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.

Increasing the secretion of reactive oxygen intermediates (ROI) by monocytes in the synovial fluid is an indicator to determine the severity of joint inflammation. Previous studies have shown that curcumin inhibit the osteoarthritis progression with its ability to inhibite the activity of the nitric oxide synthase (NOS) enzyme from macrophages. In this prospective randomized open end blinded evaluations = PROBE study, 80 patients with knee osteoarthritis were eligable. The subject were devided in to two group: group who received 3 x 30 mg of curcuminoid from Curcuma domestica Val. extract (curcuminoid group) and group who received 3 x 25 mg of diclofenac sodium (diclofenac group) as comparison. The treatment was for 4 weeks time. The secretion of ROI by sinovial fluid monocytes was calculated by scoring the amount of formazan formation after neutral red staining in nitrobleu tetrazolium reduction assay. The result of this study showed that the secretion of ROI by synovial fluid monocytes was significantly decreased in both groups (p <0.001) respectively. There was no significant difference in decreasing of ROI secretion of synovial fluid monocytes between both treatment groups (p = 0.92).

Aim To assess rheumatoid arthritis (RA)‐associated autoantibodies in the gingivocrevicular fluid (GCF) of RA patients and healthy controls with or without periodontal disease, as chronic mucosal inflammation in periodontal disease is hypothesized to contribute to the formation of these autoantibodies. Materials and methods Anti‐citrullinated protein antibodies (ACPA), rheumatoid factor (RF), and their IgA isotypes were assessed in the serum and GCF of RA patients (n = 72) and healthy controls (HC, n = 151). The presence and levels of these antibodies were studied in relation to interleukin (IL)‐8 and periodontal disease. Results In contrast to the HC, the levels of ACPA and RF in the serum and GCF of the RA patients were strongly correlated (p < .0001). The HC with high levels of IgA‐ACPA (n = 27) also had significantly higher levels of total IgG, total IgA, and IL‐8 in the GCF than the HC with low levels of IgA‐ACPA in the GCF (n = 124). Periodontal inflammation and smoking were seen more frequently in the group with high levels of IgA‐ACPA compared to the group with low IgA‐ACPA. Conclusion The IgA‐ACPA in the GCF of HC may be associated with periodontal inflammation and smoking, and could be involved in the progression to RA.

BACKGROUND: Diabetes self-management education and support (DSMES) programs are patient-centered, holistic solution that enables it one of the best approaches for improving medication adherence enhanced coping, empowerment and self-efficacy, quality of life (QoL), and lower rates of depression, in people with type 2 diabetes mellitus (T2DM). In isolation, DSME strategies have not shown significant improvements to self-care and/or reduction of diabetic foot ulcer (DFU). AIM: This study sought to determine the effect of modified DSMES on self-care, DFU severity, and QoL in rural Indonesian patients with DFUs. METHODS: A quasi-experimental design with pre-test and post-test control group design, in Singkawang, West Kalimantan, Indonesia, with a total sample of 60 patients consisting of 30 patients in the intervention group and 30 patients in the control group. The DSMES has been adapted to cover 2 h of content for a period of 8 weeks and the eight-core components of DSMES. The curriculum was culturally adapted revised to incorporate culturally appropriate nature similarities, such as a prominent change to represent changes in glucose counts; to incorporate photos; to incorporate culturally relevant eating habits, such as fish and fruit; to communicate in detail the significance of medication adherence, with an emphasis on metformin’s organic, plant-based characteristics; and to emphasize engagement. Intention-to-treat analyses were conducted to determine the effect of modified DSMES on self-care, DFU severity, and QoL. RESULTS: The DSMES program improved outcomes in three of the three outcome indicators when compared to the control group at T1: In this study, (1) the DFU degree increased by 3.3% points (95% confidence interval [CI]: 0.018–0.194), (2) the diabetes foot self-care behavior score increased by a modest 8.8% points (95% CI: 0.021–0.203), and (3) the QoL increased by 32.7% points (95% CI: 00.075–0.689). The degree of DFU (difference-in-difference [DID] coef. 0.350, 95% CI 0.084–0.572), diabetes foot self-care behavior (DID coef. 0.085, 95% CI 0.065–0.405), and QoL (DID coef. 0.343, 95% CI 0.078–0.436) are all still significantly improved compared to the control at T2. CONCLUSION: The primary outcome analyses indicate that the adapted DSMES was more effective than standard care at improving self-care and QoL and decreasing DFU degree in this sample of Indonesians with DFU, both immediately after and 3 months after the intervention. As nurse educators, it is our responsibility to ensure that we evaluate all of the support options accessible to the patients in our care.

