Background: The development of Systemic Lupus Erythematosus (SLE) treatment has led the increased of patients survival. Quality of life has became a value based medicine component that should be evaluated in treating SLE. One standardized questionnaire to asses the quality of life in SLE patients is Lupus Quality of Life (Lupus QoL). Currently, in Indonesia, there has not been any spesific questionnaire to asses the quality of life in SLE patients. This study aims to prove that Lupus QoL is valid and reliable to asses the quality of life in SLE patients in Indonesia. Methods: This study used cross sectional study method. Firstly, we translated the Lupus QoL into Indonesian language, then we tested to 10 respondents. Then, we continued the study with larger sample size. We analyzed the reliability of the test and the re-test result using the interclass coefficient correlation and the internal consistency of the tests using cronbach alpha. Construct validity was evaluated using multi trait scaling analysis and the extrenal validity was evaluated using correlation between domains in short form 36 (SF 36) with Lupus QoL and with disease activity. Results: Data collection was done to 65 SLE patients between October – November 2015 in RSCM. The test has good external validity SF 36 (r=0.38-0.66, p<0.05) and good construct validity (r >0.4; range: 0.44-0.93). The ICC value in one week >0.7 and Cronbach a was >0.7 in each domain. The correlation between lupus QoL and the disease activity was weak and consistentwith other studies. Conclusion: Lupus QoL questionnaire is valid and reliable to asses the quality of life in SLE patients inIndonesia.

Ocular involvement in Anti Phospolipid Syndrome (APS) includes a broad spectrum of manifestations from the anterior and posterior segment or the presence of neuro-ophthalmologic features. A female, 29 years old, came to ER handled by ophthalmology department, with chief complaint left visual loss suddenly since 4 hours before admission. Investigations revealed stable vital signs, VOD 20/20, VOS 1/300, funduscopy showed pale and cherry red spot on left retina, OCT revealed hyperreflective of left inner retinal layer, IgG aCL 51.7 U/mL (50.8 U/mL in OPD 3 months later), and the other examinations were within normal limit. Patient was diagnosed with Central Retinal Artery Occlusion due to Primary Antiphospolipid syndrome. She was performed occular massage and anterior chamber paracintesis procedure, and given O2 6-8 lpm NRBM, Timolol 0.5% eye drop left eye bid, acetazolamide 250 mg bid, Kalium Slow Release 1 tab qd, Levofloxacine eye drop 1 drop/ hour post surgery. After the result of IgM aCL available, we added warfarin 2 mg qd and aspirin 320 mg qd. Patient was discharged 2 days later as visual acuity improved with VOD 20/20 and VOS 0.5/60.

Background: Bone mineral density (BMD) measurement is one of the method for making osteoporosis diagnosis. World Health Organization (WHO) recommends the measurement of BMD conducted at antero-posterior lumbar vertebrae, unilateral hip (femur), and radius. However, there was a concern about osteoporosis under diagnosis if the measurement is only conducted at unilateral hip. Some studies found significant differences of BMD between both femur and evidence of the importance to examine both femur in making the diagnosis of osteoporosis. This study aims to determine anydifference between right and left femur BMD measurement and to investigate the bone status result with measurement of BMD of bilateral femur in Hasan Sadikin General Hospital. Methods: A retrospective study was conducted from June to November 2015. Patients who received dual-femur BMD testing using General Electrics (GE) Lunar Prodigy dual-energy x-ray absorptiometry at the DXA Facility in Hasan Sadikin General Hospital, Bandung between January 1, 2006 to December 31, 2014 were included. Statistical analysis performed to assess the difference and the correlation between the BMD of two femurs (g/cm2). T-scores of the subject were implemented into bone status according to WHO Diagnostic Criteria for Osteoporosis. Results: From sixty-one patients included in this study, there were difference bone status resulted from BMD of the femoral neck, Ward’s triangle, trochanter, and total hip area between right and left femur, although no statistically significance were found. There was a positive correlation between BMD of right and left femur at all areas of femur. There were 16 subjects (26.1%) showed combination level of bone status (normal, osteopenia, or osteoporosis in one femur). Conclusion: BMD results in each area of the right and left femurs are different.Therefore, performing bilateral hip BMD examination as a routine measurement for makingdiagnosis of osteoporosis is important.

