Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease with primary manifestation in the joints. Early management of RA will prevent further joint damage. The joint damages, result of uncontrolled disease activity, will decrease patient’s quality of life. RA should be diagnosed earlier and followed by early treatment initiation, in order to prevent further damages. This study aimed to determine the pattern of joint involvement in RA in order to made earlier diagnosis and treatment initiation. Method: This research was conducted using descriptive study design. Data were obtained using interview of RA patients who coming to Rheumatology Clinic of Dr. Hasan Sadikin General Hospital from August 2016 to October 2016. Collected data included number of joints involvement, duration of therapy, and duration of illness after diagnosed according to the criteria of ACR / EULAR 2010. Result: Ninety-seven RA patients were involved in this study. Subjects were dominantly women (87%), the highest age group was 45-49 years old (17.53%), duration of the disease <5 years (90.72%), and duration of therapy > 3 months (86%). Joint that frequently involved at the time when the diagnosis made was first proximal interphalangeal (49.50%), overall findings during the course of RA was the wrist joint (90.72%). There were different tendency of joint involvement between the gender, knee joints occured in 53,84% male subjects, while PIP joints were accounted for 52,38% in female subjects. Conclusion: The first PIP was the most common joint involved in RA patients when the diagnosis made. The wrist joint involvement was dominantly found in overall course of RA. Knee joint involvement was majorly found in male RA patients, whereas female RA patients would suffer mostly from PIP joint involvement.

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease with wide range of clinical symptoms. The patients frequently complain musculoskeletal involvement during the active state of the disease. Musculoskeletal manifestation in SLE patients is an important sign in making early diagnosis and monitoring treatment response. This study aims to determine the presentation of musculoskeletal involvement of SLE patients in Dr. Hasan Sadikin General Hospital Bandung. Methods: a descriptive cross-sectional quantitative study done by interviewing SLE patients concerning musculoskeletal manifestation as the primary data and tracking their medical record as the secondary data. Study was conducted between September to November 2016 in Rheumatology Clinic Dr. Hasan Sadikin General Hospital Bandung. Result: Ninety-seven SLE patients, 91 females (93,81%) and 6 males (6,19%), were enrolled in this study with mean age 35.12 (±10.91) years. The three highest proportions of muskuloskeltal manifestations were arthritis of the knee (84,5%), myalgia of upper back (40,2%), and muscle weakness (15,5%). We did not find any Jaccoud’s Arthropathy (JA) and tendinitis manifestation. Osteoporosis were occured in 4 patients (4,12%), whereas gout arthritis, spondytlitis, osteoarthritis, rotator cuff syndrome, and rhupus were only occured in one patient (1,03%), respectively. Conclusion: The common musculoskeletal manifestation in SLE patients were arthritis of knee, myalgia of upper back, and muscle weakness. Only small portion of patients suffered from osteoporosis, gout arthritis, spondytlitis, osteoarthritis, rotator cuff syndrome, and rhupus.

Introduction: Systemic Sclerosis (SSc) is a chronic autoimmune disease, characterized by vasculopathy, specific autoimmune, and fibrosis. Assesment of skin fibrosis by modified Rodnan Skin Score (mRSS) can not detect the minimal changes of skin fibrosis within less than 3 months. A biomarker is needed to assess the minimal changes of skin fibrosis progressivity with a more objective, quantitative, and rapid way. Procollagen type-1 N-Terminal Propeptide (P1NP), a degradation product of collagen type-1, may become a potential biomarker for skin fibrosis. This study aims to evaluate the correlation between skin fibrosis by mRSS with P1NP serum in systemic sclerosis. Methods: This was a cross-sectional study performed among systemic sclerosis patients at Rheumatology outpatient clinic, Dr.Hasan Sadikin Hospital Bandung, from May 2016 to July 2016. Skin fibrosis was measured by mRSS. P1NP level was determined by ELISA. Data were analyzed using Rank-Spearman Correlation. Result: There were thirty-seven subjects, with mean age 37 (SD ±7) years old. Most of subjects were female (91.9%). Subjects consisted of 23 (62.2%) limited SSc and 14 (37.8%) diffuse SSc. Six subjects (16.2%) were DMARD naïve. We found median (range) P1NP serum was 43.85 (9.81-127.90) ng/dL, while the median of MRSS was 14 (3-36). There is a moderate correlation between MRSS and P1NP serum (r=0.443, p=0.003) Conclusion: There was a significant correlation between mRSS and P1NP serum in systemic sclerosis patient at Dr. Hasan Sadikin Hospital Bandung.

