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LAPORAN AKHIR FARMAKOTERAPI IV PRAKTIKUM III PENYAKIT SISTEM LOKOMOSI SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

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SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

A< PATOFISIO OFISIOLO$ LO$IS IS Lu=us E!ieosus Sisei+ (LES) "lh =en#+i !eui+ uoiun #n6 "in"i "n# in3lsi e!se5! lus> #n6 e=en6!uhi sei= o!6n u sise "l u5uh< Pen#+i ini 5e!hu5un6n "en6n "e=osisi uoni5o"i "n +o=le+s iun sehin66 sehin66 en6+i5+ en6+i5+n n +e!us+n +e!us+n 2!in6n< 2!in6n< Eio=o6en Eio=o6enesis esis "!i LES sih 5elu "i+ehui se7! 2els> "in e!"= 5n#+ 5u+i 5h* =o6enesis LES 5e!si3 uli3+o!l se=e!i 3+o! 6enei+> 3+o! lin6+un6n> "n 3+o! ho!onl e!h"= !es=ons iun< F+o! 6enei+ ee6n6 =e!nn =" 5n#+ =en"e!i lu=us "en6n !esi+o #n6 enin6+ =" su"! +n"un6 "n +e5! ono?i6o< F+o! lin6+un6n "= en2"i =ei7u =ei7u =" =en"e!i lu=us> se=e!i !"isi ul!.iole> ul!.iole> e5+u> o5; o5n o5n>> .i!us< .i!us< Sin! UV en6! en6!h h =" ="  self-immunity   self-immunity  "n hiln6n# ole!nsi +!en en#e en#e55 55+n +n =o=o =o=osis sis +e!i +e!inos nosi< i< Selin Selin iu sin! sin! UV en#e en#e55 55+n +n =ele= =ele=sn sn e"io! iun =" =en"e!i lu=us> "n ee6n6 =e!nn "l 3se in"u+si #n6 se7! ln6sun6 en6u5h en6u5h sel DNA> se! e=en6!uhi e=en6!uhi sel iuno!e6ulo! iuno!e6ulo! #n6 5il no!l e5nu ene+n e!2"in# +elinn =" in3lsi +uli (Uoo> -<> -<> '&%')< Pen#+i Pen#+i sisei+ sisei+ lu=us e!ieosus e!ieosus (SLE) (SLE) e!2"i +i5 e!6n66u e!6n66un# n# !e6ulsi !e6ulsi +e+e5ln #n6 en#e55+n =enin6+n uo ni5o"i #n6 5e!le5ihn< P" sisei+  lu=us e!ieosus> =enin6+n =!o"u+si uo ni5o"i "i=e!+i!+n e!2"i +i5 3un6si sel T;Su=! ;Su=!eso eso!! #n6 #n6 5no! 5no!l l sehin66 sehin66 i5ul i5ul =enu =enu=u+ =u+n n +o=le +o=le+s +s iun iun "n +e!us+n +e!us+n 2!in6n< 2!in6n< In3lsi In3lsi +n ensiulsi ensiulsi ni6en ni6en #n6 #n6 seln2un# seln2un# e!n6sn6 e!n6sn6 ni5o"i 5hn> "n si+lus e!se5u 5e!uln6 +e5li< A"n# su u 5e5e!= 3+o 3+o!! =ei =ei7u 7u #n6 #n6 e= e=un un# #ii =!e" =!e"i= i=os osis isii 6ene 6enei i77 +n +n en6 en6h hsi sil+ l+n n en en6 6  =en"o!on6 5no!l e!h"= sel T CD1@> en6+i5+n hiln6n# ole!nsi sel T e!h e!h" "= = sel3; sel3;n ni6 i6en en<< Se5 Se56 6ii +i5 +i5 n# n# un7 un7ul ull lh h sel sel T uo uo!e !e+ +i3 i3 #n6 #n6 +n +n en#e en#e55 55+n +n in"u+s in"u+sii se! se! e+s=ns e+s=nsii sel 9> 5i+ 5i+ #n6 #n6 e=!o e=!o"u+ "u+si si uo uo ni5o ni5o"# "# u=un #n6 5e!u= sel eo!i< P" SLE> ni5o"i #n6 5e!5enu+ "iun2u++n e!h"= ni6en #n6 e!u e!le+ =" nu+leo=ls< Ani6en ss!n ini eli=ui DNA> =!oein hison "n non; hison< Ke5n#+n "i n!n# "l +e"n lih e!"= "l 5enu+ 6!e6  =!oein "n u +o=le+s =!oein;RNA #n6 "ise5u =!i+el !i5onu+leo=!oein (RNA)< Ci!i Ci!i +hs +hs uon uoni6 i6en en ini ilh ilh 5h* 5h* e!e+ e!e+ i"+ i"+ issue; issue;s=e s=esi3i si3i77 "n e!u= e!u=+n +n +o=onen ine6!l seu 2enis sel< Ani5o"i ini se7! 5e!s;s "ise5u ANA (ni;

