Rheumatic Arthritis (RA) is an autoimmune-rheumatic disease that requires evaluation and monitoring of disease activity. RA management aims to achieve low disease activity based on DAS28. This study was conducted to know the characteristics of RA patients at RSUP Dr. Mohammad Hoesin Palembang and associated factors. A cross-sectional study was performed on RA patients at the Rheumatology Outpatient Clinic, Department of Internal Medicine, Dr. Moh Hoesin General Hospital Palembang, that meets criteria inclusion by consecutive in October 2021. RA disease activity was assessed with Disease Activity Score (DAS 28). Analysis statistic was conducted with SPSS version 24.0. A total of 35 subjects participated in this study; 94.3% of subjects were female. The mean age of subjects is 46.54± 9.86 years old. The proportion of subjects that has low, moderate, and high disease activity based on DAS28 were 1 (2.9%), 21 (60%), and 13 (37.1%). Analysis with unpaired t-test showed that subjects with high disease activity disease have higher Erythrocyte Sedimentation Rate (76.38±30.7 vs 47.5±26.97 mm/hour, p= 0.006) and pain score based on Visual Analog Scale (VAS) (7.54 ± 1.05 vs 6.18±2.10, p=0.016) compared to subject with low and moderate disease activity. Factors associated with disease activity in RA patients are Erythrocyte Sedimentation Rate and pain scale based on VAS. Keywords: Rheumatoid Arthritis, DAS28, Disease Activity ABSTRAK Artritis Reumatoid (AR) merupakan penyakit autoimun-rematik yang membutuhkan evaluasi dan pemantauan aktivitas penyakti sebagai bagian dalam penatalaksanaannya. Aktivitas penyakit rendah berdasarkan DAS28 menjadi tujuan dalam pengobatan AR. Penelitian ini dilakukan untuk mengetahui karakteristik pasien AR di RSUP Dr. Mohammad Hoesin Palembang dan faktor-faktor yang mempengaruhinya. Studi potong lintang yang dilakukan dengan memeriksa pasien AR di Poliklinik Reumatologi Departemen Ilmu Penyakit Dalam RSUP Dr. Moh Hoesin Palembang yang memenuhi kriteria inklusi secara konsekutif pada bulan Oktober 2021. Derajat aktivitas penyakit AR dinilai dengan menggunakan Disease Activity Score (DAS 28). Analisis statistik dilakukan dengan menggunakan program SPSS versi 24.0. Sebanyak 35 subyek yang ikut dalam penelitian, 94.3% di antaranya berjenis kelamin wanita. Rerata usia subyek adalah 46.54± 9.86 tahun. Proporsi subyek yang memiliki aktivitas penyakit rendah, sedang, dan tinggi berdasarkan DAS 28 berturut-turut adalah 1 (2.9%), 21 (60%), dan 13 (37.1%). Analisis dengan uji t tidak berpasangan didapatkan subyek dengan aktivitas penyakit tinggi memiliki nilai Laju Endap Darah lebih tinggi (76.38±30.7 vs 47.5±26.97 mm/jam, p= 0.006) dan skala nyeri berdasarkan Visual Analog Scale (VAS) lebih tinggi (7.54 ± 1.05 vs 6.18±2.10, p=0.016) dibanding subyek dengan aktivitas penyakit rendah-sedang. Faktor yang mempengaruhi derajat aktivitas penyakit pada pasien AR antara nilai Laju Endap Darah dan skala nyeri berdasarkan VAS. Kata Kunci: Artritis Reumatoid, DAS 28, Derajat Aktivitas Penyakit
BACKGROUND: Vitamin D has a role in downregulating the proinflammatory cytokines as well as promoting the antiinflammatory pathway in rheumatoid arthritis (RA). Seluang fish (Rasbora sp.) has potency as a new source of vitamin D. Previous study had proven Seluang fish oil efficacy in systemic lupus erythematosus. However, there are no trials that prove its efficacy in RA yet. Hence, this study was conducted to find out the ability of Seluang fish oil to improve proinflammatory cytokines, vitamin D levels, and disease activity in RA.METHODS: A clinical trial with a randomized and double-blind method was done in two groups, each one consisting of 17 RA subjects. One group was given 500 mL of a Seluang fish oil capsule (contains 665 IU cholecalciferol), while the other group was given a placebo daily, for 12 consecutive weeks. Measurements of the RA disease activity score 28 erythrocyte sedimentation rate (DAS28-ESR) and DAS28 C-reactive protein (DAS28-CRP), as well as measurement of interleukin (IL)-6, IL-17, and vitamin D levels by using immunoassay method were performed before and after the supplementation.RESULTS: Significant alterations in the lower levels of IL-17 were observed in the Seluang fish oil group (p=0.031), but not in the placebo group (p=0.320). Reduction of DAS28-ESR (p=0.000) and DAS28-CRP (p=0.000) score demonstrated that the Seluang fish oil supplementation was useful in reducing RA disease activity. No significant shift was observed in either vitamin D (p=0.967) or IL-6 levels (p=0.076) after Seluang Fish Oil supplementation.CONCLUSION: Seluang fish oil is effective in lowering IL-17 levels, DAS28-ESR, and DAS28-CRP, but not in improving vitamin D level or lowering IL-6 level in RA patients.KEYWORDS: rheumatoid arthritis, seluang fish oil, interleukin-6, interleukin-17, vitamin D, DAS28
Rheumatoid arthritis (RA) is an autoimmune disease that requires careful management and regular evaluation of the degree of disease activity. AR is known for its pathophysiology and is strongly influenced by the increase of proinflammatory cytokines, especially IL-6. This study was conducted to determine the correlation of IL-6 levels with the degree of disease activity in AR patients at Dr. Mohammad Hoesin Palembang. A cross-sectional study was conducted on RA patients at the Rheumatology Polyclinic, Department of Internal Medicine, Dr. Moh Hoesin Palembang, who met the inclusion criteria consecutively in October 2021. The degree of RA disease activity was assessed using the Disease Activity Score (DAS 28). Statistical analysis was performed using SPSS version 24.0. A total of 34 subjects participated in the study, with most being women and a median age of 49.5 years. The majority of subjects had a moderate-high degree of RA activity. There is no significant correlation between IL-6 levels with DAS 28 CRP (r=0.256, p=0.072) and DAS 28 LED (r= 0.056, p=0.376). There was no significant correlation between serum IL-6 levels and disease activity in Rheumatoid Arthritis patients at Dr. Mohammad Hoesin Palembang.
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