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All Journal Indonesian Journal of Rheumatology The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Bambang Setiyohadi
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Medicine & Pharmacology

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Multiple autoimmune syndrome (Graves’ disease, systemic lupus erythematosus, and systemic sclerosis) in a young woman in Jakarta Dewi, Sumartini; Setiyohadi, Bambang; Mokoagow, M I
Indonesian Journal of Rheumatology Vol 2, No 2 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Multiple autoimmune syndrome (MAS) is a condition in which patients have at least threedistinct autoimmune conditions. The definition of MAS is based on 91 reported cases of such associations in the literature. A review of the literature and cluster analysis of MAS disclosed systemic lupus erythematosus (SLE), Sjögren’s syndrome, and autoimmune thyroid disease (AITD) as the “chaperones” of autoimmune diseases. This entity was described by Humbert and Dupond in 1988 as a syndrome consisting of the presenceof three or more autoimmune diseases in a single patient. While describing the syndrome, their observations led them to a rough classification of clusters based on the co-occurrence of autoimmune disease, which they identified as types one through three.1 In MAS-1, the authors grouped myasthenia gravis, thymoma, dermatopolymyositis, and autoimmune myocarditis together. In MAS-2, they grouped Sjögren’s syndrome, rheumatoid arthritis,primary biliary cirrhosis, systemic sclerosis (SSc), and AITD. MAS-3 consists of AITD, myasthenia gravis and/or thymoma, Sjögren’s syndrome, pernicious anemia, idiopathic thrombocytopenic purpura, Addison’s disese, type 1 diabetes, vitiligo, autoimmune hemolytic anemia, and SLE.1,2,3 The importance of this concept is the probability thathaving three autoimmune diseases simultaneously in one patient goes beyond epidemiological inferences or statistical chance. Disorders of autoimmune pathogenesis occur with increased frequency in patients with a history of another autoimmune disease. The tendency to develop another disease occurs in about 25% of these patients.3,4 We report a case in which the presence of Graves’ disease/AITD, SLE, vasculitis, and SSc with pulmonary hypertension and Raynaud’s phenomenon in one patient
Prevalence and factors associated with vitamin D deficiency in systemic lupus erythematosus patients Pangestu, Y; Setiati, S; Setiyohadi, Bambang; Sukmana, N
Indonesian Journal of Rheumatology Vol 4, No 1 (2013)
Publisher : Indonesian Rheumatology Association

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Background: In addition to the calcium-phosphorus metabolism, vitamin D might also play a role in the immune system. Studies have showed lower levels of vitamin D among SLE patients compared with controls. Researches regarding vitamin D in SLE patients have only been conducted in four seasons’ countries (Caucasians subjects in a large part) , but no data has been available in tropical countries, particularly Indonesia. The presence of VDR gene polymorphism in different populations will affect the role of vitamin D in the immune system. Objectives: To determine the prevalence of vitamin D deficiency and identify its risk factors such as lack of sunlight exposure, sunscreen usage, long-term corticosteroid therapy, disease activity, insufficient vitamin D supplementation, and obesity in SLE patientswith vitamin D deficiency.Methods: A cross-sectional study was conducted on SLE patients who were under treatment at Cipto Mangunkusumo General Hospital or members of Indonesian Lupus Foundation. Then those patients completed questionnaires and their 25(OH)D serum levels were measured. The cut-off value of 25(OH) D levels for vitamin D inadequacy is 75 nmol/L, which then grouped into vitamin D insufficiency (25(OH)D 25 - <75 nmol/L) and vitamin D deficiency (25(OH)D <25 nmol/L). SLE activity was assessed with MEX-SLEDAI.Results: During May-June 2008, 80 SLE patients were enrolled with 96.3% female subjects, median age of 26 years (range 17-56 years), 66.3% non-obese, 93.8% using steroid, 62.5% with active disease, and 63.8%have adequate sun exposure. In addition, 81.5% didnot use sunscreen and 83.8% did not take vitamin D supplementation. All patients had vitamin D inadequacy with 41.2% in insufficiency level and the other 58.8% in deficiency level. The median of 25 (OH)D levels were 21.85 nmol/L (range 11.5-57.7 nmol/L). It also has been found that vitamin D deficiency occurred more in subjects who were obese, used sunscreens, had lower exposure to sunlight, in a long-term high-dose steroid therapy, had active SLE disease, and had no vitamin D supplements.Conclusions: All SLE patients had vitamin D inadequacy. Vitamin D deficiency occurred more in subjects who were obese, used sunscreens, had lower exposure to sunlight, in a long-term high-dose steroid therapy, had active SLE disease, and had no vitamin Dsupplements.
Diabetes insipidus in neuropsychiatric-systemic lupus erythematosus patient Pangestu, Y; Wardoyo, A; Wijaya, Linda K; SETIYOHADI, BAMBANG; Albar, Zuljasri; Sukmana, N; Budiman, Budiman; Djoerban, Z; Effendy, S; Aziza, L; Sitorus, F
Indonesian Journal of Rheumatology Vol 2, No 1 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Systemic lupus erythematosus (SLE) is an idiopathic autoimmune chronic inflammatorydisease that is unique in its diversity of clinical manifestations, variability of disease’s progression, and prognosis. The disease is characterized by the remission and multiple flare-ups in between the chronic phase that may affect many organ systems.The prevalence of SLE in the US population is 1:1000 with a woman to man ratio of about 9-14:1. At Cipto Mangunkusumo Hospital, Jakarta in 2002, there was 1.4% cases of SLE of the total number of patients at the Rheumatology Clinic. Neuropsychiatric manifestations of SLE (NP-SLE) have a high mortality and morbidity rates. The incidence of NP-SLE ranges 18-61%. Diagnosis of NP-SLE is difficult because there is no specific laboratory examination. Accordingly, in all SLE patients with central nervous system (CNS) dysfunction, additional tests will be necessary to confirm an NP-SLE diagnosis and exclude other causes. Similar to diabetes insipidus, SLE is a systemic disease which affects many organ systems, one being the endocrine system. No data has specified the occurrence rate of diabetes insipidus in SLE patients. This disease arises from a number of factors able to interfere with the mechanism of neurohypophyseal renal reflex resulting in the body’s failure to convert water.3 There are three general forms of the disease, a polydipsicpolyuric syndrome caused by partial/complete vasopressin deficiency (central-diabetes-insipidus/CDI), vasopressin resistance of the kidney tubules (nephrogenic-diabetes-insipidus/NDI), and primary polydipsia. CDI occurs in about 1 in 25,000 persons
Risk of cardiovascular disease in rheumatoid arthritis patients Utari, A P; Hidayat, Rudy; Setiyohadi, Bambang
Indonesian Journal of Rheumatology Vol 3, No 1 (2011)
Publisher : Indonesian Rheumatology Association

