keywords
subject: Skin fibrosis
  topic: keywords
subject: IL-6
  topic: keywords
subject: TGF-beta 1
  topic: keywords
subject: Systemic sclerosis
  topic: subjects
subject: Cyclophosphamide
  topic: subjects
subject: skin fibrosis
  topic: subjects
subject: IL-6
  topic: subjects
subject: TGF-beta 1
  topic: subjects
creator: Rakhma Yanti Hellmi
creator: Harry Isbagio
creator: Suharyo Hadisaputro
rights: Copyright (c) 2026 Indonesian Journal of Rheumatology
date: 2026-07-29
publication date: 2026-07-29
doi: 10.66446/IJR.v18i1.112

Analysis of Clinical and Demographic Predictors of Anxiety and Depression in Rheumatoid Arthritis Patients
type: item
description: Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease with substantial physical and psychological impact. Anxiety and depression are common comorbidities that may affect disease outcomes, but their association with disease activity remains inconsistent, particularly in Indonesia. Objective: This study aimed to analyze clinical and demographic predictors of anxiety and depression in RA patients, with emphasis on their association with disease activity measured by DAS28-CRP. Methods: A cross-sectional study was conducted on 58 RA patients at Royal Prima Hospital, Medan. Demographic and clinical variables were recorded. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), and disease activity was measured with DAS28-CRP. Associations were tested using logistic regression, and correlations were analyzed with Spearman’s rank test. Results: The mean age was 47.9 years, and 91.4% were female. Anxiety was identified in 19.0% and depression in 17.2% of participants. High DAS28-CRP was significantly associated with anxiety (OR 5.07; 95% CI 1.26–20.37; p=0.016). In multivariate analysis, DAS28-CRP remained the strongest predictor of anxiety (AOR 3.89; p=0.073), although not statistically significant. Depression was not associated with demographic or clinical characteristics. Spearman correlation showed a positive association between DAS28-CRP and anxiety scores (r=0.304; p=0.020), while the correlation with depression was weaker and not significant. Conclusion: Anxiety, but not depression, was associated with higher disease activity in RA patients. Routine psychological screening, particularly for anxiety, should be incorporated into RA management
subject: Articles
  topic: section
subject: rheumatoid arthritis, anxiety, depression, clinical predictors, demographic predictors
  topic: keywords
subject: rheumatoid arthritis, anxiety, depression, clinical predictors, demographic predictors
  topic: subjects
creator: Herlina Yani
rights: Copyright (c) 2026 Indonesian Journal of Rheumatology
date: 2026-07-29
publication date: 2026-07-29
doi: 10.66446/IJR.v18i1.102

Sarcoidosis Manifested as Recurrent Pericardial Effusion with Signs of ImpendingTamponade
type: item
description: Pericardial effusion is a fatal and life-threatening condition. If it is not addressed thoroughly, complications such as constrictive pericarditis may occur. Etiologies of pericardial effusion varied and one of the most common etiologies is tuberculosis. Other etiologies include inflammation, malignancy or other autoimmune disorder such as sarcoidosis. Sarcoidosis is a diagnosis of exclusion and is confirmed by biopsy result that showed non-caseating epitheloid-cell granuloma, with no other organism or particles. Epidemiology of sarcoidosis in Japan is 1-2 case per 100.000 patients, with the peak incidence between the age of 20 to 39 years old. We reported a case of 37 years old woman presented to our emergency department with shortness of breath and signs of pericardial tamponade. She was previously healthy with no other significant past medical. She was first treated as a case of extrapulmonary tuberculosis and shown no improvement with anti-tuberculosis medications. Several work ups were then done in search of other etiologies of her pericardial effusion. A biopsy form one of her abdominal lymph nodes was performed, which pathologically revealed sarcoidosis. She was placed on corticosteroid and methotrexate with improvement of symptoms. One month followed up showed complete resolution of her pericardial effusion.
subject: Articles
  topic: section
subject: Pericardial effusion
  topic: keywords
subject: Extrapulmonary tuberculosis
  topic: keywords
subject: Sarcoidosis
  topic: keywords
subject: Methotrexate
  topic: keywords
subject: Sarcoidosis_Manifested_as_Recurrent_Pericardial_Effusion_with_Signs_of_Impending Tamponade_
  topic: subjects
creator: Laniyati Hamijoyo
rights: Copyright (c) 2026 Indonesian Journal of Rheumatology
date: 2026-03-16
publication date: 2026-03-16
doi: 10.37275/IJR.v13i2.200

Progressive Systemic Sclerosis with Interstitial Lung Disease Post Radio Ablationin Graves Disease's Patient: A Case Report
type: item
description: Systemic sclerosis (SSc) is a connective tissue disease marked by degenerative microvascular abnormalities and immune system activation, resulting in skin and internal organ fibrosis. The link between thyroid problems and systemic sclerosis is unknown. Although several studies have demonstrated that patients with systemic sclerosis develop Graves' illness as the condition progresses, only a few have reported that Graves' patients develop progressive systemic sclerosis. It is an uncommon instance of multiple autoimmune illnesses in which SSc develops gradually after the birth of the first child and the patient had Graves' disease since the age of 17 and had thyroid ablation 5 years ago. SSc illness has a characteristic clinical appearance, involving the skin to the rest of the body and internal organs, particularly the lungs.
subject: Articles
  topic: section
subject: Systemic sclerosis
  topic: keywords
subject: Intertital lung disease
  topic: keywords
subject: Graves disease
  topic: keywords
subject: Progressive Systemic Sclerosis with Interstitial Lung Disease Post Radio Ablation in Graves Disease's Patient: A Case Report
  topic: subjects
creator: Maha Chakri Willheljulya
rights: Copyright (c) 2026 Indonesian Journal of Rheumatology
date: 2026-03-16
publication date: 2026-03-16
doi: 10.37275/IJR.v13i2.188

