Hubungan Aktifitas Penyakit SLE (Systemic Lupus Erythematosus) Berdasarkan Mex-Sledai Scoring Terhadap Depresi Di Komunitas Odapus Kota Bandar Lampung

ABSTRACT: RELATIONSHIP OF SLE (SYSTEMIC LUPUS ERYTHEMATOSUS) ACTIVITIES BASED ON MEX-SLEDAI SCORING ON DEPRESSION IN ODAPUS COMMUNITIES BANDAR LAMPUNG Background: Depression is a clinical manifestation that can occur in patients with SLE and it is suspected that the level of SLE disease activity can affect these events (Nery, et al. 2007). Ironically, this section is a part that is often overlooked by many people, including the health sector. In fact, by understanding this point of view, cross-scientific collaborative treatment such as the Internal and Psychiatry Fields can be done to improve the treatment and quality of life of patients.Objective: To determine the relationship between SLE (Systemic lupus Erythematosus) disease activity based on MEX-SLEDAI Scoring against depression in the Odapus Community, Bandar Lampung City 2020.Methodology: The type of research used in this study is correlative analytic with cross-sectional design. The sample used in this study were patients with SLE (Systemic lupus Erythematosus) based on MEX-SLEDAI Scoring for depression in the Odapus Community, Bandar Lampung City 2020. Data analysis used the Spearman test.Results: In the activity variable SLE and depression, the P value = 0.001 (P <0.05) with a correlation value of r = 0.490 was obtained.Conclusion: There is a relationship between SLE (Systemic lupus Erythematosus) disease activity based on MEX-SLEDAI Scoring against depression in Odapus Community, Bandar Lampung City 2020 with moderate correlation strength. Keywords: Lupus, Depression, MEX-Sledai INTISARI: HUBUNGAN AKTIFITAS PENYAKIT SLE (SYSTEMIC LUPUS ERYTHEMATOSUS) BERDASARKAN MEX-SLEDAI SCORING TERHADAP DEPRESI DI KOMUNITAS ODAPUS KOTA BANDAR LAMPUNGLatar Belakang: Depresi merupakan manifestasi klinis yang dapat muncul pada penderita SLE dan diduga tingkat aktivitas penyakit SLE dapat mempengaruhi kejadian-kejadian tersebut (Nery, dkk. 2007). Ironisnya, bagian ini merupakan bagian yang sering luput diperhatikan oleh banyak orang, termasuk bidang kesehatan. Padahal, dengan memahami sudut pandang ini, pengobatan kolaboratif lintas keilmuan seperti Bidang Interna dengan Bidang Psikiatri dapat dilakukan untuk meningkatkan pengobatan dan kualitas hidup pasien.Tujuan: Untuk mengetahui hubungan aktifitas penyakit SLE (Systemic lupus Erythematosus) berdasarkan MEX-SLEDAI Scoring terhadap depresi di Komunitas Odapus Kota Bandar Lampung 2020.Metodologi: Jenis penelitian yang digunakan dalam penelitian ini adalah analitik korelatif dengan desain cross sectional. Sampel yang digunakan pada penelitian ini adalah penderita penyakit SLE (Systemic lupus Erythematosus) berdasarkan MEX-SLEDAI Scoring terhadap depresi di Komunitas Odapus Kota Bandar Lampung 2020. Analisa data menggunakan Uji Spearman.Hasil: Pada variabel aktifitas penyakit SLE dan depresi diperoleh nilai P value = 0,001 (P<0,05) dengan nilai korelasi r = 0,490.Kesimpulan: Terdapat hubungan aktifitas penyakit SLE (Systemic lupus Erythematosus) berdasarkan MEX-SLEDAI Scoring terhadap depresi di Komunitas Odapus Kota Bandar Lampung 2020 dengan kekuatan korelasi sedang.Kata Kunci : Lupus, Depresi, MEX-Sledai

O004. Assessment of the impact of lupus nephritis on clinical, biological parameters, disease activity and mortality in pediatric Systemic Lupus Erythematosus

