Background: Gout is a metabolic disease manifested mainly as an intense monoarticular inflammatory reaction which is strongly associated with hyperuricemia. Latest evidence showed that uric acid exerted effects on the development of other diseases. Many studies in developed countries had estimated the frequency of comorbidities associated with gout such as hypertension, obesity, diabetes mellitus, Chronic Kidney Disease (CKD), and Myocardial Infarct (MCI). However, no data regarding these frequencies have been found in Indonesia up to now to the best of the author’s knowledge. This study aimed to establish the frequency of these comorbidities in patients with gout in Rheumatology Clinic Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Methods: All medical records of patients with gout in Rheumatology Clinic Dr. Hasan Sadikin General Hospital from January 2012 to December 2013 were collected. The data on blood pressure; Body Mass Index (BMI); random blood glucose, fasting blood glucose or 2 hours post prandial blood glucose; history of myocardial infarction; and creatinine were taken and analyzed to determine the presence of comorbidities Results: Among all patients with gout in Rheumatology Clinic Dr. Hasan Sadikin General Hospital, 53.08% had chronic kidney disease, 42.73 % had hypertension, 25.39% had diabetes mellitus, 15.70% had myocardial infarction and 12.22% had obesity. Conclusions: Comorbidities commonly found in patients with gout in order of frequency were chronic kidney disease, hypertension, diabetes mellitus, myocardial infarct, and obesity.

Background: Fatigue is one symptom of Systemic Lupus Erythematosus (SLE), which has an important effect on the quality of life. Fatigue Severity Scale (FSS) is one parameter fatigue symptom in SLE. The purpose of this study was to determine the validity and reliability between FSS with duration of ilness and disease activity of SLE patients in Indonesia. Methods: FSS performed on 40 patients with SLE. FSS original English version has been converted-translated into Indonesian version by a team of RheumatologyImmunology Medical Faculty of Brawijaya University. Reliability determined by Cronbach’s Alpha values (>0.6). Validity was determined by the value of Corrected Item-Total Correlation which each item was a valid question if below value of Cronbach’s Alpha. Results: The reliability value was determined by Cronbach’s Alpha values (>0.6) in which the SLE patients in this study had a Cronbach’s Alpha value of 0.946. Value of Corrected Item-Total Correlation overall under Cronbach’s Alpha value (range = 0.684-0.859) which indicates that each item was a valid question. There were correlation between the FSS Indonesian version with disease duration (p = 0.000) as well as the value of r = 0.581, with SLEDAI (p = 0.000) with a value of r = 0.833. Conclusion: FSS in Indonesian version has a good reliability and validity and can be used by clinicians and other researchers to assess the condition of fatigue in SLE patients in Indonesia.

Background: Osteoarthritis (OA) in femoropatella often causes pain and disabilities in the lower extremities. In 2011 found a significance association between knee pain with osteophytes in femoropatella joints compared with osteophytes in femorotibia joints. Niu J et al. found knee joint with lateral patellar malalignment and lateral patellar tilt had increased prevalence of femoropatella OA, similar study in Caucasian and African Americans patients found an association between patellar malalignment with severe knee pain and disease progressivity. In this study, researchers correlate grading OA genu with pain and disability using WOMAC scores and malalignment correlate with pain and disability with WOMAC scores without assessing the progression of the disease. In this study, using cross-sectional at one time whereas previous studies using multi-center cohort were evaluated 3 to 5 years later to assess the progression of the disease. Objective of this study is to establish a correlation between OA grading in femoropatella joint and patellar malalignment with pain and disability using WOMAC Score. Method: Observational analytic study with crosssectional and consecutive sampling was performed in this study. In the WOMAC correlation with KellgrenLawrence grading on the WOMAC OA genu and grading narrowing between joints using the Rank Spearman while the different test WOMAC with malalignment using T test Results: WOMAC OA genu of the grading (AP/LAT/Skyline) r = 0.488; p = 0.003, WOMAC OA genu of the grading (AP/LAT) r = 0.452 ; p = 0.006, WOMAC OA genu of the grading (AP/Skyline) r = 0.362 ; p = 0.033, WOMAC towards narrowing between joints grading femoropatella r = 0.370 ; p = 0.026, no differences between patellar malalignment with WOMAC score, with malalignment (p = 0.711) without malalignment (p = 0.751). Conclusion: In AP/LAT/Skyline, AP/LAT, AP/Skyline position and grading narrowing femoropatella joint space was found a significant positive correlation between OA knee’s grading and WOMAC score. No differences in T test between patella malalignment with pain and disability using WOMAC score.

Background: Lupus nephritis is defined as renal involvement in systemic lupus erythematosus (SLE) patients and the most important cause of morbidity and mortality. The diagnostic criteria that used to diagnose lupus nephritis are 1997 American College of Rheumatology is 24 hours urine protein =500 mg and/or cellular cast, but significant renal damage can occur without proteinuria or cellular cast. Anti-C1q is an autoantibody that is produced by a chronic alteration of C1q collagen domain. Anti-C1q is a new specific marker for renal marker. Objective: To determine the validity of anti-C1q serum by using 1997 American College of Rheumatology criteria as a gold standard. Methods: This is a cross sectional study, conducted in October to December 2014 at Hasan Sadikin Hospital Bandung. The subjects had systemic lupus erythematosus with and without renal involvement, based on 1997 American College of Rheumatology criteria for SLE. Results: There were 65 subjects included in this study, 64 subjects were female and 1 subject was male. The age average was 32 (SD 11.7) years old. As many as 66.2% subjects had been diagnosed with lupus erythematosus systemic at least 3 years. Twenty four hours urine protein was measured using spectrophotometry, urine sediment was examined for cellular cast, and anti-C1q serum was measured using micro enzyme linked immunosorbent assay. Based on American College of Rheumatology criteria, 34 subjects were classified as lupus nephritis group while 31 subjects were classified as non-lupus nephritis group. The area under the curve of anti-C1q was 0.610. The cut-off value used in this study was 10.43 U/ml. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of anti-C1q assay were 41.18%, 77.42%, 66.67%, 54.55% and 58.46% respectively. Conclusion: Anti-C1q assay, based on this study, has a low sensitivity and medium specificity to detect lupus nephritis