nu7le! ni5o"#)< Den6n ni6enn# #n6 s=esi3i+> ANA e5enu+ +o=le+ iun #n6 5e!e"! "l si!+ulsi< Ko=le+s iun ini +n en6en"= =" 5e!56i 7 o!6n "en6n +i5 e!2"in# 3i+ssi +o=leen =" o!6n e!se5u< Pe!isi* ini en#e55+n +i.si +o=leen #n6 en6hsil+n su5nsi =en#e55 i5uln# !e+si !"n6< A+i.si "!i +o=leen "n sel iun en6+i5+n =ele=sn +eo+sin> sio+in> 7heo+in> =e=i"e .so+i3> "n en?i =e!us+< P" +e"n in3lsi +!onis> +uulsi 6!o*h 37o!s "n sel iun +n ei7u =ele=sn +eoin> sio+in> 7heo+in> =e=i"e .so+i3> "n en?i =e!us+< P" =e!"n6n #n6 +!onis> +uulsi "!i 6!o*h 37o! "n =!o"u+ o+si"se +!onis 5e!=e!n e!h"= +e!us+n  2!in6n i!e.e!si5el =" 6loe!ulus> !e!i> =!u;=!u> "n 2!in6n linn# (Ks=e! et  al > '&&/)< 96in #n6 =enin6 "l =o6enesis ini ilh e!6n66un# e+nise !e6ulsi #n6 "l +e"n no!l en7e6h uounis =olo6is =" in"i.i"u #n6 !esisen< Onse =en#+i "= s=onn u "i"hului oleh 3+o! =!esi=isi se=e!i +on+ "en6n sin! h!i> in3e+si .i!usB5+e!i> o5 isln# 6olon6n sul3>  =en6henin +ehiln "n !u 3isisB=si+is< Sei= se!n6n 5isn# "ise!i 6e2l uu #n6 2els se=e!i "e> lise> +elehn> n3su +n 5e!+u!n6> 5e!  5"n enu!un "n i!i5ilis< Yn6 =lin6 enon2ol ilh "e> +"n6;+"n6 "ise!i en66i6il< Po6enesis SLE "i*li "!i ine!+si n! 3+o! 6en =!e"is=osisi "n lin6+un6n #n6 +n en6hsil+n !es=on iun #n6 5no!l< Res=on ini e!su+ : %< A+i.si "!i iunis oleh C=$ DNA> DNA =" +o=le+s iun> "n RNA "l RNAB=!oein sel3;ni6en '< A5n6 +i.si sel iun "=i3 #n6 enu!un (Li3osi ni6en;s=e7i3i7 T "n Li3osi 9) 0< Re6ul!is "n inhi5isi Sel T CD1@ "n CD,@ 1< 9e!+u!n6n# +li!ens sel =o=oi7 "n +o=le+s iun (Ks=e! et al > '&&/)< $e2l #n6 =lin6 se!in6 =" SLE =" s#se us7ulos+elel> 5e!u= !h!iis u !!l6i (0) "n 6e2l;6e2l linn#< Yn6 =lin6 se!in6 e!+en "lh sen"i ine!3ln6el =!o+sil "ii+ui oleh luu> =e!6eln6n n6n> e+!=o3ln6el> si+u "n =e!6eln6n ++i> se!in6 e!+en "lh +=u 3eo!is< Di6nosis LES> "= "ie6++n 5e!"s!+n 65!n +lini+ "n l5o!o!iu< Ae!i7n Colle6e o3  Rheuolo6# (ACR)> =" hun %8> en62u+n %% +!ie!i unu+ +lsi3i+si LES>