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Abstract

Despite rheumatoid arthritis (RA) therapy development has been in advance level today, its mortality remains increasing in general population. The mortality is mainly caused by early-manifested atherosclerosis and other cardiovascular complications. Available evidences showthis condition appears in early stage of the disease. Thus, early detection and management of cardiovascular risk, followed by control of these factors are necessaryto reduce morbidity and mortality of RA patients
Role of interleukin-17 in the pathogenesis of rheumatoid arthritis Ongkowijaya, Jeffrey A; Setiyohadi, Bambang; Sumariyono, Sumariyono; Kasjmir, Yoga I
Indonesian Journal of Rheumatology Vol 2, No 2 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Rheumatoid arthritis (RA) is a systemic autoimmune disorder with an unknown etiology. It typically affects the peripheral synovial joints symmetrically. The roles of T and B cells, macrophages, plasmocytes, host tissue cells (synoviocytes, chondrocytes), and osteoclastsin RA are more defi ned. In RA, cytokines secreted by cells implicated in adaptive and natural immunity have important roles in causing infl ammation, articular destruction, and other comorbid diseases related to RA. Other than the clear roles of interleukin (IL)-1 and tumor necrosis factor α, there are other cytokines that are suspected of having roles in the pathogenesis of RA, IL-17 for instance. Interleukin-17 is a proinfl ammatory cytokine,  produced by Th17 cells, and has pleiotropic effects on various cells contributing to the pathogenic condition of RA. Several studies showed that this cytokine maintains the infl ammation and causes more destruction of joint cartilage. Advances in the understanding of the role of IL-17 elicits the idea to modulate IL-17 and/or Th17 cells as the potential targetsof therapy in RA
Avascular necrosis of the right femoral head in female patient with Systemic Lupus Erythematosus Sinaga, A; Nufus, H; Setiyohadi, Bambang
Indonesian Journal of Rheumatology Vol 5, No 1 (2014)
Publisher : Indonesian Rheumatology Association

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Abstract

Avascular necrosis (also known as osteonecrosis, aseptic necrosis, or ischemic necrosis) represents collection of pathologic conditions from various etiologies causing impairment of blood supply to particular bone resulting in bone cellular death.Avascular necrosis remains a significant cause of morbidity in patients with systemic lupus erythematosus (SLE).1 It often involves multiple joints in SLE, in which the femoral head is involvedin most of these patients. Corticosteroids use is known as a major risk factor in the development of this complication.2-3 We report this case due to its quite common occurrence in SLE patients. The early recognition of avascular necrosis is essentialto prevent morbidity
Experience with cyclophosphamide in the treatment of a young woman with refractory dermatomyositis Setiyohadi, Bambang; Sinto, R
Indonesian Journal of Rheumatology Vol 3, No 1 (2011)
Publisher : Indonesian Rheumatology Association