Objective Rheumatoid arthritis (RA) and periodontitis share several pathological features including bone and soft tissue destruction and high levels of circulating inflammatory proteins. Studies related to cytokines in the periodontal inflammatory exudate (gingivocrevicular fluid, GCF) of RA patients might provide insight into the association between periodontitis and RA. The aim of our study was to review the literature on cytokines in GCF of RA patients including the effect of anti‐rheumatic treatment with biological disease‐modifying anti‐rheumatic drugs (DMARDs) and periodontal treatment on these cytokines. Materials and methods MedLine/PubMed searches with different combinations of keywords “rheumatoid arthritis or RA” and “crevicular fluid or GCF” until June 2019 revealed 64 articles. Ten cross‐sectional observational studies and nine treatment studies fulfilled the inclusion criteria. Results Rheumatoid arthritis patients have increased circulating and GCF levels of pro‐inflammatory cytokines and proteins, despite anti‐rheumatic treatment with biological DMARDs. Presence of periodontitis was accompanied by higher cytokine and protein levels. Treatment of periodontitis resulted in a decrease of these levels. Conclusion Analysis of GCF of RA patients reveals that the relationship between periodontitis and RA is bidirectional, probably caused by a non‐specific inflammatory burden. Data for a specific relationship are barely present in GCF.

A particular role for Porphyromonas gingivalis (Pg) and Aggregatibacter actinomycetemcomitans (Aa) has been suggested in periodontitis and rheumatoid arthritis (RA), as these bacteria could initiate the formation of rheumatoid factor (RF) and anticitrullinated protein autoantibodies (ACPA). We assessed whether serum antibodies against Pg and Aa in RA patients and non-RA controls reflect the subgingival presence of Pg and Aa, and evaluated the relationship of these antibodies to the severity of periodontal inflammation and RA-specific serum autoantibodies. In 70 Indonesian RA patients and 70 non-RA controls, the subgingival presence of Pg and Aa was assessed by bacterial 16S rRNA gene sequencing, and serum IgG levels specific for Pg and Aa were determined. In parallel, serum levels of ACPA (ACPA:IgG,IgA) and RF (RF:IgM,IgA) were measured. The extent of periodontal inflammation was assessed by the periodontal inflamed surface area. In both RA patients and the controls, the presence of subgingival Pg and Aa was comparable, anti-Pg and anti-Aa antibody levels were associated with the subgingival presence of Pg and Aa, and anti-Pg did not correlate with ACPA or RF levels. The subgingival Pg and Aa were not related to RA. No noteworthy correlation was detected between the antibodies against Pg and Aa, and RA-specific autoantibodies.

Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune inflammatory disease with extensive clinical features. The role of Interleukin 10 (IL-10) is to promote autoantibody production and autoreactive B cell proliferation. Interleukin 17 (IL-17) associated with pathogenesis of SLE and positively correlated with disease activity. Intraperitoneal pristane can induce lupus in mice. Mesenchymal stem cells secretome work in paracrine effects asantiinflammatory and immunomodulation agent by suppressing autoreactive T and B cell, which play an important role in pathogenesis of SLE. The aim of this study is to evaluate effect of mesenchymal stem cells secretome on the expression of IL-10 and IL-17 in murine lupus models induced by pristane. Methods: A randomized experimental study, post-test only control group design, samples using 21 female Mus Musculus mice strain Balb/C, divided into 3 groups: control group with intraperitoneal injection of 0.5 mL of 0.9% NaCl, treatment group with intraperitoneal injection of 0.5 mL pristane, therapy group with intraperitoneal injection of 0.5 mL pristane and 0.45 mL of secretome. Statistical analysis using ANOVA test. A p-value < 0.05 was considered statistically significant. Results: The results showed significant relationship between control and pristane groups both at the levels of IL-17 (control 6.9±1.95,pristane 9.9±2.27, pristane+secretome 6.1±1.95 p=0.016), and there are significant differences in the expression of IL-10 in the control group vs pristane group (-4,42±1,43 per 100 lymphocyte; p=0,006), pristane group vs pristane+secretome group (4,00±1,43 per 100 lymphocyte; p=0,012). Conclusion: Mesenchymal stem cells secretome decreased the expression of IL-10 and IL-17 levels in murine lupus models induced by pristane.

Meningkatnya pengunaan obat herbal di masyarakat menyebabkan laporan terkait adverse event dan toksisitas juga meningkat. Adverse event dan toksisitas dapat dideteksi dengan sistem pharmacovigilance. Kejadian Adverse Drug Reaction (ADR) dari obat-obat herbal merupakan hal yang masih jarang diteliti di Indonesia sehingga diperlukan studi pharmacovigilance untuk mendeteksi kejadian ADR. Penelitian ini bertujuan untuk memberikan gambaran tentang kejadian ADR dari penggunaan obat herbal. Penelitian ini merupakan studi deskriptif dengan menggunakan data retrospektif pada pasien yang mendapat resep obat herbal di Puskesmas X Yogyakarta. Penelitian dilakukan dengan mengambil data pasien yang menggunakan obat herbal 10 bulan sebelum penelitian melalui rekam medik. Dilakukan wawancara untuk mengidentifikasi kejadian ADR kemudian dilakukan analisis kausalitas menggunakan algoritma Naranjo. Dari hasil penelitian diketahui bahwa 3 (13,63%) dari 22 pasien mengalami ADR dengan kategori probabilitas probable (1) dan possible (2). Gejala ADR yang muncul adalah peningkatan frekuensi defekasi, penurunan konsistensi feces dan diuresis. Dari hasil penelitian dapat disimpulkan bahwa terdapat kejadian ADR pada pasien yang mendapat resep obat herbal di Puskesmas X Yogyakarta.