Pengetahuan Lupus bagi masyarakat umum
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Rachmat Gunadi Wachjudi
Lahir di Garut, 16-1-1955
SD-SMA : Garut Dokter umum: FK UNSRI Palembang Internist: FK UNPAD Bandung Clinical Rheumatology & Osteoporosis
Training: Arthritis Foundation of WA Perth
Konsultan Reumatologi : FKUI Jakarta
Kepala Divisi Reumatologi RS Dr Hasan Sadikin
IRA, PAPDI, PEROSI, PERALMUNI, APLAR, IASP, OARSI
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L u p u s
Apa dan bagaimana ?
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A cohort study found that within seven years of diagnosis, 20.5 percent of patients with systemic lupus erythematosus have neuropsychiatric damage, 18.5 percent have musculoskeletal damage, and 15.5 percent have renal damage.
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Apakah LUPUS
1. Penyakit self-allergy, peradangan
2. Autoantibodi gangguan organ
3. Kambuh >< terkendali (tenang)
4. Sangat beragam
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Rheumatic ailments
1%
1%
6%
4%
4%
69%
3%2%
10%
Osteoartritis
Lupus EritematosusSistemik
Rheumatoid Artritis
Gouty Artritis
Spondiloartropati
Sistemik Sklerosis
Osteoporosis
Soft Tissue Rheumatism
Lain-lain
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Fenomena gunung es Gejala sering tidak khas Beragam Kambuh/tenang
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Siapa yang mengalami LUPUS
90% : wanita. 80% : 15 sampai 45 tahun. Lebih sering pada orang Afro-
Amerika , Asia.
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Semua usia 85% mengenai usia 20-60 tahun 15% mengenai
• bayi baru lahir (neonatal Lupus)• Lupus pada anak kecil • Lupus pada remaja • Lupus pada usia lanjut.
Hanya mengenai wanita muda?
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Faktor-faktor yang berpangaruh ?
Genetik
Hormonal
Lingkungan
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General Concepts
Common features
1. Host and genetic predisposition – familial occurrence, female preponderance
2. Overlapping clinical features
3. Blood vessel as important target organ – vasculitis, vasculopathy
4. Immunologic correlates – circulating Ig, immune complexes
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Apa gejala dan tanda Lupus ?
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1. (Discoid LE) Lupus Kutaneus : 10%
2. Lupus Eritematosus Sistemik : 70%* Non-organic-threatening disease : 35%
* Organ-threatening diseas : 35%
3. Drug induced Lupus Erythematosus (DILE): 10%4. Crossover atau overlap syndrome dan/ MCTD:
10%
GAMBARAN KLINIS
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Gejala
Tidak spesifik:• Lelah• Berat badan turun• Lemas• Demam• Anoreksia / tidak ada nafsu makan• Artritis
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Dokter yg pertama dikunjungi :
87% Primary Care Physician
84% Rheumatologist84% Opththalmologist75% Dentist63% Obstetric &
Gynecologist
39% Dermatologist37% Internist30% Nephrologist27% Cardiologist19% Psychiatrist/
Psychologist
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Gejala dan tanda Lupus
Gejala dan tanda Jumlah (%)
Bercak Malar 534 (49%)
Bercak Discoid 283 (26%)
Fotosensitivitas 355 (33%)
Ulser mulut 355 (33%)
Nyeri/radang sendi 732 (68%)
Radang selaput organ 130 (12%)
Gangguan ginjal 502 (47%)
Gangguan syaraf 135 (13%)
Psikiatri 151 (14%)
Lekopenia 41 (4%)
Thrombositopenia 46 (4%)
Anemia 311 (29%)
Pembesaran Kelenjar 201 (19%)
Rambut rontok 488 (45%)
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Tanda pada kulit
Ruam Malar / Kupu-kupu
Hanya 30-40% pasien lupus yang mengalami manifestasi kulit.
