SYSTEMIC LUPUS ERYTHEMATOSUS, NEFRITIS LUPUS, ULKUS KRONIS DAN OSTEOPOROSIS

DICKY ARI RISANDY, dr. Sumadiono, SpA(K); Prof. Dr. dr. Madarina, PhD. Sp.A(K)

2017 | Tesis | S2 Ilmu Kedokteran Klinik

Systemic lupus erythematosus (SLE) merupakan penyakit autoimun kronis, multisistem dengan periode peningkatan aktifitas penyakit akibat peradangan di pembuluh darah dan jaringan ikat. Onset awal SLE terjadi pada 2 dekade awal kehidupan, dan SLE anak biasanya muncul pada wanita post pubertas, pada usia sekitar 16 tahun tapi bisa bervariasi antara usia 14 sampai 20 tahun. Anak dan remaja merupakan 15% dari jumlah pasien SLE. Dilaporkan seorang anak perempuan berumur 13 tahun dengan SLE dan memiliki komplikasi nefritis lupus dan osteoporosis. Pada periode awal, anak didiagnosis dan tatalaksana dengan AIHA. Pada 11 kriteria SLE oleh ACR 1997, diagnosis SLE ditegakkan dan dimulai pemberian pengobatan sesuai protokol SLE berat. Selama menjalani protokol terapi severe SLE, pasien mengalami komplikasi osteoporosis dan ulkus kronik. Selama pengamatan 18 bulan, didapati adanya remisi parsial untuk lupus nefritis, aktivitas penyakit dengan MEX SLEDAI menunjukkan aktivitas ringan sampai berat dengan penyulit berupa vaskulitis. Keluhan utama nyeri punggung semenjak pemberian steroid hingga protokol fase maintanace bulan ke 2 dan gambaran radiologi terdapat fraktur kompresi vertebra thoraks X hingga XII dan vertebra lumbal I dan III, menyokong gambara osteoporosis. Kesimpulan: Selama pengamatan kepatuhan terapi pasien baik, efek samping yang timbul berupa osteoporosis regio vertebra, tetapi keluhan nyeri pinggang berkurang dibanding sebelum pengamatan. Remisi renal memungkinkan tidak terjadinya progresi gangguan ginjal kronis. Akan tetapi remisi renal berisiko mengalami flare di kemudian hari yang pada akhirnya bisa menimbukan progresivitas gangguan ginjal. Sehingga meskipun protokol terapi fase maintenance telah selesai, pemberian terapi suportif tetap dilanjutkan dan pemantauan berkala tetap dilakukan bertahap dengan pengawasan ketat.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease, a multisystem with periods of increased disease activity due to inflammation in blood vessels and connective tissue. Early onset of SLE occurs in the early 2 decades of life, and SLE children usually appear in post puberty women, at about 16 years of age but may vary between 14 and 20 years of age. Children and adolescents account for 15% of SLE patients. Reported by a 13 year old girl with SLE and has complications of lupus nephritis and osteoporosis. In the early period, the child was diagnosed and managed with AIHA. In the 11 SLE criteria by ACR 1997, SLE diagnosis was established and initiated treatment according to the SLE protocol was severe. During a SLE Severe therapy protocol, patients experience complications of osteoporosis and chronic ulcers. During the 18-month observation, partial remission was found for lupus nephritis, disease activity with MEX SLEDAI showed mild to severe activity with complications of vasculitis. The main complaints of back pain since steroid administration until the 2nd month maintanace protocol phase and radiological features are compression fractures of X-th XII and X-lumbar vertebrae and Lumbar I and III vertebrae, supporting the osteoporosis image. Conclusions: During the observation of the patient's adherence to good therapy, the side effects of osteoporosis occur in the vertebral region, but lower back pain complaints than before the observation. Renal remission allows for no progression of chronic renal impairment. However, renal remissions are at risk of developing flares later in life, which can ultimately lead to progression of renal impairment. So even though the maintenance phase maintenance protocol has been completed, supportive therapy continues and regular monitoring is done gradually with close monitoring.

Kata Kunci : Nefritis lupus, osteoporosis, ulkus kronik