Pathogenesis, Clinical Presentations and Diagnosis of IgG4-related Disease: AReview
type: item
description: IgG4-Related Disease (IgG4RD) was identified by the International Classification of Diseases (ICD) in 2012. Numerous diseases, including Mikulicz’s disease, Kuttner’s tumor, Riedel’s thyroiditis, and Ormond’s disease, are pathologically associated with IgG4. Here, we present a review of the clinical presentation and pathogenesis of IgG4-associated disease. IgG4-RD term has been used to refer to a group of diseases involving multiple organs in which there is an abundant IgG4-positive lymphoplasmacytic infiltration, storiform fibrosis, obliterative phlebitis, and mild to moderate tissue eosinophilia, all of which show clinically as a tumefactive lesion, usually in more than one organ. IgG4 exhibits a unique property called an unstable disulfide bond between its heavy chain, as described by Fab-arm exchange which enables the recombination of a single IgG4 heavy chain with other IgG4 heavy chains, resulting in a bispecific antibody incapable of cross-linking and thus of forming an immune complex. IgG4-RD pathomechanism that causes serum IgG4 increase and tissue IgG4-plasma-cell deposition that is pathogenic, rather than the IgG4 itself. Genetic predisposition, autoimmunity, T-cell dysregulation, infection, and dysbiosis are just a few of the underlying pathomechanisms. Clinical symptoms are also frequently complex and may involve many organs. Confirmation of a diagnosis required a comprehensive anamnesis and examination.
subject: Articles
  topic: section
subject: IgG4-related disease
  topic: keywords
subject: Lymphoplasmacytic infiltrate
  topic: keywords
subject: Obliterative phlebitis
  topic: keywords
subject: Storiform fibrosis
  topic: keywords
subject: Tumefactive lesion
  topic: keywords
subject: Pathogenesis, Clinical Presentations and Diagnosis of IgG4-related Disease: A Review
  topic: subjects
creator: Perdana Aditya Rahman
rights: Copyright (c) 2026 Indonesian Journal of Rheumatology
date: 2026-03-16
publication date: 2026-03-16
doi: 10.37275/IJR.v13i2.189

Difference between the Decrease in P1NP Concentration and MRSS Within 3Months Treatment of Systemic Sclerosis
type: item
description: Introduction: Systemic sclerosis is characterized by extensive and progressive organ fibrosis leads to organ failure and death. Progression of skin thickening is a predictor of morbidity and mortality. Due to the limitation of modified Rodnan skin score (MRSS) sensitivity in detecting small changes in skin fibrosis, thus we proposed Procollagen Type I N-Terminal Propeptide (P1NP) as potential biomarker. This study aimed to analyze the difference between the decrease in P1NP concentration and MRSS within 3 months treatment of systemic sclerosis. Methods: We conducted a retrospective cohort of paired numerical comparative analytic methods, as follow up of a study done by Vincent et al. and Dewi et al. Analyzis of MRSS changes and serum P1NP concentrations were done prior to treatment (baseline), and on week 4th, 8th and 12th treatment. Result: Fifty-nine subjects were enrolled in the study. We analyzed the results of P1NP and MRSS at 4th, 8th and 12th weeks of treatment, there was a significant decrease in mean rank of P1NP and MRSS (p=0.033 and <0.001). The effect of MRSS change was greater than P1NP. The highest decreasing effect of MRSS was obtained at week 8th (η2 = 0.424, 42.4% decrease effect), and the largest decrease effect of P1NP was obtained at week 12th (η2 = 0.120; 12% decrease effect). Conclusion: There was a difference in decreasing P1NP concentrations and MRSS in systemic sclerosis within 3 months of observation. MRSS showed a larger decrease in change than P1NP after treatment.
subject: Articles
  topic: section
subject: Fibrosis
  topic: keywords
subject: MRSS
  topic: keywords
subject: P1NP
  topic: keywords
subject: Systemic Sclerosis
  topic: keywords
subject: Therapeutic Response
  topic: keywords
subject: Difference between the Decrease in P1NP Concentration and MRSS Within 3 Months Treatment of Systemic Sclerosis
  topic: subjects
creator: Devy Priyantini Hanafi
rights: Copyright (c) 2026 Indonesian Journal of Rheumatology
date: 2026-03-16
publication date: 2026-03-16
doi: 10.37275/IJR.v13i2.184

Avascular Osteonecrosis in Systemic Sclerosis Patient: Risk Factors and Role ofVasculopathy?
type: item
description: Avascular Necrosis (AVN) or osteonecrosis refers to the death of osteocytes and osteoblasts. Sites such as the femoral head, the head of the humerus and the mandibular with restricted access to local blood supply are particularly vulnerable to osteonecrosis. Various traumatic and non-traumatic causes of AVN are known, including systemic autoimmune diseases. Among traumatic causes, physical trauma, decompression sickness or radiation may be cited. In the non-trauma cases, two theories are disputed: the first concerns the occurrence of an intravascular coagulation and the second one attributes the ischemia to extravascular compression. AVN has been well described in patients with autoimmune diseases such as systemic lupus erythematosus, but in systemic sclerosis (SSc) patients, there have been limited case reports and case series. We present a case of a 32-year old woman with systemic sclerosis on corticosteroid and avascular osteonecrosis and elaborating possible etiologies or mechanism of avascular osteonecrosis in SSc.
subject: Articles
  topic: section
subject: Systemic sclerosis
  topic: keywords
subject: Avascular osteonecrosis
  topic: keywords
subject: Avascular Osteonecrosis in Systemic Sclerosis Patient: Risk Factors and Role of Vasculopathy
  topic: subjects
creator: Safarina Kharima Laitupa
rights: Copyright (c) 2026 Indonesian Journal of Rheumatology
date: 2026-03-16
publication date: 2026-03-16
doi: 10.37275/IJR.v13i2.162