Background : In recent years, rheumatoid arthritis (RA) uses a “treat to target” treatment strategy. This strategy requires a valid and accurate tool for assessing disease activity. The most widely used tool is DAS28, which was developed from DAS with the omission of ankle and foot joints. There has been many critization about the accuracy of DAS28 in classifying the state of RA disease. Most importantly, when an active disease state was misclassified as an inactive state (false negative) which lead to under treat and subsequently to disability. The difference between DAS28 and DAS lies mainly in the exclusion of ankle and foot joints, thus DAS28- squeeze, a new and simple tool has been proposed. It comprises the same 28 joints in DAS28 added with a sqeeze test on both metatarsophalangeal joints. However, this new tool has never been validated with any imaging techniques. Objective : To assess the diagnostic values of DAS28 and DAS28-squeeze. Methods : This study comprised a cross-sectional diagnostic study, using Power Doppler sonography as a standard reference in evaluating the diagnostic value of DAS28 and DAS28-squeeze. This study uses the most sringent sonography criteria of active disease which is an active Doppler signal with a moderate synovial hypertrophy on B-mode. Results : Over the study period, 56 subjects underwent diagnostic tests using DAS28, DAS28-squeeze and Power Doppler sonography. There were 4 false negative cases in DAS28 and 1 case in DAS28-squeeze. The sensitivities of DAS28 and DAS28-squeeze to identify active disease using Power Doppler sonography as reference standard were 73.3% (95%CI ± 11.59) and 93.3% (95%CI ± 6.55), respectively. While the specificities of DAS28 and DAS28-squeeze were 36.6% (95%CI ± 12.62) and 34.1% (95%CI ± 12.42), respectively. Furthermore the negative likelihood ratio of DAS28 and DAS28-squeeze were 0.73 and 0.19, respectively. Conclusion : This study is the first to validate DAS28- squeeze using imaging techniques. From this study the false negative rate of DAS28-squeeze is lower than DAS28. DAS28-squeeze has a better sensitivity and negative likelihood ratio than DAS28 in identifying RA disease state.

Background: Atherosclerosis and cardiovascular diseases have been known as the cause of increasing mortality among rheumatoid arthritis (RA) patients. Carotid intima media thickness (CIMT) measurement by ultrasound has been used as surrogate marker of atherosclerosis and cardiovascular disease. Methods: A cross sectional study of 86 RA patients fulfills EULAR/ACR 2010 critera for RA was conducted to study proportion and predictor factors of atherosclerosis and atherosclerosis plaque in rheumatoid arthritis patients. Results: Atherosclerosis and plaque was found in 47,7% and 29 % of patients. Age = 40 yo, hypertension and duration of illness = 24 mo were associated with atherosclerosis in multivariate logistic regression analysis with OR 10.70 (95% CI: 2.93-39.10), 4.99 (95% CI: 1.15-21.61) and 3.66 (95% CI: 1.11-11.99) respectively. Whereas hypertension, presence of antiCCP antibody and age = 40 yo, were associated with plaque formation with OR 3.96 (95% CI: 1.15-13.57), 3.20 (95% CI: 1.11-9.24) and 3.61 (95% CI: 1.03-12.63) respectively. Conclusions: Age = 40 yo, hypertension and duration of illness = 24 mo was the predictors of atherosclerosis, while hypertension, presence of antiCCP antibody and age = 40 yo was the predictors of atherosclerosis plaque.