Background: Osteoarthritis (OA) is the most common musculoskeletal disease. World Health Organization (WHO) estimates that 10% of the aged over 60 year population have this disease. The aim of OA treatment is to reduce pain, which is the most OA patients chief complaint. People in Indonesia are very interested in use of herbal therapies from original traditional plant to treat pain now, one of the traditional plants that are known have a benefit is Phaleria macrocarpa or Mahkota Dewa fruit. Phaleria macrocarpa has been shown to decrease the degree of inflammation of OA animal model experiments. In order to know what is the effect of this fruit extract to reduce degrees of pain and change the levels of IL-1, IL-6, TNF-a in the blood as the marker of inflammation of patients with knee OA, and what is the effects to liver, kidney and haematology in the Indonesian population has not been investigated Methods: The research method is an experimental study and the research design is PROBE (Prospective Randomized Open End Blinded Evaluation), to evaluate the efficacy of the extract Mahkota Dewa fruit (Phaleria macrocarpa fructus) 330 mg (Super Mahkota POM TR 053 345 491) compared to meloxicam 7.5 mg in patients with knee osteoarthritis. The study population was outpatients with knee OA at Rheumatology Clinic Dr Hasan Sadikin Hospital Bandung. Patients are given Phaleria macrocarpa 330 mg or meloxicam 7.5 mg once a day for 14 days. Observations were made to evaluate the degree of pain as measured by VAS and Lequesne index at day 0, day 14 and measured again at day 28, after they are not taking the extract anymore. Results: Phaleria macrocarpa 330 mg is equal to meloxicam 7.5 mg in reducing the degree of pain as measured by VAS (p=0.78) and the Lequesne index (p=0.51). Our finding, t here is no effect of decreasing the proinflammatory cytokine IL-1 (p=0.72), IL-6 (p=0.53) and TNF-a (p=0.07) in the blood of both groups. Safety analysis shown that this extract is safe for consumption. Conclusions: Phaleria macrocarpa 330 mg equal to meloxicam 7.5 mg in reducing the degree of pain however there is no effect on reducing proinflammatory cytokines in the blood of OA patients who had received therapy for 14 days in both groups. There is no adverse effects found on hematological, liver function and kidney function after consumption this plant’s fruit extract.

Background : Systemic lupus erythematosus (SLE) is a systemic autoimmune disease involving multiple organs including kidney and known as lupus nephritis (LN). Lupus nephritis has a poor prognosis after a 10-years onset, more than 25% will be ended by end stage renal disease. There are glomerular and tubulointerstitial tissue damages due to immune complex deposits in LN which is activating inflamation cascade and causing disfunction of glomerular filtration and tubular reabsorption resulting proteinuria. In LN, proteinuria is used to diagnose, to assess the disease activity and to monitor the therapy. The gold standard of proteinuria is 24-hour urine protein examination, but the process of collecting in 24 hour urine is difficult, then the result is less accurate and reliable. Another alternative parameter is spot urine protein/creatinine ratio. Several studies have found a positive correlation between spot urine protein/creatinine ratio and 24-hour urine protein levels, but in LN, the results are various. Objective: The aim of this study was analyzing the correlation between spot urine protein/creatinine ratio and 24-hour urine protein in lupus nephritis. Methods: The study was conducted at Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia in October 2014 to December 2014. The subjects were 45 patients with lupus nephritis based on the criteria of the American College of Rheumatology. The study analyzed correlation through cross-sectional model. Results: The results of Spearman correlation test analysis showed a significantly strong positive correlation between spot urine protein/creatinine ratio and 24-hour urine protein levels in lupus nephritis (rs =0.96; p <0.001). Based on the degree of proteinuria there was a strong positive correlation between spot urine protein/creatinine ratio and 24-hour urine protein levels in lupus nephritis significantly on the degree of protein <1 g/24-h (rs = 0.91; p <0.001) and at 1–3.5 g/24-h (rs = 0.73; p<0.05). Conclusion : There is a significant strong positive correlation between spot urine protein/creatinine ratio and the 24-hour urine protein levels in lupus nephritis, so it is recommended to use spot urine protein/creatinine ratio, as an alternative quantitative examination in lupus nephritis.

Hypertrophy of the posterior spinal elements leading to compromise of the spinal canal and its neural elements is a well-recognized pathological entity affecting the lumbar or cervical spine. Such stenosis of the thoracic spine in the absence of a generalized rheumatological, metabolic, or orthopedic disorder, or a history of trauma is generally considered to be rare. Spinal ligaments, such as the ligamentum flavum (LF), are prone to degeneration and can lead to back pain and nerve dysfunction. Ossification of ligamentum flavum (OLF) is a pathological condition that cause neurological symptoms and usually occurs in the thoracic spine and less frequently in the cervical spine. However the disease is now being increasingly recognized as a cause of thoracic myelopathy. We report a rare case of thoracic myelopathy caused by OLF. A 48-year-old male presented with a chief complaint of weakness of bilateral lower extremities. Neurological examination revealed sensory deficit at Th 11 level below. Magnetic resonance imaging and computed tomography demonstrated OLF at the right T9–11 level. Thoracic myelopathy caused by OLF was consider and surgical intervention was performed. Posterior decompression and laminoplasty has been performed for this patient.