Pseudogout Overlapping with Pre-Existing Joint Pathologies: A Case Series
type: item
description: Pseudogout, or calcium pyrophosphate deposition disease (CPPD), is a crystal-induced arthritis frequently mistaken for gout or septic arthritis, particularly in elderly patients or those with inflammatory disorders. We present two cases highlighting the diagnostic value of synovial fluid analysis and musculoskeletal ultrasonography (MSUS). A 34-year-old man diagnosed with ankylosing spondylitis presented with acute right knee pain after running; synovial fluid revealed rhomboid-shaped crystals with high leukocyte count, confirming pseudogout, while MSUS showed intra-cartilaginous crystal deposits. An 87-year-old man presented with mild left knee pain and swelling; synovial fluid again demonstrated rhomboid-shaped crystals, and MSUS confirmed intra-cartilaginous crystal deposition, consistent with pseudogout coexisting with osteoarthritis. These cases highlight the diagnostic challenges of acute monoarthritis in chronic inflammatory disease and advanced age, where inflammatory markers may mislead. Synovial fluid crystal analysis remains crucial, while MSUS offers a non-invasive alternative when aspiration poses challenges, ensuring accurate diagnosis and appropriate anti-inflammatory therapy.
subject: Articles
  topic: section
subject: Calcium pyrophosphate deposition disease
  topic: keywords
subject: Pseudogout
  topic: keywords
subject: Synovial fluid analysis
  topic: keywords
subject: Calcium pyrophosphate deposition disease
  topic: subjects
subject: Pseudogout
  topic: subjects
subject: synovial fluid analysis
  topic: subjects
subject: Musculoskeletal ultrasonography
  topic: subjects
subject: Osteoarthritis
  topic: subjects
creator: Johanda Damanik
creator: Rizki Fauzi Suskhan
creator: Rendy Asmaradhana Sahara
creator: Rudy Hidayat
creator: Suryo Anggoro Kusumo Wibowo
creator: Anna Ariane
creator: Faisal Parlindungan
creator: Abirianty Priandani Araminta
rights: Copyright (c) 2026 Indonesian Journal of Rheumatology
date: 2026-07-29
publication date: 2026-07-29
doi: 10.66446/IJR.v18i1.82

Inflammatory Cascade in Aortic Wall: Latent Tuberculosis Complicating Takayasu Arteritis in a Young Bangladeshi Lady- The Silent Duo
type: item
description: Takayasu disease or pulseless disease is a rare chronic granulomatous panarteritis of unknown aetiology affecting large vessels, particularly the aorta and its main branches. It mainly affects females more than males with the ratio of 8:1 and in the second and third decade of life. Mechanism may be transmural fibrous thickening of the arterial walls. Takayasu arteritis is characterized by inflammation of the vessel wall, leading to occlusion of the vessel wall. It is represented with claudication, fever, and arthralgia. Clinical features are chest pain, vascular bruits, hypertension. There is indirect evidence signifying a potential link between tuberculosis (TB) and Takayasu’s arteritis (TAK); however, the exact mechanism and relationship between TAK and Mycobacterium tuberculosis (TB) remain elucidated. This case intends to highlight the association between latent TB and TAK, as early detection can avoid devastating consequences.
subject: Articles
  topic: section
subject: Pulseless disease
  topic: keywords
subject: Granulomatous panarteritis
  topic: keywords
subject: Aorta
  topic: keywords
subject: Claudication
  topic: keywords
subject: Tuberculosis
  topic: keywords
creator: Richmond Ronald Gomes
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2026-02-25
publication date: 2026-02-25
doi: 10.37275/ijr.v17i2.71

The Characteristics of Septic Arthritis Patients at Dr. Kariadi Hospital Semarang
type: item
description: Background: Septic arthritis is an inflammatory disease caused by microbial infections such as bacteria, fungi, and viruses. Late diagnosis can lead to permanent joint damage, while overdiagnosis may result in unnecessary medical procedures. Although the incidence is relatively low, septic arthritis remains a medical concern due to its impact on joint function and patient quality of life. Determining the characteristics is needed to improve the diagnosis, treatment strategies, and prognosis of septic arthritis. Methods: This descriptive study utilized a retrospective design and was conducted on adult patients diagnosed with septic arthritis at dr. Kariadi General Hospital, Semarang, from January 2017 to August 2023. The analyzed variables included clinical manifestations, comorbidities, laboratory test results, synovial fluid analysis, synovial fluid culture, and antibiotic resistance. Results: Among the 49 patients, most were under 60 years old (67.4%) and male (61.2%). The knee joint was the most commonly affected site (87.8%) with the main symptoms such as joint pain, edema, and reduced range of motion (100%), along with inflammatory signs such as joint warmth (89.9%) and redness (83.7%). Synovial fluid analysis revealed that 53.06% of patients had cloudy and foul-smelling synovial fluid, with an average white blood cell count of 93,679.43/mm³ and a predominance of neutrophils (80.37%). Synovial fluid culture identified Staphylococcus aureus as the most common pathogen (34.7%), followed by Klebsiella pneumoniae (4.1%) and Salmonella sp. (2%). Antibiotic sensitivity tests showed Ampicillin/Sulbactam as the most effective treatment, while antibiotic resistance was observed in Gentamicin, Penicillin, and Linezolid. Conclusion: Staphylococcus aureus is the dominant pathogen, and rising antibiotic resistance remains a concern. Early diagnosis and targeted therapy are crucial for better patient outcomes.
subject: Articles
  topic: section
subject: Clinical manifestations
  topic: keywords
subject: Microbiological profile
  topic: keywords
subject: Septic Arthritis
  topic: keywords
subject: Synovial fluid analysis
  topic: keywords
creator: Zulfikar Alem Abdillah Malik
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2026-02-25
publication date: 2026-02-25
doi: 10.37275/ijr.v17i2.70

The Relationship between Disease Activity Level and the Incidence of Depression in Systemic Lupus Erythematosus Patients at Haji Adam Malik Hospital Medan
type: item
description: Background: Systemic Lupus Erythematosus (SLE) is a autoimmune disease that affects many organs of the body. SLE is a disease that cannot be completely cured. Life is difficult with SLE because the symptoms may come and go and it is unpredictable what will happen next. This condition causes the SLE patients feel unhappy, frustrated, angry, and sad. If this happens for a long time, it can cause SLE patients to experience depression. Methods: This study used a cross sectional design of 63 respondents at H. Adam Malik General Hospital Medan. This research data was obtained through history taking using primary data in the form of MEX SLEDAI questionnaires and Patient Health Questionnaire 9 (PHQ 9) and secondary data in the form of patient medical records. Results: It was found that SLE patients at H. Adam Malik General Hospital were all female, most of them were in the late adolescent age group with an age range of 17-25 years (39.7%), the last high school education level (68.3%), not working (81%), Married (54%), duration of SLE disease 1-2 years (36.5%), most SLE patients had mild disease activity levels (49.2%), most SLE patients have a mild depression (34,9%). There is a significant relationship between the level of disease activity and the incidence of depression in SLE patients at H. Adam Malik General Hospital (p ≤ 0.05) with a strong and unidirectional relationship (ρ = 0.64). Conclusion: There is a significant relationship between the level of disease activity and the incidence of depression in SLE patients at H. Adam Malik Hospital Medan with a strong relationship.
subject: Articles
  topic: section
subject: Systemic Lupus Erythematosus
  topic: keywords
subject: Disease
  topic: keywords
subject: Activity
  topic: keywords
subject: MEX-SLEDAI
  topic: keywords
subject: PHQ-9
  topic: keywords
creator: Yohansen Martunas Sagala
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2026-02-25
publication date: 2026-02-25
doi: 10.37275/ijr.v17i2.69