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Abstract

Dermatomyositis is an idiopathic inflammatory myopathy characterized by the presence of rash and moderate-to-severe muscle weakness secondary to inflammation of the muscle. It can be a difficult condition to treat. Systemic corticosteroids are the first choice of treatment. However, about a quarter of patients either fail to respond to steroids or develop steroid-related toxicity. Second-line agents such as azathioprine and methotrexate are then added either alone, or in combination with corticosteroids. Failure of the disease to respond tosecond-line agents can then be a problem and this is often referred to as “refractory dermatomyositis”. Unfortunately, there is neither agreement nor wellestablished guidelines on the best regimen or combination of immunosuppressive agents in the case of refractory dermatomyositis.
Diagnosis and management of osteomyelitis Gunawan, Gunawan; Setiyohadi, Bambang
Indonesian Journal of Rheumatology Vol 2, No 3 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Osteomyelitis is an infection of the bone that causes bone destruction and formation of new bone as the result of the infl ammatory process. Proper diagnosis in osteomyelitis is important since it determines the decision-making in the management of the disease: whether to perform aggressive treatments or administration of long-term antibiotic treatment. Imaging techniques play an important role in the diagnosis of osteomyelitis, but their results should be interpreted with care as they have a wide range of sensitivity and specifi city. A combination of imagingtechniques could improve their sensitivity and specifi city. Conventional radiography is an affordable and widely available technique, and has been proven to be useful in diagnosing and excluding the differential diagnosesof osteomyelitis. Surgical intervention to remove necrotic tissues and administration of antibiotics to eradicate pathogens are necessary in the anagementof osteomyelitis. Several antibiotics such as quinolones,rifampin, and clindamycin have been proven to havegood penetration into bone.
Arthritis in leprosy without specific skin lesion Dewi, Sumartini; Setiyohadi, Bambang
Indonesian Journal of Rheumatology Vol 2, No 2 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Leprosy patients could display a great variability of signs and symptoms. An overabundance of rheumatic manifestations, occuring alone or in varying combinations, are associated with leprosy, particularly with lepra reactions A study involving seventy cases of leprosy found that rheumatic manifestations were seen in 61.42% of cases: arthritis in 54.28% and soft tissue rheumatism in 17.14%. Enthesitis was seen in 2.84% of cases. Rheumatic manifestations may be the primary complaint, thus delaying accurate diagnosis. Musculoskeletal involvement in leprosy is the third most frequent manifestation after dermatological and neurological involvements. It can occur at anytime during the infection. Articular inflammation in leprosy, which closely mimics other rheumatic disorders, usually occurs in reactive states, particularly erythema nodosum leprosum (ENL).1 About 1–5% of leprosy patients are reported of developing arthritis (synovial inflammation) at some stage of the disease but this rate increases to over 50% during lepra reactions.2 Here we report a case of arthritis in leprosywithout any typical skin lesion thus causing a delay in diagnosis.
Osteoarticular tuberculosis of the right foot: a diagnostic delayed Akil, Natsir; Setiyohadi, Bambang; Lubis, A MT; Fawziah, A
Indonesian Journal of Rheumatology Vol 2, No 1 (2010)
Publisher : Indonesian Rheumatology Association

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Abstract

Extrapulmonary tuberculosis (TB) involving the musculoskeletal system occurs in approximately 1% to 3% of patients with extrapulmonary TB. Concurrent pulmonary or intrathoracic TB is present in less than 50% of cases.1 Spine is the most frequent site of osseous tuberculous involvement. Other affected sites include the hip, knee, foot, elbow, hand, and bursal sheaths.2 Tuberculosis of the foot and ankle remains anuncommon site of the infection, present in 8% to 10% of osteoarticular infection. The diagnosis of osteoarticular tuberculosis is often delayed due to a lack of familiarity with the disease.3 We describe a patient with foot pain and swelling without any respiratory symptom as initial presentation of pulmonary and osteoarticular tuberculosis
Co-Authors A Harahap, A Abd. Rasyid Syamsuri Abdullah, A A Abdullah, M Aji, G Akil, Natsir Anggraini, N Aru W. Sudoyo Aru W. Sudoyo Aziza, L Azizi, M S Budihusodo, U Budiman Budiman Cleopas Martin Rumende David R.S. Samosir Dewi, Sumartini Djoerban, Z Fawziah, A Gunawan Gunawan Isbagio, H Kasjmir, Yoga I L. A. Lesmana L. A. Lesmana Laniyati Hamijoyo, Laniyati Loli Simanjuntak Lubis, A MT Lusiani Lusiani, Lusiani Marcellus Simandibrata Mesanti, O Mokoagow, M I Nasution, A R Nilasari, D Nufus, H Nyoman Suarjana Oemardi, M Oktaviana, F Ongkowijaya, Jeffrey A Pangestu, Y Rudy Hidayat Rumende, C Matin S Effendy, S Sandra, R Santosa, D Setiati, S Simadibrata, M Sinaga, A Sinto, R Sitorus, F Suhendro Suhendro Sukmana, N Sulaiman, A S Sumariyono Sumariyono Titis, Titis Umami, V Utari, A P Wahyuningsih, R Wardoyo, A Wijaya, Linda K Yudharto, M A Yuliani, Ika Wulan Zuljasri Albar