Tesis

Perbedaan Kadar Leucine Rich α-2 Glycoprotein (LRG) Serum pada Artritis Reumatoid (AR) dan Spondiloartritis (SpA) = The Difference between Leucine Rich α-2 Glycoprotein (LRG) Serum Level in Rheumatoid Arthritis (RA) and Spondyloarthritis (SpA).

Latar Belakang: Artritis adalah peradangan (inflamasi) pada sendi yang ditandai dengan nyeri, bengkak dan kaku pada sendi. Penyebab yang termasuk diantaranya adalah Artritis Reumatoid (AR) dan Spondiloartritis (SpA). SpA terbagi menjadi SpA aksial dan SpA perifer, juga dapat dikelompokkan sebagai Ankilosing Spondilitis (AS) dan Psoriatik Artritis (PsA), artritis yang berhubungan dengan Inflammatory Bowel Disease (IBD), reaktif artritis dan artritis yang tidak dapat dikelompokkan. Pada tahap awal penyakit, beberapa gejala dan tanda peradangan sendi pada AR mungkin menyerupai SpA. Hal ini dapat menyebabkan kesulitan penegakan diagnosis yang berdampak pada progresivitas kerusakan sendi. Diagnosis yang tepat akan berdampak positif pada pemberian terapi yang efektif. Dibutuhkan suatu pemeriksaan yang dapat membantu membedakan AR dan SpA, yaitu Leucine Rich α2 Glycoprotein (LRG). Penelitian terdahulu menyatakan bahwa hasil analisis cairan sinovial pasien AR menunjukan kadar LRG serum yang lebih tinggi dibanding SpA. Sejauh ini, belum ada penelitian terkait perbandingan kadar LRG serum pada AR dan SpA. Tujuan: Tujuan dari penelitian ini untuk mengetahui peran LRG serum dalam membedakan AR dan SpA. Studi ini juga menilai kadar LRG pada AR dan SpA. Metode: Penelitian ini merupakan studi potong lintang dengan 52 subjek, diantaranya 26 subjek AR dan 26 subjek SpA. Pengambilan sampel dilakukan secara konsekutif di Poliklinik Reumatologi Rumah Sakit Cipto Mangunkusumo. Pemeriksaan LRG serum dilakukan dengan metode ELISA di Laboratorium Universitas Indonesia yang tersertifikasi ISO. Uji perbedaan dua kelompok menggunakan uji Mann Whitney. Hasil: Hasil penelitian ini menemukan bahwa kadar LRG serum meningkat pada subjek AR (76,9%) dan SpA (84,6%). Median kadar LRG lebih tinggi pada subjek AR (77,03 (27,16107,73) dibandingkan pada subjek SpA (68,67 (33,15-115,18). Tidak terdapat perbedaan kadar LRG yang bermakna pada subjek AR dan SpA (P=0,442). AR dan PsA didominasi oleh aktivitas penyakit sedang (58,3% vs 88,5%), sedangkan AS didominasi oleh aktivitas penyakit tinggi (85,7% vs 68,7). Median LRG serum tertinggi pada subjek AS dan SpA terdapat pada pasien dengan awitan baru (82,21 vs 72,25 g/dl). Simpulan: Median kadar LRG serum AR lebih tinggi dibanding SpA (77.03 vs 68.67 µg/dl). Tidak didapatkan adanya perbedaan kadar LRG serum yang signfikan antara subjek AR dan SpA.
Kata kunci: Artritis reumatoid, Spondiloartritis, LRG serum


Background: Arthritis is an inflammation condition of the joint, characterized by pain and swelling of the joint. Two causes of arthritis are rheumatoid arthritis (RA) and spondyloarthritis (SpA). SpA consist of axial SpA and peripheral SpA, and also divided into subgroup ankylosing spondylitis (AS), psoriathic arthritis (PsA), IBD related arthritis, reactive arthritis and undifferentiated arthritis. In the early stages of the disease, some of the symptoms and signs of joint inflammation in RA may resemble with SpA. This can cause difficulty in making a diagnosis which has an impact on the progression of joint damage. Correct diagnosis will have a positive impact on the delivery of effective therapy. It takes an examination that can help distinguish RA and SpA, namely Leucine Rich -2 Glycoprotein (LRG). Previous studies stated that the results of analysis of synovial fluid in RA patients showed higher levels of LRG than SpA. So far, there have been no studies related to the comparison of serum LRG levels in RA and SpA. Objective: This study aimed to determine the role of LRG in differentiating RA and SpA. Furthermore, this study examined the LRG levels in RA and SpA. Methods: This is a cross-sectional study with 52 subjects, consisting of 26 AR subjects and 26 SpA subjects. Sampling was carried out consecutively at the Rheumatology Polyclinic of Cipto Mangunkusumo Hospital. Measurement of LRG levels were conducted using enzymelinked immunoassay in an ISO-certified laboratory at Universitas Indonesia. Difference between LRG levels of the two groups were compared using Mann-Whitney test. Results: The results of this study found that the distribution of LRG serum levels increased in AR (76.9%) and SpA (84.6%) subjects. Median LRG levels were higher in AR subjects (77.03 (27.16-107.73) than SpA (68.67 (33.15-115.18). There was no significant difference in LRG levels in AR and SpA subjects (p = .442). The distribution of disease activity was uneven in RA and SpA subjects, RA and PsA were dominated by moderate disease activity (58.3% vs 88.5%). In comparison, AS was dominated by high disease activity (85.7% vs 68.7 µg/dL) The highest median LRG serum levels in AS and SpA subjects were in new-onset patients (82.21 vs 72.25 g/dl). Conclusion: Median LRG serum levels in RA subjects were higher than those with SpA (77.03 vs 68.67 µg/dl). There was no significant difference in LRG serum levels between RA and SpA subjects.
Keyword: Rheumatoid arthritis, Spondyloarthritis, LRG serum