Indonesian Rheumatology Association (IRA) Recommendations for Diagnosis and Management of Hyperuricemia and Gouty Arthritis
type: item
description: Background: Gout is a progressive systemic disease caused by deposition of monosodium urate (MSU) crystals in various tissues such as joints, kidneys, and other connective tissues as a result of chronic hyperuricemia. If this condition is not adequately treated, it may progress to chronic gout, tophus formation, and even serious kidney function problems, which will lower quality of life. With the emergence of new treatment options in the last several years, a better understanding of diagnosis and management is required by every physician in Indonesia. Methods: A panel of eighteen selected rheumatologists from the Indonesian Rheumatologist Association (IRA) developed recommendations based on key questions formulated by a steering committee from IRA. These recommendation materials were taken from several online databases such as PubMed, Science Direct, and Google Scholar. Level of evidence and grades of recommendation were then assigned, and each member of the panellist team will assign a score to express their level of agreement. Results: A total of 16 recommendations discussing the diagnosis, non-pharmacological and pharmacological therapies, as well as monitoring for hyperuricemia and gouty arthritis were formulated. Conclusion: These recommendations can be used to help clinicians in accurately diagnosing hyperuricemia and gouty arthritis and choosing the most suitable therapy for their patients. All recommendation statements were tailored to the clinical setting, facility, and drug availability in Indonesia.
subject: Articles
  topic: section
subject: Hyperuricemia
  topic: keywords
subject: Gouty
  topic: keywords
subject: Arthritis
  topic: keywords
creator: Ida Ayu Ratih Wulansari Manuaba
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2026-02-25
publication date: 2026-02-25
doi: 10.37275/ijr.v17i2.68

Indonesian Rheumatology Association (IRA) Recommendations for Diagnosis and Management of Systemic Sclerosis
type: item
description: Background: Systemic Sclerosis (SSc) or Scleroderma is a systemic autoimmune rheumatic disease characterized by dysregulation of the immune system, fibrosis of the skin and visceral organs and vasculopathy. The global prevalence of SSc reaches 17.6 per 100,000 population and the incidence reaches 1.4 per 100,000 people per year. The prevalence and incidence of SSc in Asia reaches 6.8 per 100,000 and 0.9 per 100,000, which is lower than other continents. Women have a prevalence and incidence of SSc five times higher than men. The prevalence and incidence of SSc depends greatly on the results of the study. There has not been much research on the epidemiological studies of SSc in Indonesia. Methods: Twelve selected rheumatologists from the Indonesian Rheumatologist Association (IRA) made recommendations based on key questions formed by a steering committee from IRA. These recommendation materials were taken from several online databases such as PubMed, Science Direct, and Google Scholar. Level of evidence and grades of recommendation were then assigned, and every member of the panelist team will assign a score for level of agreement. Results: A total of 50 recommendations that discussed the diagnosis, pharmacological and non- pharmacological therapy, and prognosis for SSc were made. Conclusion: These recommendations can be used to help clinicians correctly diagnose and choose the most suitable therapy for SSc patients. All recommendation statements were created with the consideration of Indonesia’s clinical setting, facility, and drug availability.
subject: Articles
  topic: section
subject: Systemic Sclerosis
  topic: keywords
subject: diagnostic
  topic: keywords
subject: comorbidities
  topic: keywords
subject: complication
  topic: keywords
subject: management
  topic: keywords
creator: Sumartini Dewi
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2026-02-25
publication date: 2026-02-25
doi: 10.37275/ijr.v17i2.67

Behcet Disease: When Laryngeal Tuberculosis Unforeseably Strikes
type: item
description: Behçet disease (BD) is a chronic vasculitis that can affect all organs, particularly the skin, mucous membranes, eyes and joints. It can lead to severe complications requiring immunosuppressive therapy (IS). Although the prescription of IS is indisputable and life-saving, they carry a significant risk of opportunistic infections. Tuberculosis is an infectious disease primarily caused by the bacterium Mycobacterium tuberculosis, also known as Koch's bacillus. It predominantly affects the lungs due to airborne transmission and favorable conditions for the bacillus's survival in this area; however, it can also affect other sites to a lesser extent, such as the brain, bones, skin and « ear, nose and throat » (ENT) regions. Laryngeal tuberculosis (LT) is a rare and underdiagnosed localization that often occurs in immunocompromised patients. This article reports the case of a patient with BD under IS who developed LT secondary to subclinical pulmonary tuberculosis. The outcome after discontinuing azathioprine and initiating antituberculous treatment was favorable. The case report aims to shed light on the rare and underrecognized presentation of tuberculosis in BD and in case of immune vulnerability, unraveling the intricate interplay between immunosuppression and opportunistic infections. Its significance lies in underscoring the critical need for heightened clinical vigilance, as LT can masquerade as BD-related manifestations, posing diagnostic dilemmas.
subject: Articles
  topic: section
subject: Laryngeal tuberculosis
  topic: keywords
subject: Subclinical pulmonary tuberculosis
  topic: keywords
subject: Behçet disease
  topic: keywords
subject: Immunosuppressant
  topic: keywords
subject: Azathioprine
  topic: keywords
creator: Chaïmaâ Zeroual
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2026-02-25
publication date: 2026-02-25
doi: 10.37275/ijr.v17i2.66

