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"Latar Belakang : Adiponektin saat ini dianggap berperan penting dalam etiopatogenesis gangguan metabolik dan inflamasi termasuk artritis reumatoid (AR). Data terbaru menekankan peran adiponektin dalam peradangan dan degradasi matriks yang dapat menyebabkan kerusakan sendi erosif. Hubungan tingkat adiponektin serum dengan kerusakan sendi radiografi pada pasien dengan AR perlu diteliti lebih lanjut. Selain itu, telah dilaporkan bahwa adiponektin memberikan efek anti-aterosklerosis pada pasien non AR. Menariknya, beberapa studi telah melaporkan peningkatan kadar adiponektin pada pasien AR, hal ini berlawanan mengingat tingginya prevalensi aterosklerosis pada AR. Dengan demikian, efek adiponektin pada aterosklerosis belum sepenuhnya jelas. Metode: Penelitian ini merupakan studi potong lintang. Subjek penelitian diambil dari 50 orang pasien yang memenuhi kriteria EULAR/ACR 2010 untuk AR yang datang ke poliklinik reumatologi RSCM Jakarta. Pengambilan sampel adalah secara consecutive sampling. Dilakukan pemeriksaan kadar adiponektin serum dan foto rontgen tangan/kaki dengan menggunakan Skor Sharp-van der Heijde (SSH). Adanya aterosklerosis ditentukan dengan mengukur ketebalan Tunika Intima Media arteri karotis melalui pemeriksaan USG karotis bilateral. Hasil: Dari 50 pasien yang diteliti, 28 (56%) mengalami peningkatan kadar adiponektin. Aterosklerosis ditemukan pada 13 (26%) subjek. Uji Spearman memperlihatkan tidak ada hubungan antara adiponektin serum dengan aterosklerosis pada pasien AR (p =0.706 dan r=0,055). Adiponektin juga tidak berhubungan dengan skor SSH, tetapi setelah di analisa dengan beberapa karakteristik AR, adiponektin berhubungan dengan SSH pada kelompok pasien dengan anti CCP negatif (p=0,036 dan r=0,38). Kesimpulan: Dari penelitian ini, peneliti menyimpulkan bahwa kadar adiponektin serum meningkat pada pasien AR, tetapi peningkatan adiponektin serum tidak berhubungan dengan aterosklerosis. Adiponektin berhubungan dengan kerusakan sendi pada kelompok pasien dengan anti CCP negatif.

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Background : Adiponectin is now considered important players in the etiopathogenesis of metabolic and inflammatory disorder including rheumatoid arthritis ( RA ). Recent data stress the role of adiponectin in inflammation and matrix degradation that may contribute to erosive joint damage. The association of serum adiponectin level with radiographic joint damage in patients with RA need to be explored. Furthermore, it has been reported that adiponectin exerts an antiatherosclerotic effect in non RA patients. Interestingly, several studies have reported increased level of adiponectin in RA patients, findings which appear paradoxical in light of the higher prevalence of atherosclerosis in RA. Thus, the effect of adiponectin on atherosclerosis has not been clarified sufficiently.

Methods: This was a cross sectional study. Subjects were fifty patients who fulfill Eular Criteria/ACR 2010 for RA from the Rheumatology clinic of Cipto Mangunkusumo Hospital / Faculty of Medicine University of Indonesia Jakarta. Patients with RA underwent serum adiponectin assessment and hand/feet x-rays, scored using the Sharp-van der Heijde Score (SHS). Carotid intima media thickness represent of atherosclerosis was measured by using Ultrasound (USG Bmode).

Results: Of the 50 patients studied, 28 (56%) showed an increased in adiponectin levels. Atherosclerosis was diagnosed in 13 (26%) of this subject. Spearman test showed there was no correlation between adiponectin serum level with adiponectin in RA patients (p =0.706 and r=0,055). Adiponectin level did not correlate with SHS, but after adjusting for disease characteristics, adiponectin level correlate with SHS in negative anti CCP group (p=0,036 and r=0,38).

Conclusion : From this study, we conclude that adiponectin serum level was increase in rheumatoid arthritis patients, but the increasing of the adiponectin serum level was not correlated with atherosclerosis event. Adiponectin level correlate with radiographic joint destruction in negative anti CCP group."