Background Systemic lupus erythematosus (SLE) is an autoimmune disorder affecting multiple organ systems. Kidney involvement is one of the most frequent and severe manifestations of pediatric systemic lupus erythematosus (pSLE), seriously affecting the prognosis. It usually manifests as glomerulonephritis of varying severity. Objective: Knowledge of the correlation of lupus nephritis (LN) with clinical, biological, immunological parameters, disease activity and mortality in pediatric systemic lupus erythematosus is limited. This study aims to describe the impact of renal involvement with these different determinants. Methods This was a prospective, multicenter, descriptive 36-month study (January 2015 - December 2018) including patients less than 16 years of age with LN. The presence of LN was defined according to the American College of Rheumatology classification SLE criteria. The LN class was determined by renal biopsy and was classified according to the Morphology in Kidney International Society of Nephrology (ISN)/Renal Pathology Society (RPS) 2004 classification of lupus nephritis. The disease activity was estimated by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), the use of which has been validated in children. Means, percentages and Chi-square tests were specified. P values less than 0.05 were considered statistically significant. Results We included 83 patients in this study. 37/83 patients (44.6%) developed LN with the following urinary signs: 92% of proteinuria (mean 3366.147 mg ± 2785.93 / 24h) including 2/3 of cases of nephrotic syndrome, 81% of hematuria, 14% of acute renal failure with significant reduction in glomerular filtration rate (average creatinine clearance of 32.42 ml / min) and 12% high blood pressure. Out of a total of 30 renal biopsies interpreted at disease diagnosis, 73.4% diffuse proliferative glomerulonephritis forms were observed: (III (30%), IV (36.7%) and VI (6, 7%)). Lupus nephritis were significantly correlated with hypocomplementemia in its C3 (P = 0.00002) and C4 (P = 0.00005) fraction, lymphopenia (P = 0.02), anti-DNA antibodies (P = 0.026), SLEDAI (P = 0.00001) and mortality (P = 0.03). The most frequently used induction drugs for LN classes III, IV and VI were pulsed intravenous methylprednisolone (500 mg daily for 3 doses) in combination with low dose intravenous cyclophosphamide (23%) in the short term (500 mg/m2/15 days X 6) followed by mycophenolate mofetil (28%) (600mg/ m2 in two daily doses) as maintenance treatment associated with a daily dose of oral glucocorticoids with a gradual decrease until reaching the minimum amount necessary to control the disease. All of our SLE patients with nephritis were treated with HCQ with a significant correlation with the decrease in SLEDAI. During the first two years of disease progression, the frequency of LN increased to 43/83 (51.8%) mainly in these severe forms: (IV (41.7%), V (2.8 %). The progression to chronic renal failure had a prevalence of 6, 9% (3/43) of cases; these were mainly patients with severe lupus nephritis (III, and IV) Conclusion Nephritis is a major risk factor for morbidity and mortality in pSLE; LN in children is most often proliferating and more active. The early diagnosis and management of kidney damage are the only guarantee of a good course and prevention of the progression of chronic renal failure. Keywords lupus nephritis; child; systemic lupus erythematosus; disease activity, mortality.

The Relationship of Neutrophil Lymphocyte Ratio and Levels of Vitamin D against Disease Activity Systemic Lupus Erythematosus

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the presence of autoantibodies against cell nuclei and immune complexes involving multiple organ systems in the body. The Lupus Foundation estimates about 1.5 million cases of SLE in America and at least 5 million cases of SLE in the world and from year to year, the number of people with lupus also tends to increase. Several laboratory findings are also associated with signs and symptoms of SLE activity including the ratio of neutrophil lymphocytes and vitamin D levels. Method: This study is an observational analytic study using medical record data from central installation patients at H. Adam Malik Hospital in the period December 2019 to March 2021. The sample is calculated using the large proportion estimation formula. Then the distribution test was carried out with the Shapiro Wilk test. Bivariate analysis was carried out to determine the relationship between neutrophil lymphocyte ratio and vitamin D levels with the MEX SLEDAI score using the ANOVA test if the data was normally distributed. Results: 75 subjects participated in the study and there were 12 people (16%) experiencing mild systemic lupus erythematosus, 38 people (51%) moderate degree, and 25 people (33%) severe degree. The neutrophil-lymphocyte ratio was associated with systemic lupus erythematosus disease activity (p=0.001) and vitamin D levels were associated with systemic lupus erythematosus disease activity. Conclusion: Neutrophil-lymphocyte ratio and vitamin D levels are associated with systemic lupus erythematosus disease activity. Keywords: neutrophil lymphocyte ratio, vitamin D levels, systemic lupus erythematosus.