Evidence Based Case Report: Secukinumab versus golimumab for Ankylosing Spondylitis Patients
type: item
description: Background: Ankylosing spondylitis is a chronic inflammation of the axial spine and joints that can lead to a wide spectrum of clinical manifestations, with chronic back pain and progressive vertebrae stiffness being two hallmark symptoms. The choice of medication for ankylosing spondylitis depends on both efficacy and cost. This study aims to compare Secukinumab, the cheapest and only available anti-interleukin-17, against Golimumab, a TNF-alpha inhibitor, in terms of efficacy and cost. Methods: A systematic search was conducted until October 30th, 2023, using keywords such as ankylosing spondylitis, secukinumab, golimumab, ASAS20, and their synonyms on databases including PubMed, Embase, SCOPUS, and Cochrane to find relevant studies. Critical appraisal of included studies was performed using the Oxford Center of Evidence-based Medicine (CEBM) tools for harm scenarios. Results: Three eligible articles were collected, observing both Secukinumab and Golimumab with different doses and administration routes. Chen et al.'s comparative analysis between secukinumab 150 mg and golimumab 50 mg revealed an odds ratio (OR) (95% confidence interval (CI)) of 1.19 (0.03-8.94), while secukinumab 150 mg against golimumab 100 mg presented an OR of 1.45 (0.03- 11.98). Zhang et al.'s comparison results between golimumab and secukinumab yielded an OR of 0.62 (0.20-1.89). Finally, Deodhar et al. analyzed different doses of secukinumab and golimumab with an OR range of 1.04-1.15 (0.4-3.11). Conclusion: Both secukinumab and golimumab showed comparable results in ASAS20, exhibiting insignificant differences in the superiority of ASAS20 improvement. However, the cost-effectiveness and personal drug choice need to be evaluated to add further considerations to the medication choice.
subject: Articles
  topic: section
subject: Ankylosing spondylitis
  topic: keywords
subject: Secukinumab
  topic: keywords
subject: Golimumab
  topic: keywords
subject: ASAS20
  topic: keywords
creator: Yosafat Sebastian Prayogo
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2026-02-25
publication date: 2026-02-25
doi: 10.37275/ijr.v17i2.65

Management of Non-Radiographic Axial Spondyloarthritis Cases with IL-17A Inhibitors
type: item
description: A B S T R A C T Background: Non-radiographic axial spondyloarthritis (nr-axSpA) is a key subgroup within the spondyloarthritis (SpA) spectrum, recognized via the ASAS classification criteria. Treatment options for nr-axSpA are similar to AS and include nonsteroidal anti-inflammatory drugs, tumor necrosis factor-alpha inhibitors, and IL-17A inhibitors. Secukinumab, a fully human monoclonal antibody, targets and neutralizes IL-17A, and is the first IL-17A inhibitor approved for AS treatment. Case Presentation: This case involves a 34-year-old male with non-radiographic axial spondyloarthritis. The patient presented with chronic back pain and stiffness, mainly in the sacroiliac joints. Initial treatments were inadequate, leading to the administration of secukinumab. The patient showed significant clinical improvement following secukinumab treatment, indicating its efficacy in managing nr-axSpA. Conclusion: This case demonstrates the potential benefits of secukinumab in treating non-radiographic axial spondyloarthritis. As the first IL-17A inhibitor approved for AS, secukinumab offers a promising therapeutic option for nr-axSpA patients, providing substantial symptom relief and enhancing quality of life. Further research is needed to assess the long-term efficacy and safety of secukinumab in this patient population.
subject: Articles
  topic: section
subject: Non-radiographic
  topic: keywords
subject: Axial spondyloarthritis
  topic: keywords
subject: IL-17A inhibitor
  topic: keywords
creator: I Putu Yogi Sastrawan
creator: Dewa Ayu Kartika Tejawati
creator: Pande Ketut Kurniari
rights: Copyright (c) 2026 Indonesian Journal of Rheumatology
date: 2026-07-29
publication date: 2026-07-29
doi: 10.66446/IJR.v18i1.60

The The Correlation Between Serum Vitamin D Level and Quality of Life inSystemic Sclerosis Patients
type: item
description: Background: Systemic sclerosis (SSc) is an autoimmune rheumatic disease that is associated with disability and a reduced quality of life. Patients with SSc have lower levels of vitamin D than healthy people. Vitamin D influences the pathological mechanisms of SSc such as autoimmunity, vasculopathy, and fibrosis. The aim of this study was to know the correlation between serum vitamin D levels and the quality of life in SSc patients. Methods: This study was a cross-sectional study. Data were taken from the SSc patient registry at the Rheumatology Clinic of Dr. Hasan Sadikin General Hospital Bandung from September to November 2023. Vitamin D level were assessed by measuring serum 25-hydroxyvitamin D levels. The quality of life was measured using the Indonesian version of the Short Form (SF-36), which was divided into physical component summary (PCS) and mental component summary (MCS). Statistical analysis was performed using the Rank-Spearman test. Results: There were 81 SSc patients enrolled in this study. Vitamin D levels were found low in 44 subjects (54.3%), which were divided into 23 subjects deficiency and 21 subjects insufficiency. Thirty seven subjects (46.7%) had normal vitamin D levels. The results of this study showed that there was a significant weak positive correlation between serum vitamin D levels and PCS SF-36 (r=0.222, p=0.023) and MCS SF-36 (r=0.209, p=0.031) quality of life in SSc patients. Conclusion: Serum vitamin D levels of SSc patients had a significant weak positive correlation with physical and mental quality of life component.
subject: Articles
  topic: section
subject: SF-36 Quality of life
  topic: keywords
subject: Systemic sclerosis
  topic: keywords
subject: Vitamin D levels
  topic: keywords
creator: Sumartini Dewi
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2024-12-12
publication date: 2024-12-12
doi: 10.37275/ijr.v16i2.54

Relationship Between Interleukin 6 (IL-6) and Organ Damage Based on SLICCDamage Index -SDI Score in Systemic Lupus Erythematosus Patients
type: item
description: Background: Systemic Lupus Erythematosus (SLE) is a heterogeneous and complex chronic autoimmune disease. Interleukin 6 (IL-6) is a cytokine known to be elevated in people with SLE. This research was conducted to determine the relationship between IL-6 levels and organ damage based on the SLICC Damage Index-SDI Score in SLE patients. Method: The study was a retrospective cross-sectional study involving 67 SLE patients conducted based on the SLICC 2012/ACR EULAR 2019 criteria at least 6 months prior to their inclusion. They were patients treated at the Rheumatology Clinic of Adam Malik General Hospital in Medan from June to August 2023, who met the inclusion and exclusion criteria. Organ damage assessment was done using the SLICC Damage Index (SDI) score, while disease activity degree was measured using the SLE Disease Activity Index (SLEDAI-2K) scoring system. Results: 94 % subject were women with a median SLEDAI-2K score of 6 (10 – 16) where the moderate degree of activity was the majority in this study (41.8%), followed by the mild degree (37.3%), severe (16, 4%), and remission (4.5%). The median IL-6 level was 63.3932 pg/ml (8.88 – 5966.67) where a significant correlation was found between IL-6 levels and the SDI score (p=0.017) and the degree of disease activity and the SDI score (P<0.001). Conclusion: A significant positive correlation was found between IL-6 levels and SDI scores in SLE patients (p=0.017).
subject: Articles
  topic: section
subject: IL-6 levels
  topic: keywords
subject: Organ damage
  topic: keywords
subject: SDI-Score
  topic: keywords
subject: SLE
  topic: keywords
creator: Yesanopa Sianturi
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2024-12-12
publication date: 2024-12-12
doi: 10.37275/ijr.v16i2.53

