Indonesian Rheumatology Association (IRA) Recommendations for Diagnosis and Management of Rheumatoid Arthritis

Abstract

Introduction: Rheumatoid arthritis (RA) is an autoimmune rheumatic disease which often found in daily practice and requires certain considerations in recognizing clinical appearance also managing the disease as it often causes permanent joint damage, disability, even premature death. This recommendation is expected to become the latest reference for diagnosis and management of RA in Indonesia.
 Methods: The steering committee was formed by the Indonesian Rheumatology Association (IRA) to formulate key questions; conduct literature search, selection, and review; then formulate recommendation statements for diagnosis, therapy, and monitoring of RA. Furthermore, the steering committee determined the level of evidence and grades of the recommendations. After that, the level of agreement (LOA) was determined for each item by panelists including rheumatology consultants who have been appointed by IRA to represent Indonesia regions.
 Results: The steering committee established 30 recommendations including diagnosis, the role of laboratory and radiology tests, general treatment, the use of glucocorticoids, sDMARD, bDMARD, and tsDMARD. This recommendation also discusses guidelines on monotherapy, combination therapy, treatment strategies (treat-to-target), tapering, and continuous clinical remission. Treatment on co-morbidities and complications are also included in brief.
 Conclusion: IRA recommendations regarding the diagnosis and management of RA was made by considering various aspects such as the availability of drugs and supporting facilities, socioeconomic and cultural conditions in Indonesia, as well as the latest research that can be applied to Indonesian population.

Seluang Fish (Rasbora sp.) Oil Improves Interleukin-17 Levels and Disease Activity in Rheumatoid Arthritis

“…These drugs include dglucocorticoid and/or disease modifying anti rheumatic drugs (DMARD), such as 7.5-25 mg/week of methotrexate, 10-20 mg/day of leflunomide, or another DMARD (sulfasalazine, hydroxychloroquine, azathioprine, cyclosporine) or targeted therapy (tocilizumab) based on physician discretion. (1,18) The study was conducted according to the protocols established by the Declaration of Helsinki, and this study has been approved by Dr. Mohammad Hoesin General Hospital Ethics Committee (No. 92/kepkrsmh/2021).…”

“…The number of people with RA in Indonesia is between 0.5-1% of the population, which is increasing every year. (1) This disease is characterized by the presence of immunoglobulin against the component of citrullinated protein. RA is initiated by the peptide citrullination followed by the formation of autoantibodies, namely rheumatoid factor (RF) or anticitrullinated peptide antibody (ACPA), which is present in approximately 71.4 % of cases.…”

“…(8-10) So, providing vitamin D supplements for RA patients has become a key part of the treatment. (1) Management of RA is necessary to obtain remission or low-disease activity. A previous multicenter study found that the number of patients that achieve remission in RA is 62.3% based on disease activity score 28 C-reactive protein (DAS28-CRP), and 35.5% based on DAS28 erythrocyte sedimentation rate (DAS28-ESR).…”

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“…About 36% of patients reported worsening health and were twice as likely to have their ability to engage in some activities restricted. Furthermore, nearly 30% of patients are more likely to require personal care assistance than persons without arthritis [1]. According to basic health research in 2018, the total of people with rheumatoid arthritis in Indonesia is around 7,30% [2].…”

Serum leucine-rich alpha-2 glycoprotein levels in rheumatoid arthritis and spondyloarthritis: A promising biomarker

“…However, based on a prevalence of 0.5-1% of the total population of Indonesia, it can be estimated that RA occurs in around 1.3 million Indonesians in 2020. 4 Meanwhile, the prevalence of SpA is about 0.5-2% of the world population. 5,6 The pathogenesis of RA and SpA is complex and distinct from one another.…”