Renal Tubular Acidosis Type I with Prominent Hypokalemia and Nephrolithiasis as a Presentation of Sjögren’s/Systemic Lupus Erythematosus Disease

Female patient, suffering from nephrolithiasis, at the age of 32 was admitted for renal colic caused by a stone obstructing UP junction with left hydronephrosis. Nephrostomy was placed, resulting in brisk diuresis. Severe metabolic acidosis with normal anion gap and urine pH of 6.5 was noted. Potassium level dropped to extremely low level (1.6 mEq/L), causing muscle paralysis and respiratory failure, necessitating mechanical ventilation. The patient was treated by potassium chloride infusion, followed by correction of severe metabolic acidosis by sodium bicarbonate. Diagnosis of distal type renal tubular acidosis type I (dRTA) was made based on normal anion gap metabolic acidosis, alkaline urine, hypokalemia, and nephrolithiasis. Five years later, the patient presented with severe hypoxia, lung opacities, and bronchiolitis obliterans organizing pneumonia which was confirmed by bronchoscopy with lung tissue biopsy. Concurrently, the patient presented with dry mouth, pruritus, skin rash with hypocomplementemia, elevated anti-DNA, anti-Ro, and anti-SmAb. Diagnosis of overlap Sjögren’s/systemic lupus erythematosus disease was done and treatment by hydroxychloroquine, prednisone, and azathioprine was started. Possible presence of Sjögren’s syndrome should be considered in adult patients with unexplained dRTA.

Clinical and serological associations of autoantibodies in patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by the formation of antigen–antibody complexes which trigger an immune response. We investigate certain autoantibodies including nucleosome, double-stranded DNA (dsDNA), Smith, ribonucleoprotein, and Sjögren’s syndrome-related antigens, and examine their associations with disease activity, damage accrual, and SLE-related clinical and serological manifestations in patients with SLE. We conducted a cross-sectional study with a total 293 patients (90.4% female, mean age 46.87±12.94 years) and used the Systemic Lupus Erythematosus Disease Activity Index 2000 and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) to evaluate disease activity and disease-related damage, respectively. Systemic Lupus Erythematosus Disease Activity Index scores were significantly higher in anti-nucleosome-positive (3.87±2.72 vs 2.52±2.76, p=0.004) and anti-dsDNA-positive (3.08±2.91 vs 2.04±2.48, p=0.010) patients compared with patients without these antibodies. SDI scores were also significantly higher in anti-nucleosome-positive patients (1.61±1.99 vs 0.89±1.06, p=0.004). The presence of antinucleosome (p=0.019) and anti-dsDNA antibodies (p=0.001) both correlated significantly with the incidence of nephritis; anti-La antibodies were associated with arthritis (p=0.022), and we also observed a relationship between the presence of antinucleosome antibodies and leukopenia (p=0.011). Patients with antinucleosome or anti-dsDNA antibodies had a higher disease activity and were likely to have nephritis. Antinucleosome was also associated with more damage accrual. A greater understanding of these autoantibodies could lead to the development of new approaches to more accurate assessments of SLE.

Systemic Lupus Erythematosus Disease: An Overview of the Clinical Approach to Pathogenesis, Diagnosis, and Treatment

The systemic lupus erythematosus (SLE), commonly known as Lupus, is a rare and complex multisystem autoimmune disease where one’s immune system is overactive, and the body attacks its organ systems. SLE is a historically old disease described already in antiquity; it is an example of a chronic disease with physical, psychological, financial, and social implications for individuals diagnosed. It has inspired medical and basic biological scientists that focus on molecular biology, basic immunology, immunopathology, clinical science, genetics, and epidemiology. The syndrome is real in its existence-although hidden behind obstacles, cumbersome for patients and clinicians, and rebellious for scientists. There is currently no cure for SLE. The goal of treatment is to ease symptoms. This article will review information on the general approach to SLE therapy, focusing on currently approved therapies and novel approaches that might be used in the future.