Plasmapheresis as a Promising Therapeutic Option to TreatMacrophage Activation Syndrome
type: item
description: Macrophage activation syndrome (MAS) is a lethal complication of autoimmune conditions. Its diagnosis and management remains challenging till date in view of paucity of standard protocols. Plasmapheresis has shown promise if used early in the course of disease. We hereby describe a case report of a young male patient who presented with multiorgan failure. He was diagnosed with MAS triggered by systemic lupus erythematosus (SLE). He was successfully treated with steroids, cyclophosphamide and plasmapheresis.
subject: Articles
  topic: section
subject: Plasmapheresis
  topic: keywords
subject: MAS
  topic: keywords
creator: Bansal Varun
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2024-12-12
publication date: 2024-12-12
doi: 10.37275/ijr.v16i2.52

Correlation Between sCD28 and sCD80 Levels with Disease Actiity of SystemicLupus Erythematosus (SLE) Patients Based on SLEDAI Score
type: item
description: Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease with multisystem involvement that is caused by multifactorial. Prolonged exposure to autoantigens and sustained immune system activation, particularly in memory T lymphocytes, can contribute to premature immunosenescence. Soluble costimulatory molecules such as sCTLA-4 and sCD86, originating from CTLA-4 and CD86 respectively, contribute to the progression of immunosenescence in patients with SLE. This condition is associated with higher morbidity and mortality. This study aimed to investigate the relationship between elevated levels of sCTLA-4 and sCD86 and the severity of SLE disease activity, as assessed by the SLEDAI score. Methods: The study employed an analytical observational design with a cross-sectional approach, involving 35 female participants diagnosed with SLE according to the 2012 SLICC criteria. SLE disease activity was assessed using the SLEDAI score, and serum levels of sCD28 and sCD80 were measured using the ELISA method. The Mann-Whitney test was used for group comparisons, while the Spearman test was conducted for correlation analysis, with statistical significance defined as p < 0.05. Results: SLE patients had an average sCD28 and sCD80 level of 24.93 and 27.41, respectively. Spearman test results showed that sCD28 level had a significant correlation with SLEDAI score [R=0.364; p=0.031 (p<0.05)], while sCD80 level did not correlate significantly with SLEDAI score [R=0.048; p=0.786 (p<0.05)]. Conclusion: The rise in sCD28 levels showed a positively correlation with the SLE severity activity, as indicated by the SLEDAI score.
subject: Articles
  topic: section
subject: Systemic lupus erythematosus
  topic: keywords
subject: sCD28
  topic: keywords
subject: sCD80
  topic: keywords
subject: Disease activity
  topic: keywords
subject: SLEDAI
  topic: keywords
creator: Ahmad Harissul Ibad
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2024-12-12
publication date: 2024-12-12
doi: 10.37275/ijr.v16i2.51

Is It Obesity or Metabolic Syndrome Which Has a Greater Prevalence ToCause Muscoloskeletal Complaints? A Cross Sectional Study in theCepokomulyo District, Malang Regency
type: item
description: Introduction: Musculoskeletal (MSK) complaints including pain, swelling, stiffness, or immobility of joints and muscles are among the most common health issues that biomechanical factors are one of the risk factors. Metabolic syndrome is a combination of several risk factors including obesity, hypertension, low HDL-C levels, hypertriglyceridemia, and impaired glucose tolerance. These issues are known to influence the incidence of metabolic inflammation associated with several MSK diseases, in which obesity is one of the main biomechanical factors. Aim: To compare the Prevalence Odd Ratio (POR) of MSK complaints associated with metabolic syndrome (MetS) and obesity. Conclusion: This study included 260 patients, with 49.6% (n=129) of them having metabolic syndrome. The most common MSK complaint region was the right knee (n=85). MSK complaints were most common in the group of patients with MetS and obesity (n=109), compared to the group with MetS or obesity alone. Prevalence Odd Ratio (POR) results show that Group III (group of patients with obesity and without MetS) has the highest prevalence of MSK complaints when compared to the other three groups.
subject: Articles
  topic: section
subject: Metabollic syndrome
  topic: keywords
subject: Musculoskeletal complaints
  topic: keywords
subject: Obesity
  topic: keywords
creator: Perdana Aditya Rahman
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2024-12-12
publication date: 2024-12-12
doi: 10.37275/ijr.v16i2.50

Factors Contributed to a Difficult-To-Treat Juvenile IdiopathicArthritis: A Systematic Review and Meta Analysis
type: item
description: Background: Juvenile Idiopathic Arthritis is the foremost common unremitting rheumatic illness in childhood, with a global prevalence ranging from 16 to 150 per 100.000 population. However, in some cases, clinician may face a difficult-to-treat Juvenile Idiopathic Arthritis (D-JIA), which indicate to a group of patients who have not affected by administration of standard anti-rheumatic drugs. This study aims to identify factors that correlate to D-JIA. Methods: We conducted a systematic review and meta analysis, collecting studies from PubMed, Scopus, Embase, Cochrane, and Google Scholar. Eligible Studies were trials that analyze factors that may contribute to D-JIA. Results: Six studies were included, enrolling 1.177 patients. Female composes 70.9% (835) of the population (OR 1.04, CI 95% 0.83-1.31, p=0.72). Median of age and duration of disease respectively were 5.79 years and 11.06 months. Some factors correlate with occurancy of DJIA including Caucasian race (OR 0.96, CI 95% 0.44-2.07, p=0.91), ANA negative (OR 1.77, CI 95% 1.42-2.22, p<0.00001), HLA B27 positive (OR 1.86, CI 95% 0.85-4.08, p=0.12), prescence of atypical skin lesion (OR 8.5, CI 95% 1.6-72.4, p=0.022), and spesific subtype of JIA such as Oligoarthritis (OR 0.86, CI 95% 0.70-1.07, p=0.17), Poliarthritis (OR 1.77, CI 95% 1.422.22, p<0.00001), Systemic-type (OR1.22, CI 95% 0.60-2.49, p=0.58), Psoriatic (OR1.61, CI 95% 0.69-3.78, p=0.27), Enteritis-related (OR 1.33, CI 95% 0.68-2.59, p=0.40), and Undiffrentiated (OR 1.46, CI 95% 0.55-3.83, p=0.45). Conclusion: Eventhough many factors identified, but only ANA negativity, presence of atypical skin lesion, and Poliarthritis subtype that have been statistically proved related in the development of D-JIA. This finding may be due to the study's limitations and remaining differences in subsequent results. Future studies are needed for further analysis regarding this issue.
subject: Articles
  topic: section
subject: Difficult to treat
  topic: keywords
subject: Relapse
  topic: keywords
subject: Juvenile Idiopathic Arthritis
  topic: keywords
creator: Louis Edwin Wirya
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2024-12-12
publication date: 2024-12-12
doi: 10.37275/ijr.v16i2.49