Background : Osteoarthritis (OA) is the most common chronic rheumatic diseases that causing pain and disability. The imaging of knee OA were found in 15,5% men and 12,7% women of Indonesia population. Radiography is still used as a standard modalities in assesing OA progression, and Kellgren-Lawrence scale (KL) is the most common measurement used by clinicians. Superficial cartilage degradation is the first sign of OA, the early detection of the superficial cartilage degradation is very important for diagnosis. Our study was established to assess the correlation between OA grading in femorotibial joint examined by standard Kellgren-Lawrence scale (KL) measurement with cartilage defects examined by ultrasound. Methods : Observational analytic study with cross sectional and consecutive sampling was performed. Rank Spearman test for correlation of OA grading, cartilage defect, BMI and joint malalignment. McNemar test for correspondence between the location of the narrowing of the femorotibial joint and location of cartilage defects. Result : Correlation of OA grading of femorotibial joints (KL) with cartilage defects grading on ultrasound resulted r =0.459, p<0.05; correlation of OA grading of femorotibial joints (KL) with BMI or joint malalignment resulted p>0,05; correlation of cartilage defect grading with BMI or joint malalignment also resulted p>0.05. McNemar test for location of the narrowing of the femorotibial joint with location of cartilage defects on ultrasound resulted p = 1.00, k = 0.714. There was a significant positive correlation of OA grading of femorotibial joints (KL) with cartilage defects grading on ultrasound. There was no significant correlation between OA grading of femorotibial joints (KL) with BMI and joint malignment, and no significant correlation between cartilage defects grading with BMI and joint malalignment. There is a correspondence between the location of the narrowing of the femorotibial joint with location of cartilage defects on ultrasound. Conclusion: For assesing the grade of osteoartritis, cartilage defect grading and assesment by ultrasound can be used as an alternative to X-Ray KellgrenLawrence scale (KL) measurement.

Background: Lupus Nephritis (LN) is still the most frequent complication in Systemic Lupus Erythematous (SLE) patients which causing the major and significance morbidity and mortality. Proteinuria and Glomerular Filtration Rate (GFR) serves as objective and routine examinations to assessrenal function. 24-hour proteinuria still regarded as gold standard to quantify amount protein in urine. Estimated GFR (eGFR) is preferably used due its convenient. On the hand, estimated GFR (eGFR) is preferably used due its convenient. However, both of them should be measured in order to determine renal progression and prognosis. Only few studies have been conducted to find out the correlation between 24-hour proteinuria and eGFR in lupus nephritis patients as both of them serve as potential marker in progression of renal involvement. This study addressed to find out correlation between 24-hour proteinuria and eGFR in lupus nephritis patients. Method: Analytic-correlation study with cross-sectional approach at Dr. Hasan Sadikin Hospital, Bandung was done. Secondary data was used and paralleled with previous study entitled “Correlation of Random Urine Protein Creatinine (P-C) Ratio with 24-Hour Protein Urine in Lupus Nephritis Patients” carried out from October to December 2014.Correlation coefficient was analyzed by Spearmans’ correlation test. Results: Forty five samples were obtained based on inclusion criteria. Spearmans’ correlation test revealed non significant and very weak correlation between 24-hour proteinuria and eGFR (r=-0.095) with p>0.05. Conclusion: The 24-hour proteinuria and eGFR are weakly correlated. Despite the weak correlation, these examinationsshould be considered as important markers to monitor prognosis of renal involvement in lupus nephritis patients

Background : Low level of vitamin D impact the disease activity and the degree of fatigue in SLE patients. This study aims to determine the effect of vitamin D supplementation on disease activity and fatigue condition in Systemic Lupus Erythematosus (SLE) patients with hipovitamin D. Methods: We performed an open clinical trial. Subjects were randomized into two different groups (supplementation or placebo) using simple random sampling. The treatment group got vitamin D3 softgel/ cholecalciferol 1200 IU/day or 30 mg/day, while the control group gotplacebo for 3 months. SLEDAI scores and FSS scores were calculated at pre and post treatment. Results: There were 20 subjectsfor supplementation group and 19 subjects in the placebo group. From this study, before and after treatment, we found a significant difference of mean level of vitamin D in supplementation group (p=0.000), and no significant difference in patients with placebo (p=0.427). Moreover, from the SLEDAI score analysis, observed a significant difference bothin the supplemented group (p=0.000) and the placebo group (p=0.006). FSS scores significantly different in the supplemented group (p=0.000). In correlation test,there was a negative correlation (r=-0763) between vitamin D level and disease activity (SLEDAI), and both showing stastistical significance between thepre supplementation (p=0.000) and post supplementation (r=-0846; p=0.000). Similarly to the FSS scores, there was a meaningfulnegative correlation (r=-0.931, p=0.000) between the level of vitamin D with FSS scores pre and post supplementation (r=-0.911; p= 0.000). Furthermore, there was a significant correlation between disease activity (SLEDAI) pre supplementation with fatigue condition pre supplementation (r=0.846; p = 0.000) and post supplementation (r=0.913; p= 0.000). Conclusion: The supplementation of vitamin D 1200 IU per day in patients with SLE improve disease activity and degree of fatigue