Tesis

KORELASI ANTARA ANTI-CITRULINATED PROTEIN ANTIBODIES DAN PETANDA TURNOVER TULANG PASIEN ARTRITIS REUMATOID LOW-DISEASE ACTIVITY DAN REMISI DENGAN DISEASE MODIFYING ANTI RHEUMATIC DRUGS SINTETIK KONVENSIONAL = CORRELLATION BETWEEN ANTI-CITRULLINATED PROTEIN ANTIBODIES (ACPA) LEVEL AND BONE TURNOVER MARKER (CTX-1 AND P1NP) IN PATIENT WITH RHEUMATOID ARTHRITIS ON LOW-DISEASE ACTIVITY AND REMISSION ACHIEVED BY CONVENTIONAL SYNTHETIC DISEASE MODIFYING ANTI RHEUMATIC DRUGS.

Latar Belakang. Arthritis Reumatoid terkait dengan kehilangan massa tulang dan fraktur osteoporosis. Kehilangan massa tulang pada penyakit ini disebabkan oleh proses inflamasi dan autoimunitas. Penelitian ini bertujuan menilai kaitan antara autoimuntas dan kehilangan massa tulang pada pasien yang telah mencapai remisi dan low-disease activity dengan pemberian conventional synthetic Disease Modifying Anti-Rheumatic Drugs. Metode. Penelitian ini diikuti oleh 38 pasien dengan usia rerata 40 ± 7,6 yang telah mencapai remisi dan low-disease activity di RS Cipto Mangunkusumo pada bulan Agustus hingga September 2019. Data pasien yang dikumpulkan berupa data demografis, skor aktivitas penyakit 28 (DAS-28), dan riwayat pengobatan. Semua subjek menjalani pemeriksaan darah untuk menilai kadar Anti Citrullinated Protein Antibodies (ACPA) yang diwakili oleh Anti-Mutated Citrullinated Vimentin (AntiMCV), C-Terminal cross-linking telopeptide of type I collagen (CTX-1), N-Terminal Propeptide of Type 1 Procollagen (P1NP). Hasil. Sebagian besar subjek merupakan wanita dengan median lama sakit selama 36 bulan. Pada subjek penelitian ditemukan 26 pasien (68,4%) dengan ACPA positif. Korelasi antara kadar ACPA dengan kadar CTX-1 ditemukan koefisien r 0,101 (p: 0,279). Korelasi antara kadar ACPA dan P1NP ditemukan koefisien r -0,449 (p: 0,001). Simpulan. Tidak ditemukan korealasi antara kadar ACPA dengan kadar CTX-1 dan ditemukan korelasi negatif lemah yang bermakna secara statistik anatra kadar ACPA dan P1NP pada pasien Artritis Reumatoid yang telah mencapai remisi dan Low Disease Activity dengan penggunaan conventional synthetic disease modifying antirheumatic drugs.
Kata Kunci. Autoimmunity, ACPA, CTX-1, P1NP, Rheumatoid Artritis


Background. Rheumatoid Arthritis is related to bone loss and risk of osteoporotic fracture. Bone loss in this disease is mediated by inflammation and autoimmunity. Our objective was to determine correlation between autoimmunity and bone loss in patients with Rheumatoid Arthritis in Remission and Low-Disease Activity achieved by conventional synthetic disease modifying anti rheumatic drugs. Methods. This study enrolled 38 patients with disease remission and low-disease activity, aged 40 ± 7,6 years who participated in Cipto Mangunkusumo Hospital in August to September 2019. We collect patients’ demographic data, disease activity score 28 (DAS-28), and treatment history. All participants undergo blood work for Anti Citrullinated Protein Antibodies (ACPA) represented by Anti-Mutated Citrullinated Vimentin (Anti-MCV), C-Terminal cross-linking telopeptide of type I collagen (CTX-1), N-Terminal Propeptide of Type 1 Procollagen (P1NP). Results. Most subjects are woman with median disease duration is 36 months. Among the subject we found ACPA positivity in 26 patients (68,4%). The correlation between ACPA and CTX-1 is r 0,101 (p: 0,274) and the correlation between ACPA and P1NP is r -0,449 (p: 0,001). Conclusion. There is no correlation between ACPA and CTX-1 and moderate negative correlation between ACPA and P1NP in Rheumatoid Arthritis patient with low disease activity and remission achieved by conventional synthetic disease modifying anti-rheumatic drugs.
Keywords. Autoimmunity, ACPA, CTX-1, P1NP, Rheumatoid Artritis