Massive Pericardial Effusion – An Uncommon Initial Presentation in aMale Patient With Systemic Lupus Erythematosus
type: item
description: Systemic lupus erythematosus (SLE) is an autoimmune disease which has predilection for female gender. Usually, it manifests as myriad of clinical signs and symptoms which can involve any organ system of the body, however cardiovascular involvement solely as an initial presentation is uncommon. Here we present a case of a male patient who initially presented with a large pericardial effusion. Later, on extensive workup he was diagnosed with SLE with lupus nephritis.
subject: Articles
  topic: section
subject: Systemic lupus erythematosus
  topic: keywords
subject: Pericardial effusion
  topic: keywords
subject: Autoimmune disease
  topic: keywords
creator: Vivek Kumar
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2024-12-12
publication date: 2024-12-12
doi: 10.37275/ijr.v16i2.48

Relationship between Knowledge Level and Preventive Behavior of SepticArthritis in Student Batch 2019-2020, Faculty of Medicine, University of NorthSumatra
type: item
description: Background: Septic arthritis is an infectious disease that severely damages the joints with clinical manifestations such as swelling, erythema and warmth of the affected joint. The most common cause of this disease is the result of hematogenous spread of microorganisms. Some of the risk factors include injection drug use, prosthetic joints and skin infection. The incidence of septic arthritis is 5 to 8 per 100,000 population per year with 5-10% mortality rate, therefore preventive behavior is needed to minimize the incidence of septic arthritis. Methods: This study is an observational analytic study with a cross-sectional approach. The research population consisted of students from batch 2019-2020 of the Faculty of Medicine, University of North Sumatra and the sample was determined using stratified random sampling method. Primary data were obtained directly from research subjects using questionnaires via Google Forms. Results: The univariate research analysis found that the knowledge level of the majority of respondents was in the good category, with 45 subjects (53.6%). The most predominant behavior observed in the respondents was negative behavior, with 49 subjects (58.3%). Bivariate analysis found that there was no significant relationship between knowledge level and septic arthritis prevention behavior with p value = 0.809. Conclusion: Students from batch 2019-2020 of the Faculty of Medicine, University of North Sumatra, on average have a good level of knowledge and negative behavior on the prevention of septic arthritis. There is no relationship between the level of knowledge with septic arthritis prevention behavior.
subject: Articles
  topic: section
subject: Knowledge
  topic: keywords
subject: Prevention
  topic: keywords
subject: Septic arthritis
  topic: keywords
creator: Christine Silalahi
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2024-06-12
publication date: 2024-06-12
doi: 10.37275/IJR.v16i2.281

Correlation between sCTLA-4 and sCD86 Levels with Disease Activity of SystemicLupus Erythematosus (SLE) Patients Based on SLEDAI Score
type: item
description: Background. Systemic Lupus Erythematosus (SLE) is an autoimmune disease with multisystem involvement which arises from multifactorial causes. Continuous exposure to autoantigens and chronic activation of the immune system, especially memory T lymphocytes, contribute to premature immunosenescence. sCTLA-4 and sCD86 are soluble costimulatory molecules of CTLA-4 and CD86, which play a role in the occurrence of immunosenescence in SLE. The presence of immunosenescence will cause higher morbidity and mortality. This research was conducted to establish the correlation between the increased levels of sCTLA-4 and sCD86 and the severity of SLE, as measured by the SLE Disease Activity Index (SLEDAI) score. Methods. This analytical observational research utilized a crosssectional approach involving 35 female SLE patients diagnosed according to the SLICC 2012 criteria. SLE disease activity was measured using SLEDAI score. Serum sCTLA-4 and sCD86 levels were measured using the ELISA method. Statistical analysis was conducted using the Mann-Whitney test for comparisons and the Spearman test for correlation analysis, with a significance level of p<0.05. Results. sCTLA-4 levels were higher and significantly different in patients with moderate SLE (p=<0.001; p<0.05), and there was no significant difference in sCD86 levels (p=0.915; p>0.05). Increased sCTLA-4 levels were positively correlated with the severity of SLE (r =0.361, p=0.033), while no significant correlation was observed in sCD86 levels (r=-0.094, p=0.591). Conclusion. Elevated sCTLA-4 levels were positively correlated with increased severity of SLE based on the SLEDAI score.
subject: Articles
  topic: section
subject: Disease activity
  topic: keywords
subject: sCD86
  topic: keywords
subject: sCTLA-4
  topic: keywords
subject: SLEDAI
  topic: keywords
subject: Systemic lupus erythematosus
  topic: keywords
creator: Helsa Eldatarina
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2024-06-12
publication date: 2024-06-12
doi: 10.37275/IJR.v16i2.266