"Latar Belakang : Penyakit jantung rematik (PJR) merupakan komplikasi paling serius dari demam rematik (DR). Penelitian terbaru telah menyoroti adanya inflamasi kronis yang ditandai tingginya kadar CRP, keterlibatan limfosit T serta sitokin inflamasi seperti TNF-α, IFN-γ dan IL-4. Obat yang memiliki efek anti inflamasi adalah penyekat HMG KoA reduktase, yang mampu menurunkan kadar TNF-α dan IFN-γ serta meningkatkan kadar IL-4. Tujuan : Untuk membuktikan efek atorvastatin dalam menurunkan ekspresi gen TNF-α dan IFN-γ, serta meningkatkan ekspresi gen IL-4. Menilai hubungan antara penurunan ekspresi gen TNF-α dan IFN-γ dengan peningkatan ekspresi gen IL-4. Metode : Penelitian ini merupakan studi eksperimental. Pasien dengan penyakit katup jantung dengan etiologi rematik yang akan menjalani tindakan perbaikan/penggantian katup diberikan perlakuan atorvastatin/plasebo 6 minggu sebelum operasi, dilakukan pemeriksaan ekspresi gen TNF-α, IFN-γ dan IL-4 pada jaringan katup dan Appendiks Atrium Kiri (AAK) yang dieksisi saat operasi, menggunakan alat Real Time PCR. Hasil : Dari 53 responden, dengan rerata usia 35 tahun, 70% di antaranya adalah perempuan. 25 responden mendapatkan atorvastatin. Kelompok Atorvastatin memiliki ekspresi gen TNF-α di AAK yang lebih rendah dengan p 0,005 (95% CI 0,05-0,58), setelah disesuaikan dengan jenis kelamin dan fraksi ejeksi. Namun tidak terdapat perbedaan yang bermakna secara statistik dari ekspresi gen IL-4 dan IFN-γ di AAK antara kedua kelompok responden, begitu pula dengan seluruh sitokin pada jaringan katup. Kesimpulan : Pemberian atorvastatin dapat mengurangi inflamasi pada jaringan appendiks atrium kiri penderita penyakit jantung rematik yang ditandai dengan rendahnya ekspresi gen TNF-α namun tidak terbukti mengurangi inflamasi pada jaringan katup. Terdapat hubungan antara penurunan ekspresi gen TNF-α dan IFN-γ dengan peningkatan ekspresi gen IL-4.

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Background : Rheumatic Heart Disease is the most troublesome complication of rheumatic fever. Recent trials emphasized ongoing chronic inflammation represented by CRP, TNF-α, IFN-γ and IL-4,. HMG CoA reductase inhibitor was agent with antiinflamatory effect, suppressing TNF-α and IFN-γ and increasing IL-4.

Objectives : This study was to prove the effect of atorvastatin in suppressing gene expression of TNF-α and IFN-γ, and also effect of atorvastatin in increasing gene expression of IL-4. Knowing correlation between suppressed TNF-α and IFN-γ gene expression and increased IL-4 gene expression.

Method : This study was designed as an experimental study. Patients with valvular dysfunction due to rheumatic process planned to underwent cardiac valves repair/replacement operation were given atorvastatin/placebo 6 weeks before. Gene expression method was used to check mRNA TNF-α, mRNA IFN-γ and mRNA IL-4 level from excised valves and Left Atrial Appendage (LAA).

Result : 53 patients were enrolled. Proportion of women was 70% and age average was 35 years old. Atorvastatin group had lower gene expression TNF-α level in LAA with p 0,005 (95% CI 0,05-0,58), after adjusted with gender and ejection fraction. But there were no differences of IL-4 and IFN-γ gene expression in LAA, either all inflammation cytokines in valves.

Conclusions : Atorvastatin reduced inflammation in LAA patients with Rheumatic Heart Disease by suppressing TNF-α gene expression but didn’t proved reducing inflammation in cardiac valves. There was correlation between supressed gene expression of TNF-α and IFN-γ with increased gene expression of IL-4 level."