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RUAM Diskoid
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Fotosensitivitas
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Alopecia areata
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ulser di selaput lendir
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SLE
Cutaneous manifestations
Oral Ulcers
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Radang/nyeri sendi
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SLE
Raynaud’s phenomenonVasculitis
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Autoantibodi
ANA
Anti ds-DNA
Anti Smith
Anti phospholipid antibody (APS)
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Gangguan syaraf Kejang Psikosis
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Gangguan ginjal
NormalGlomerulonefritis
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1. Ruam malar2. Ruam diskoid 3. Fotosensitivitas4. Ulkus di mulut5. Artritis6. Serositis7. Gangguan ginjal 8. Gangguan Neurologi 9. Gangguan hematologi10.Gangguan Immunologi (Anti ds DNA, Anti Sm dll)11.Anti-nuclear antibody (ANA)
Kriteria ACR untuk klasifikasi Lupus
Ada 4 dari 11 = SLE
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Bagaimana dokter mendiagnosis LUPUS
Anamnesis Pemeriksaan fisik Test Laboratorium Biopsi kulit atau ginjal
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Dokter pemerhati LUPUS
Dokter umum Spesialis penyakit dalam Konsultan Reumatologi Konsultan hematologi Konsultan Imunologi Konsultan Nefrologi Jantung dan pembuluh darah Konsultan Paru Spesialis lain yang terkait (Kulit, mata,
THT)
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Treatment of SLE
Goals:
1) to control acute, severe flares
2) to develop maintenance strategies in which symptoms are suppressed to acceptable levels
SLE
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Non-Pharmacologic Therapies
Patient education and psychosocial interventions
- psychological support group (e.g. Lupus Club)
Lifestyle changes
- avoid intense sun exposure
- liberal use of sun screens and protective
clothing/gears (umbrellas, hats, etc.)
SLE
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Permasalahan
Depresi Lelah Aktivitas fisik Hubungan
sosial Kehamilan
Perawatan medis Rasa percaya diri Pekerjaan Masa depan
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Apa yang bisa diupayakan bagi Odapus ?
Edukasi/Informasi Deteksi dini (?) Mencegah Kambuh Hubungan baik Kontrol secara
teratur
Mengobati nyeri Mengatasi stres Dukungan
keluarga Kelompok
pendukung Lupus
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Sampai dimana kemajuan ilmu pengetahuan mengenai Lupus ?
Bagaimana sistim imun bekerja?
Penyebab lupus?
Cara optimal mengobati lupus?
Penelitian preklinis Penelitian klinis Identifikasi gen Penelitian
bakteri/virus/paparan zat Mencari penyebab Pengembangan terapi
baru Obat untuk
menyembuhkan lupus (?)
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Rahman A and Isenberg D. N Engl J Med 2008;358:929-939
Targeted Therapeutic Approaches in Systemic Lupus Erythematosus
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Pharmacologic Therapies
1. Corticosteroids
2. Cytotoxic drugs (e.g. Cyclophosphamide, Azathioprine)
3. Cyclosporine
4. NSAIDs
5. Antimalarials (e.g. Hydroxychloroquine)
6. Experimental therapies
Rituximab
Ocrelizumab
Atacicep
Abetimus sodium
Belimumab / Benlysta
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• Aktivitas berlebih• Stres dan fluktuasi emosi• Sinar matahari• Infeksi virus tertentu• Hamil• Berhenti obat secara mendadak• Obat tertentu• Vaksin tertentu
Para provokator…..
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Pencegahan
Hindari paparan sinar matahari Istirahat Makan sehat/ diet Olah raga Mencegah infeksi Hindari rokok pasif / aktif
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Prognosis:
Survival: 90 - 95% in 2 years
82 - 90% in 5 years
71 - 80% in 10 years
63 - 75% in 20 years
SLE
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Cu in Bandung
Aula Barat ITB7 May 2011