The The Role of 25-Hydroxy Vitamin D and Cartilage Oligomeric Matrix Protein(COMP) Serum in Knee Osteoarthritis
type: item
description: Background. Osteoarthritis (OA) is a prevalent disease of the musculoskeletal system that affects over 528 million individuals worldwide, with 73% of those diagnosed being aged 55 or older. The knee joint is most commonly affected, along with the hip and hand joints. Vitamin D is essential for maintaining bone and cartilage metabolism. In chondrocytes, the presence of the vitamin D receptor (VDR) regulates the expression of metalloproteinase. The purpose of this investigation is to examine the correlation between vitamin D (25(OH)D) and cartilage oligomeric matrix protein (COMP) serum in knee osteoarthritis. Methods. The cross-sectional study was conducted by the Rheumatology Division at RSMH Palembang. Patients diagnosed with knee osteoarthritis based on the 1990 ACR criteria were included. The chemoluminescent immunoassay and the Human Cartilage Oligometric Matrix Protein ELISA Reagent were used to measure the levels of vitamin D (25(OH)D) and COMP serum. Results. Thirty participants took part in this study from July to December 2022. According to this study, 33% had insufficiency and 67% had a deficiency of vitamin D. Spearman's Rho test shows that there is a strong negative correlation between vitamin D (25(OH)D) and COMP serum. Conclusion. Vitamin D (25(OH)D) and COMP serum levels were significantly correlated in knee osteoathritis.
subject: Articles
  topic: section
subject: COMP vitamin D (25(OH)D)
  topic: keywords
subject: Knee
  topic: keywords
subject: Osteoarthritis
  topic: keywords
creator: Khoriun Mukhsinin Putra
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2024-06-12
publication date: 2024-06-12
doi: 10.37275/IJR.v16i2.262

Initial Clinical Presentation of Systematic Lupus Erythematosus (SLE) Patientsin Cipto Mangunkusumo Hospital
type: item
description: Background. Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease characterized by highly diverse and nonspecific symptoms with clinical presentations involving more than one organ system which often leads to delayed diagnosis and poor prognosis. This study aims to understand patients’ initial clinical presentation in order to enhance early detection and establish an early diagnosis. Methods. This descriptive crosssectional quantitative study included patients who commenced their visits to the Rheumatology Clinic at RSCM from May 2021-December 2022. A consecutive sampling method was used, and data were analyzed for age, gender, symptom onset, as well as patients' initial clinical presentations (SPSS 25.0). Results. Out of 231 subjects, 96.1% were females. A total of 38.1% of the patients belonged to the 21-30 age group, and symptom onset was most commonly observed in the 0-1 year age group, accounting for 67.5%. Approximately 24.2% of the patients exhibited constitutional manifestations with involvement of other organs, including musculoskeletal (87.4%), mucocutaneous (84%), hematologic (3.,5%), renal (33.3%), and neuropsychiatric (8.7%) systems. Lungs, heart, blood vessels, gastrointestinal and hepatic systems, eyes, obstetric, and endocrine involvements were not found in this study. Among the 231 subjects, 44.2% of them had simultaneous involvement of two organs, which emerged as their initial clinical presentation. Conclusion. Musculoskeletal and mucocutaneous involvement were most commonly observed as th e initial clinical presentation of SLE patients at RSCM, followed by hematologic, renal, and neuropsychiatric involvement.
subject: Articles
  topic: section
subject: Initial clinical presentation
  topic: keywords
subject: RSCM
  topic: keywords
subject: Systemic lupus erythematosus (SLE)
  topic: keywords
creator: Teresa Isabela
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2024-06-12
publication date: 2024-06-12
doi: 10.37275/IJR.v16i2.261

Perfect Timing for Canakinumab Use in Gout
type: item
description: Gout is an inflammatory disease caused by the deposition of monosodium urate (MSU) crystals. Recently, the American College of Rheumatology (ACR) has recommended the usage of interleukin (IL)-1 inhibitor in gout patients who are refractory to typical anti-inflammatory drugs. An example of IL-1 inhibitor is canakinumab. Not much is known regarding the usage of canakinumab in gout arthritis. Thus, we decided to conduct a narrative review that summarizes the efficacy and safety of canakinumab in gout patients. In this review, we found that canakinumab is superior to nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids in treating acute gout flares. In addition, canakinumab may also be considered as a preventive therapy for gout flares in patients receiving urate-lowering therapy. Overall, canakinumab has mild side effects but may occasionally cause serious infections. Canakinumab is also generally safe for use during pregnancy. Due to the lack of studies, the safety of canakinumab in lactating women, geriatric patients, and patients with hepatic or renal impairment is still unknown.
subject: Articles
  topic: section
subject: Canakinumab
  topic: keywords
subject: Interleukin-1β inhibitor
  topic: keywords
subject: Gout
  topic: keywords
creator: Hadi Kurniawan Wijaya
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2024-06-12
publication date: 2024-06-12
doi: 10.37275/IJR.v16i2.254

Acute Lupus Pneumonitis with Cytomegalovirus Co-infection in Patients withLupus Nephritis
type: item
description: Introduction: Most patients with systemic lupus erythematosus (SLE) show signs of pulmonary involvement. The clinical manifestations of Lupus Pneumonitis are the similar to those of acute interstitial pneumonia. The use of cyclophosphamide in lupus nephritis (LN) is associated with high CMV titers. Ganciclovir is the main choice of therapy for CMV pneumonia infection. Case presentation: A 19-year-old female with previous history of lupus nephritis presented with worsening dyspnea, productive cough with yellowish sputum and hemoptysis. Following physical, laboratory and radiological examinations, the patient was diagnosed with acute lupus pneumonitis, with a differential diagnosis of pneumonia infection. During treatment in the intensive care unit (ICU), she was put on ventilator and received routine hemodialysis due to pulmonary edema. She was given intravenous antibiotics before the culture results came out, but there was no clinical improvement. Once the culture results returned negative, the antibiotics were discontinued and IV pulse methylprednisolone was started. There was significant clinical, radiological, and laboratory improvements. After discharge, the patient experienced hemoptysis again due to CMV pneumonia infection and was given ganciclovir therapy with satisfactory results. Conclusion: In patients with advanced LN and pulmonary involvement, distinguishing between infection and SLE flares may be challenging, which can cause dilemma in diagnosis and treatment decisions. Adequate oxygenation with ventilator, hemodialysis, and administration of ganciclovir and mycophenolic acid provides significant improvements in patient care.
subject: Articles
  topic: section
subject: CMV Pneumonia Ganciclovir
  topic: keywords
subject: CMV Pneumonia
  topic: keywords
subject: SLE
  topic: keywords
creator: Hadi Kurniawan Wijaya
rights: Copyright (c) 2025 Indonesian Journal of Rheumatology
date: 2024-06-12
publication date: 2024-06-12
doi: 10.37275/IJR.v16i2.249