"ABSTRAK Latar belakang:.Demam reumatik DR dan penyakit jantung reumatik PJR merupakan penyakit kronis yang berdampak terhadap fisik, psikososial, dan akademik. Penting menilai kualitas hidup anak DR dan PJR serta faktor-faktor yang memengaruhinya, untuk mengetahui prioritas masalah. Tujuan: Mengetahui gambaran kualitas hidup anak DR dan PJR serta faktor-faktor yang memengaruhinya. Metode: Studi potong lintang pada April-Agustus 2017, dengan subyek anak berusia 5-18 tahun. Data didapatkan secara consecutive sampling menggunakan kuesioner PedsQL trade; 3.0 modul jantung dan rekam medis retrospektif. Hasil: Kualitas hidup baik ditemukan pada 53 laporan anak dan 52 laporan orangtua subyek. Skor median laporan anak 79,70 29,7-100 , dan laporan orangtua 77,31 45,03-99,40 . Kepatuhan berobat merupakan kunci penyebab membaiknya kualitas hidup. Tidak ada faktor sosiodemografi yang berhubungan dengan kualitas hidup. Faktor klinis yang berhubungan dengan kualitas hidup adalah rute antibiotik. Anak DR dan PJR yang mendapat antibiotik intramuskuler, 3,2 kali laporan anak memiliki kemungkinan kualitas hidup lebih baik dibandingkan yang mendapatkan antibiotik oral p ABSTRACT Background Rheumatic fever RF and rheumatic heart disease RHD are chronic diseases that affect physical, psychosocial, and academic. Assessment of quality of life in children with RF and RHD and the factors affecting it, is important to identify problems. Objective To identify quality of life in children with RF and RHD and the factors influencing it. Method A cross sectional study on RF and RHD patients aged 5 18 years old, using PedsQLTM 3.0 Cardiac Module questionnaire and retrospective medical records from April 2017 until August 2017. Result High quality of life was found in 53 child report and 52 parent report of subjects. Median score from children rsquo s reports and parents rsquo reports are, 79,70 29,7 100 , and 77,31 45,03 99,40 respectively. Compliance was the key to cause quality of life to increase. Clinical factors affecting quality of life included the route of antibiotic administration, and there were no sociodemographic factors. By child report, children with RF and RHD who received intramuscular antibiotics were 3.2 times more likely to have higher quality of life than children who received oral antibiotics p "

"This book features: current, thorough coverage of important immunology and rheumatology topics, including the immune system in health and disease, disorders of immune-mediated injury, and disorders of the joints and adjacent tissues; delivers insights designed to reduce pain, lesson joint and organ damage, and improve overall patient outcomes and integrates pathophysiology with clinical management."

