Background: Patients with rheumatoid arthritis (RA) may have more prevalent and severe periodontitis than healthy controls. Periodontitis may increase the systemic inflammation in RA. The aim of this study is to assess periodontitis prevalence and severity and its potential association with systemic inflammation in Indonesian patients with RA.Methods: A full‐mouth periodontal examination including probing depth, gingival recession, plaque index, and bleeding on probing was performed in 75 Indonesians with RA and 75 age‐, sex‐, and smoking‐matched Indonesian controls. A validated questionnaire was used to assess smoking, body mass index, education, and medical conditions. In addition, in all participants, the use of drugs was noted, and erythrocyte sedimentation rates and serum levels of high‐sensitivity C‐reactive protein (hsCRP), rheumatoid factor, and anti‐citrullinated protein antibodies were measured. Differences in periodontitis prevalence and 12 measures of periodontitis severity between patients with RA and controls were analyzed using univariate analyses.Results: No significant differences in periodontitis prevalence and 11 measures of periodontitis severity between patients with RA and controls were observed. Conversely, patients with RA had a significantly lower surface area of healthy pocket epithelium versus controls (P = 0.008), and a tendency toward higher hsCRP levels was observed in patients with RA with severe periodontitis compared with patients with RA with no mild or moderate periodontitis (P = 0.063). It has to be noted that all patients with RA were on anti‐inflammatory drugs, whereas none of the controls used such drugs.Conclusion: Prevalence and severity of periodontitis in Indonesian patients with RA is comparable to controls but with less healthy pocket epithelium than in controls and a tendency toward a higher inflammatory state in patients with RA and severe periodontitis.

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Expectant management of preterm preeclampsia is a realistic option in a major Indonesian perinatal referral center. Steroids (outside the use for fetal lung maturation) should not be used in the expectant management of preterm preeclampsia in Indonesia.

Aim:  To determine the risk factors of symptomatic osteoarthritis (OA) of the knee.Methods:  Two hundred and thirty‐nine cases of symptomatic OA of the knee (ACR Criteria for OA 1986) with radiographic OA (Kellgren‐Lawrence I or more) taken from a rheumatology outpatient clinic were compared to 279 controls without radiographic (Kellgren‐Lawrence 0) OA taken from general internal medicine outpatient clinic at the same hospital. Independent variables to be assessed were age, sex, ethnic group, body mass index (BMI), education, marital status, parity, smoking, and history of acute trauma, hysterectomy, anatomical abnormality of knee, diabetes mellitus, and uric acid levels. Multiple logistic regression analysis was done to assess the independent risk factors.Results:  After going through the steps of multiple logistic regressions analysis, the results were: symptomatic cases compared to controls: age > 50 (OR: 1.86, 95% CI = 1.78–2.82), being female (OR: 2.08, 95% CI = 1.35–3.50), BMI > 25 units (OR: 3.28, 95% CI = 2.20–4.89), elementary education (OR: 0.29, 95% CI = 0.14–0.61) and genu valgus (OR: 4.07, 95% CI = 2.43–7.93). For the female subset of symptomatic cases compared with controls: age > 50 (OR: 9.34, 95% CI = 4.77–18.24), BMI > 25 units (OR: 5.27, 95% CI = 2.85–9.73) and genu valgus (OR: 13.64, 95% CI = 4.58–41.44).Conclusions:  Age > 50, being female, BMI > 25 units and genu valgus, may be the risk factors for symptomatic OA of the knee.

BackgroundRecent evidence has demonstrated that the increased risk of mortality in rheumatoid arthritis (RA) patients is largely related to cardiovascular disease (CVD). Overall, RA increases the risk of cardiovascular (CV) mortality by up to 50% for reasons which are insufficiently understood. Chronic inflammation may impair vascular function and lead to increase of arterial stiffness. Measurement of arterial stiffness provide an independent risk factor of CV mortality and morbidity. Brachial pulse-wave velocity (BPWV) is a reproducible method to estimate of arterial stiffness. Whether the disease activity or duration of illness has more contribution in arterial stiffness of RA patients is still controversial.ObjectivesTo investigate the correlation of disease activity and duration of illness in RA patients with pulse-wave velocity as a measure of arterial stiffness, free of cardiovascular disease and risk factors.MethodsRA patients aged 55 years-old or younger were screened for the absence of clinical cardiovascular disease or risk factors (diabetes mellitus, dyslipidemia, hypertension, chronic kidney disease, smoking, obesity, cancer, prolong infections, excessive steroid use, or other inflammatory diseases). Patients were subjected to full history taking, clinical examination, and laboratory investigations including serum lipid profile, CRP, and ESR. Then they were recorded for their brachial pulse-wave velocity using PWV Sphygmograph.ResultsThere were 30 suitable patients (all were female, mean age was 44.17 ± 7.98 years-old, mean duration of illness was 1.88 ± 0.94 years). Average systolic blood pressure was 121.67 ± 7.46 mmHg, mean diastolic pressure was 74.00 ± 4.98 mmHg. Average body mass index was 22.43 ± 1.18. Mean DAS28-ESR was 3.29 ± 1.32, and mean DAS28-CRP was 3.30 ± 4.02. Average of BPWV was 14.44 ± 3.86 m/s. This study did not show any correlation between duration of illness and arterial stiffness (p=0.832). But it revealed moderate correlation between disease activity (either DAS28-ESR or DAS28-CRP) with arterial stiffness (r=0.441 with p=0.015 and r=0.501 with p=0.005).ConclusionThis preliminary suggests that disease activity of RA is correlated with arterial stiifness free of cardiovascular disease or risk factors. But duration of illnes does not show any correlation with arterial stiffness as believed before, it may need more sample size to determine that. This findings support the importance of inflammation control in RA patients not just to improve quality of life but also to decrease cardiovascular mortality in RA.References[1] Klocke R, Cockcroft JR, Taylor GJ, Hall IR, Blake DR. Arterial stiffness and central blood pressure, as determined by pulse wave analysis, in rheumatoid arthritis. Ann Rheum Dis2003; 62:414-418.[2] Provan SA, Angel K, Semb AG, Mowinckel P, Agewall S, Star D, Kvien TK. Early prediction of increased arterial stiffness in patients with chronic inflammation: A 15-year followup study of 108 patients with rheumatoid arthritis. The J of Rheumatol 2011; 38:606-612.[3] Avina-...