Renal Tubular Acidosis, a group of disorders characterized by defective renal acid-base regulation, can impair mineralization of bone matrix in adults known as osteomalacia. RTA is classified into 3 major forms, such as proximal RTA or type 2; distal RTA or type 1; and hyperkalemic RTA or type 4. Among all type of RTA, proximal RTA or type 2 is known have association with Fanconi syndrome and bone involvement. However, distal RTA or type 1 can also cause osteomalacia. Hereby we report a case of 22 years old Asian woman who was firstly diagnosed with distal type RTA several years ago then started developing bone involvement recently. She was complaining with low back pain due to fracture on left medial side of inferior pubic ramus and endplate fracture on right side superior L4 and BMD examination showed low mineral density. She was diagnosed with osteomalacia induced by distal type RTA due to the loss of calcium salts from bone and hypophosphatemia. Keywords: Osteomalacia; Renal Tubular Acidosis; Hypokalemia; Hypophosphatemia

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune diseases caused by deposition of immune complex with the involvement of various organ system and certain autoantibodies production. One of the most significant manifestation is neuropsychiatric symptoms, known as NPSLE (Neuropsychiatric Systemic Lupus Erythematosus). This study aims to portray the distribution of neuropsychiatric manifestation of SLE patients using a screening method in Hasan Sadikin General Hospital. Method: An observative, descriptive categoric study, with consecutive sampling were done. Data were collected by spreading the questionnaire to subjects diagnosed as SLE who visiting Hasan Sadikin General Hospital during August-October 2016 and by tracing their medical records. Data analyzed included age, sex, education background, duration of lupus, diagnosis criteria, ongoing therapy, and neuropsychiatric manifestation. Result: Samples volunteered in this study were 97 patients. Of them 94 patients (96.9%) were women and 47 patients (48.5%) were senior high school graduated. Most common diagnosis criteria found was positive ANA test (91.8%). Most necessary ongoing therapy given was methylprednisolone (96.9%). Common neuropsychiatric manifestations were mood disorders (73,2%), headache (57,7%), and mononeuropathy (51,5%). Conclusion: The common psychiatric, central nervous, and peripheral nervous manifestations were mood disorder, headache, and mononeuropathy, respectively.

Background: Anemia is a common manifestation found among patients with Systemic Lupus Erythematosus (SLE). It may be caused by iron-deficiency, autoimmune hemolytic, and chronic inflammation. Each anemia has different therapy approachments. Without adequate management, anemia may lead to poor prognosis. By identifying the etiology of anemia, appropriate management could be conducted. Reticulocyte Hemoglobin Equivalent (RET-He) and reticulocyte count test may distinguish anemia based on its etiology. This study aimed to give scientific portrayed of the proportion of anemia based on its etiology among patients with SLE using RET-He and reticulocyte count. Method: This study involved women diagnosed with SLE underwent outpatient treatment in Rheumatology Clinic, Dr. Hasan Sadikin General Hospital during SeptemberOctober 2016. Data were collected from blood exam using 35-parameters hematology Sysmex by calculating levels of hemoglobin, RET-He, and reticulocyte count. Results: Seventy four female patients were volunteered as subject in this study with median of age was 29.5 (16-70) years old. Thirty four (46%) of 74 subjects were suffering from anemia and 12 (35%) of them were between 25-34 years old. Proportion of iron-deficiency anemia, autoimmune hemolytic anemia, and chronic inflammatory anemia were 14 ( 41%), 13 (38%), and 7 (21%), respectively. Conclusion: Based on hemoglobin, RET-He, and reticulocyte count, iron-deficiency anemia is the most common anemia among patients with SLE in repoductive age.

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease which involves many different organ systems and immunological abnormalities. SLE mainly affects females in their reproductive age. This study aimed to describe the fetal outcome, neonatal complications, maternal outcome, and obstetrics complication in patients diagnosed with SLE, in order to help the physicians to reduce the fetal loss, improve maternal morbidity, and reduce neonatal or maternal deaths. Method: This research was conducted using descriptive quantitative design. Data were obtained from direct interview noted in a report form and medical records. Subjects were SLE patients who came to Rheumatology Outpatient clinic, Dr. Hasan Sadikin General Hospital, Bandung from September 2016 to November 2016; and fulfilled the inclusion and exclusion criteria. The minimal required sample was 96 subjects. Results: Due to time limitation, only 53 pregnancies from 40 females were managed to be recorded. The median age when being diagnosis of the subjects was 24 (14 - 41) years old. The fetal outcomes showed 64.2% live births, 18.9% spontaneous abortions, 9.4% intrauterine death, 1.8% intrauterine growth retardation, and 9.1% neonatal deaths. Neonatal complications included premature delivery, low birth weight, and growth retardation. Maternal complications during pregnancy included rash, pregnancy-induced hypertension, arthritis, anemia, and thrombocytopenia. Furthermore, obstetric complications included 13.2% pre-eclampsia, 13.2% placenta previa, and 1.8% stroke. There were 2 cases (3.8%) of maternal death happened during the delivery. Conclusion: The most frequent maternal complications during pregnancy were arthritis and rash. Pre-eclampsia and placenta previa were the most frequent obstetric complications which experienced by the pregnant SLE patients. Exclude the live births, the most frequent fetal outcome was spontaneous abortion. The most frequent neonatal complications were preterm delivery and low birth weight.