"Latar belakang: Penyakit jantung rematik (PJR) merupakan salah satu penyebab kematian kardiovaskular pada anak yang dapat dicegah. Indonesia merupakan salah satu negara endemis PJR. Data mengenai kesintasan, perbaikan katup, dan faktor-faktor yang memengaruhi pada populasi anak masih terbatas.Tujuan: Penelitian ini bertujuan untuk mengetahui kesintasan dan perbaikan katup lima tahun setelah terdiagnosis pada anak dengan PJR serta faktor-faktor yang memengaruhi.Metode: Penelitian ini merupakan studi prognostik dengan rancangan penelitian kohort retrospektif di Rumah Sakit Cipto Mangunkusumo menggunakan data rekam medis pasien yang terdiagnosis dengan PJR sebelum Desember 2018 dan diikuti selama lima tahun, paling akhir Desember 2023. Subjek yang diteliti adalah anak berusia kurang dari 18 tahun saat terdiagnosis dengan PJR. Faktor yang diteliti untuk kesintasan dan perbaikan katup adalah status gizi, kepatuhan profilaksis penisilin, kelas gagal jantung New York Heart Association (NYHA), fraksi ejeksi, derajat katup, jumlah katup, dan operasi katup.Hasil: Sebanyak 100 anak yang terdiagnosis PJR dengan rerata usia 11,29 (8,42-14,16) tahun dan proporsi jenis kelamin 1:1 dimasukkan dalam analisis. Rerata pengamatan adalah 47,96 bulan (simpang baku 20 bulan). Keterlibatan katup terbanyak adalah regurgitasi mitral (32%). Sebagian besar pasien terdiagnosis dengan derajat katup berat (58%). Kesintasan 5 tahun didapatkan 90% dengan prediktor independen kematian yaitu fraksi ejeksi <55% saat terdiagnosis dengan HR 6,34 (IK95% 1,72-23,46; p = 0,006) dan kelas NYHA III-IV saat terdiagnosis dengan HR 5,33 (IK95% 1,05-27,11; p = 0,04). Proporsi anak dengan PJR yang mengalami perbaikan katup 5 tahun setelah terdiagnosis adalah 60% dengan faktor yang memengaruhi yaitu operasi katup dengan RR 1,40 (IK95% 1,05-1,88; p=0,02). Analisis subgrup pada subjek yang tidak operasi mendapatkan bahwa kelas NYHA I-II dan fraksi ejeksi >55% saat tediagnosis secara signifikan berpengaruh terhadap perbaikan katup dengan RR 3,05 (IK95% 1,33-7,03; p = 0,01) dan RR 1,62 (IK95% 1,28-2,04; p<0,01) secara berturut-turut. Kesimpulan: Kesintasan lima tahun anak dengan PJR adalah 90% dengan faktor yang memengaruhi yaitu fraksi ejeksi <55% dan kelas gagal jantung NYHA III-IV saat terdiagnosis. Sebanyak 60% subjek mengalami perbaikan katup dengan faktor yang memengaruhi adalah operasi katup.

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Background: Rheumatic heart disease (RHD) is a major contributor of preventable cardiovascular disease in children. Indonesia is one of the most endemic countries with RHD. However, data on clinical outcomes and prognostic factors are still lacking.

Objective: This study aimed to evaluate the five year survival rate, proportion of valve improvement, and prognostic factors of both outcomes.

Method: We conducted a retrospective cohort study in Cipto Mangunkusumo Hospital which included patients aged below 18 years at diagnosis before December 2018. Subjects were followed for 5 years up to December 2023. Factors analyzed for both mortality and valve improvement were nutrition status, adherence to penicillin prophylaxis, New York Heart Association (NYHA) class, ejection fraction, valve severity, number of valve involved, and valve surgery.

Results: One hundred patients with RHD were included with mean age of 11.29 (8.42-14.16) years. The proportion of female : male was 1:1. Mean duration of follow up was 47.96 (SD 20) months). The majority of valve abnormality was mitral regurgitation (32%). As many as 58% were diagnosed with severe valve disease. Five year survival rate was 90%. Significant prognostic factors for mortality were ejection fraction <55% at diagnosis with HR 6.34 (95%CI 1.72-23.46; p=0.006) and NYHA class III-IV at diagnosis with HR 5.33 (95%CI 1,05-27.11; p=0.04. The proportion of subjects with valve improvement after 5 years was 60%. Multivariate analysis revealed that valve surgery was the only significant factor for valve improvement with RR 1.40 (95%CI 1.05-1.88; p=0.02). Subgroup analysis in subjects who did not undergo surgery showed that NYHA class I-II and ejection fraction >55% at diagnosis significantly affected valve improvement with RR 3,05 (95% CI 1,33-7,03; p = 0,01) dan RR 1,62 (95% CI 1,28-2,04; p<0,01)

Conclusion: The five year survival rate of children with RHD was 90%. Mortality predictors were ejection fraction <55% and NYHA class III-IV at diagnosis. Sixty percent of patients had valve improvement with valve surgery as a predictor."