In previous studies, Zingiber officinale, Piper retrofractum, and the combination showed cytotoxic activity, induced apoptosis, and p53 expression of HeLa, T47D, and MCF-7 cell lines. This study was conducted to investigate the cytotoxic and apoptotic activity of Zingiber officinale (ZO), Piper retrofractum (PR), and the combination as well as their effect to p53 expression on Myeloma and WiDr cells. The powder of ZO, PR, and ZO + PR combination (1:1) were macerated with 96% ethanol for 3 x 24 hours. MTT cytotoxic assay was performed on Myeloma and WiDr cell lines. Apoptotic cells were stained with ethidium bromide and acridine orange. Imunohistochemical expression of p53 was examined on Myeloma and WiDr cell lines. Doxorubicin was used as positive control in all assays. Results showed that ZO, PR, and ZO + PR combination had cytotoxic activity on Myeloma cells with IC 50 of 28, 36, and 55 mg/ml respectively and WiDr cell lines with IC 50 of 74, 158, and 64 mg/ml respectively, induced apoptotic activity, and increased p53 expression on Myeloma and WiDr cells. These results suggest that ZO, PR, and their combination induced Myeloma and WiDr cells in apoptosis through p53 expression.

Hansen’s disease or leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae. Musculoskeletal complaints might be the initial presentation of patients with Hansen’s disease. Symptoms are common with clinical spectrum ranging from mild to debilitating arthritis.  Regarding its wide clinical spectrum, a history taking especially in an endemic area like Indonesia on the possibility of Hansen’s disease cannot be ruled out in patients with arthritis. We reported 3 cases of arthritis in Hansen’s disease. First case was a 62-year-old Javanese female who had a deformity and chronic poly symmetry arthritis. Second case was a 45-year-old Javanese male with chronic bilateral knee pain as initial presentation of Hansen’s disease and the last case was 61-year-old Javanese male who had acute bilateral knee pain with erythematous maculae associated with Erythema Nodosum Leprosum. All cases responded to corticosteroid 1 mg/BW/day.

Kata kunci : Algoritma Naranjo, efek samping, diabetes melitus. A B S T R A KMeningkatnya prevalensi penyakit diabetes melitus di Indonesia menyebabkan peningkatan penggunaan obat anti diabetes yang berpengaruh pada prevalensi kejadian efek samping. Untuk mengkaji efek samping pada penggunaan obat digunakan Algoritma Naranjo, yang merupakan skala resmi di Indonesia untuk mengukur potensi efek samping. Penelitian ini bertujuan untuk mengkaji potensi efek samping terapi obat anti diabetes pada pasien diabetes melitus rawat jalan di Puskesmas Kota Malang. Penelitian ini dinyatakan laik etik dari Fakultas Kedokteran Universitas Brawijaya No. 215/EC/KEPK-S1-FARM/03/ 2015. Penelitian ini observasional menggunakan rancangan purposive sampling dengan kriteria inklusi pasien DM telah menggunakan terapi minimal 3 bulan dan menggunakan Algoritma Naranjo sebagai alat bantu pengukuran potensi efek samping. Penelitian ini dilakukan dengan cara wawancara terstruktur dan pengisian kuesioner oleh responden sebanyak 69 responden. Selanjutnya dilakukan penghitungan skor Algoritma Naranjo yang dicocokkan dengan skala potensi efek samping. Hasil penelitian menunjukkan efek samping potensial mual pada penggunaan Metformin 18,53% (Definite) dan Glimepiride 13,33% (Definite). Glibenklamid berpotensi menimbulkan efek samping hipoglikemia 15,79% (Definite). Kesimpulan penelitian adalah penggunaan obat anti diabetes dapat menimbulkan efek samping potensial berdasarkan pengukuran Algoritma Naranjo. Potential Side Effects of Anti-Diabetic Drug Therapy In Diabetes Mellitus Patients Based On Naranjo AlgorithmKey words: Naranjo algorithm, side effects, diabetes mellitus. A B S T R A C TThe increasing prevalence of diabetes mellitus in Indonesia led to the increased use of anti-diabetic drugs that affect the prevalence of side effects of anti-diabetic drugs. To assess the side effects on drug use, used Naranjo Algorithm, which is the official scale in Indonesia for the assessment of potential side effects. This study aims to assess the potential side effects of anti-diabetic drug therapy in patients with diabetes mellitus outpatients. Ethical Clearance have accepted from Medical Faculty, University of Brawijaya. This study is an observational study with the sampling method is purposive sampling. The inclusion criteria is DM patients have been using therapy for at least 3 months. This research using Naranjo algorithm as a tool for measuring the potential side effects. It was conducted by interviews and questionnaires with respondents whose were 69 patients. The calculation of the total score and the Naranjo Algorithm matched to the scale of the potential side effects Naranjo. In the research found a potential side effect of the emergence of nausea in Metformin 18,52% (Definite) and Glimepiride 13, 33 % (Definite). Glibenclamide potentially adverse effects of hypoglycaemia 15, 79% (Definite). It can be concluded that the use of anti-diabetic drugs can cause potential side effects is based on the measurement of Naranjo algorithm.