"[ABSTRAKLatar belakang : Stenosis mitral (SM) masih merupakan masalah kesehatan yang penting di Indonesia. Pada SM terjadi peningkatan kadar P selectin karena disfungsi endotel dan aktivasi platelet. Komisurotomi mitral transvena perkutan (KMTP) merupakan tatalaksana baku untuk penderita SM yang dapat memperbaiki kemampuan aktivitas fisik yang pada akhirnya akan mempengaruhi kadar P selectin. Belum ada penelitian yang menghubungkan antara tingkat aktifitas fisik dengan kadar P Selectin 3 bulan pasca KMTP pada SM rematik.Metode : Penelitian ini merupakan penelitian potong lintang. Dari 56 subyek penelitian yang menjalani KMTP sejak bulan Mei 2013 sampai Februari 2014 di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita, didapatkan 35 sampel yang memenuhi kriteria penerimaan . Data klinis dan data ekokardiografi sebelum dan 3 bulan pasca KMTP diambil dari catatan medis. Dilakukan wawancara 3 bulan pasca KMTP. Tingkat aktivitas fisik dibagi menjadi 2 kelompok: kelompok 1 1-4 METs, kelompok 2 > 4 METs. Kadar P selectin diambil 3 bulan pasca KMTP. Selanjutnya dilakukan analisa statistik untuk mengetahui hubungan antara tingkat aktivitas fisik dengan kadar P Selectin 3 bulan pasca KMTP pada SM rematikHasil : Pasien yang akan menjalani KMTP memiliki rerata usia 40,00±11,58 tahun dengan proporsi perempuan lebih tinggi daripada laki-laki (74,3%) dan dengan proporsi irama sinus yang lebih tinggi daripada irama atrial (57,1%). Dari uji T didapatkan ada perbedaan bermakna rata-rata kadar P selectin 3 bulan pasca KMTP pada tingkat aktivitas fisik 1-4 METs dan > 4 METs, dimana rerata kadar P selectin 3 bulan pasca KMTP pada tingkat aktivitas fisik > 4 METs lebih rendah secara bermakna dibandingkan 1-4 METs (p=0,003). Setelah dilakukan analisa multivariat terlihat tingkat aktivitas fisik pasca KMTP tetap berpengaruh terhadap kadar P Selectin 3 bulan pasca KMTP (p=0,001). Area Katup Mitral (AKM) pasca KMTP berpengaruh terhadap kadar P selectin 3 bulan pasca KMTP (p=0,018), namun tingkat aktivitas fisik pasca KMTP lebih besar pengaruhnya dibandingkan AKM.Kesimpulan : Terdapat hubungan antara tingkat aktivitas fisik dengan kadar P selectin 3 bulan pasca KMTP dimana pada tingkat aktivitas yang lebih tinggi ( > 4 METs) kadar P selectin lebih rendah 10,489 ug/ml dibandingkan tingkatan aktivitas fisik 1-4 METs.

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ABSTRACTBackground: Mitral stenosis (MS) is an important health problem in Indonesia. P selectin level in MS increases due to endothelial dysfunction and platelet activation. Percutaneous transvenous mitral commissurotomy (PTMC) is one of the management for MS patients. Thus, the physical activity can improve and in turn affect the level of P selectin. There has been no study link the level of physical activity with the level of P Selectin 3 months after of PTMC.Method: This is a cross sectional study with 56 subjects who underwent PTMC from May 2013 to February 2014 at the Hospital of National Heart Centre Harapan Kita. Then, 35 samples met the inclusion criteria. Clinical and echocardiography data before and 3 months after PTMC were taken from medical records. Interviews were conducted 3 months after PTMC. Physical activity levels were divided into 2 groups: group 1 (1-4 METs) and group 2 (> 4 METs). Sample for P selectin was taken 3 months after PTMC. Further statistical analysis was done to determine the relationship between physical activity level with level of P Selectin 3 months after PTMC in rheumatic MS.Result: Patients who will undergo PTMC have the mean age of 40.00 ± 11.58 years with a higher proportion of women than men (74.3%) and the proportion of sinus rhythm is higher than atrial rhythm (57.1%) . T-test analysis result showed significant difference in the average levels of P selectin 3 months after PTMC on the level of physical activity 1-4 METs and > 4 METs. The average P selectin levels on the level of physical activity in group with > 4 METs was significantly lower compared with group 1-4 METs (p = 0.003). After multivariate analysis, the physical activity level still has an effect on the P selectin levels 3 months after PTMC (p = 0.001). The Mitral Valve Area (MVA) after PTMC also has an effect on P selectin levels (p = 0.018). However, the level of physical activity after PTMC has a greater effect than MVA.Conclusion: There is a relationship between the level of physical activity with P selectin levels 3 months after PTMC.Group with higher activity level (> 4 METs) have lower level of P selectin (with the mean difference levels of P Selectin 10,489 ug/ml);Background: Mitral stenosis (MS) is an important health problem in Indonesia. P selectin level in MS increases due to endothelial dysfunction and platelet activation. Percutaneous transvenous mitral commissurotomy (PTMC) is one of the management for MS patients. Thus, the physical activity can improve and in turn affect the level of P selectin. There has been no study link the level of physical activity with the level of P Selectin 3 months after of PTMC.Method: This is a cross sectional study with 56 subjects who underwent PTMC from May 2013 to February 2014 at the Hospital of National Heart Centre Harapan Kita. Then, 35 samples met the inclusion criteria. Clinical and echocardiography data before and 3 months after PTMC were taken from medical records. Interviews were conducted 3 months after PTMC. Physical activity levels were divided into 2 groups: group 1 (1-4 METs) and group 2 (> 4 METs). Sample for P selectin was taken 3 months after PTMC. Further statistical analysis was done to determine the relationship between physical activity level with level of P Selectin 3 months after PTMC in rheumatic MS.Result: Patients who will undergo PTMC have the mean age of 40.00 ± 11.58 years with a higher proportion of women than men (74.3%) and the proportion of sinus rhythm is higher than atrial rhythm (57.1%) . T-test analysis result showed significant difference in the average levels of P selectin 3 months after PTMC on the level of physical activity 1-4 METs and > 4 METs. The average P selectin levels on the level of physical activity in group with > 4 METs was significantly lower compared with group 1-4 METs (p = 0.003). After multivariate analysis, the physical activity level still has an effect on the P selectin levels 3 months after PTMC (p = 0.001). The Mitral Valve Area (MVA) after PTMC also has an effect on P selectin levels (p = 0.018). However, the level of physical activity after PTMC has a greater effect than MVA.Conclusion: There is a relationship between the level of physical activity with P selectin levels 3 months after PTMC.Group with higher activity level (> 4 METs) have lower level of P selectin (with the mean difference levels of P Selectin 10,489 ug/ml), Background: Mitral stenosis (MS) is an important health problem in Indonesia. P selectin level in MS increases due to endothelial dysfunction and platelet activation. Percutaneous transvenous mitral commissurotomy (PTMC) is one of the management for MS patients. Thus, the physical activity can improve and in turn affect the level of P selectin. There has been no study link the level of physical activity with the level of P Selectin 3 months after of PTMC.Method: This is a cross sectional study with 56 subjects who underwent PTMC from May 2013 to February 2014 at the Hospital of National Heart Centre Harapan Kita. Then, 35 samples met the inclusion criteria. Clinical and echocardiography data before and 3 months after PTMC were taken from medical records. Interviews were conducted 3 months after PTMC. Physical activity levels were divided into 2 groups: group 1 (1-4 METs) and group 2 (> 4 METs). Sample for P selectin was taken 3 months after PTMC. Further statistical analysis was done to determine the relationship between physical activity level with level of P Selectin 3 months after PTMC in rheumatic MS.Result: Patients who will undergo PTMC have the mean age of 40.00 ± 11.58 years with a higher proportion of women than men (74.3%) and the proportion of sinus rhythm is higher than atrial rhythm (57.1%) . T-test analysis result showed significant difference in the average levels of P selectin 3 months after PTMC on the level of physical activity 1-4 METs and > 4 METs. The average P selectin levels on the level of physical activity in group with > 4 METs was significantly lower compared with group 1-4 METs (p = 0.003). After multivariate analysis, the physical activity level still has an effect on the P selectin levels 3 months after PTMC (p = 0.001). The Mitral Valve Area (MVA) after PTMC also has an effect on P selectin levels (p = 0.018). However, the level of physical activity after PTMC has a greater effect than MVA.Conclusion: There is a relationship between the level of physical activity with P selectin levels 3 months after PTMC.Group with higher activity level (> 4 METs) have lower level of P selectin (with the mean difference levels of P Selectin 10,489 ug/ml)]"