"in =5il "i"=+n 1 +!ie!i> "i6nosis LES "= "ie6++n< K!ie!i e!se5u "lh : %< Ru l!< '< Ru ninu7< 0< Foosensii.is< 1< Ul+us "i ulu< 4< A!h!iis non ninu7< /< Pleu!iis u ninu7le!1< 8< $n66un !enl> #iu =!oeinu!i =e!sisen  &>46!B h!i> u silin"e! sel "=  5e!u= e!i!osi> ninu7le!> 6!nul!> u5ul! u 65un6n< ,< $n66un neu!olo6i> #iu +e2n6;+e2n6 u =si+osis< < $n66un ninu7le!> #iu nei heolii+ "en6n !ei+ulosis> u leu+o=eni u li3o=eni u !o5osio=eni< %&< $n66un iunolo6i+> #iu ni DNA =osisi3> u ni S =osii3 u es ninu7le unu+ si3ilis #n6 =osii3 =lsu< %%< Ani5o"i ninu7le! (Aninu7le! ni5o"#> ANA) =osii3  (Uoo> -<> '&%') Po6enesis SLE<

(Uoo> -<> '&%')

Po3isiolo6i nei Kei"+no!ln sel "!h "n 3+o!;3+o! =e5e+un se!in6 "ieu+n ="  =en"e!i lu=us e!ieosus sisei+< Mni3essi +lini+ #n6 u "lh nei (=enu!unn

heo6lo5in)>

leu+o=eni

(=enu!unn

2ulh

sel

"!h

=uih)>

!o5osio=eni (=enu!unn 2ulh sel =e5e+u "!h) "n sin"!o ni3os3oli=i"< F+o!;3+o! #n6 5e!=e!n "l e!2"in# +elinn "!h =" lu=us e!ieosus sisei+ "lh : ;

A"n# in3lsiB=e!"n6n #n6 5e!ln6sun6 e!us;ene!us (+!onis)

;

A"n# =!oses iun (!e+si ni5o"# "en6n sel;sel "!h)

;

A"n# =e!"!hn slu!n 7e!n #n6 5e!si3 +!onis +!en e3e+ s=in6 o5; o5n #n6 "i6un+n

Anei "lh 5e!+u!n6n# +"! heo6lo5in (=" *ni  %' 6! )< P" lu=us e!ieosus sisei+> "= "ieu+n 0 2enis nei> #iu : ;

Anei +!en =e!"n6nB=en#+i +!onis

;

Anei heolii+ iun: nei +!en =e!"n6n sel "!h e!h #n6 5e!le5ihn

;

Anei +!en 5e!+u!n6n# 3un6si susu uln6

Tn" "n 6e2l nei: ;

Pu7

;

Leh 5"n

;

Mu"h lelh

;

Pen6lihn 5e!+unn6;+unn6

;

nun6 5e!"e5!  (Oeh"in> A<> '&&,)

9< PENYELESAIAN KASUS I. SUBJEKTIF

 N =sien

: N#
T9B99

: ;B14+6

enis Kelin

: Pe!e=un

 No
: 814GGG

Ri*# =!i5"iB+elu!6

:;

Al

: Ke5uen

Sus

: Uu

Run6B+els

:;

Uu!

: '1 hun

Tn66l MRS

: '% No.e5e! '&%0

Tn66l KRS

:;

Ri*# Pen#+i Te!"hulu : ;

II.

Ri*# Pen66unn O5

:;

Li3e S#le

:;

Keluhn MRS

: Psien "n6 "en6n +eluhn les

Di6nos

: S#sei7 Lu=us E!#heosus (SLE)

OBJECTIVE

P!ee! =en#+i : Pee!i+sn Nili no!l %'&B,& /&;%&& %/;'& 0/>4;08>4

TD  N RR Suhu

'%

''

Tn66l '0 '1

%%&B8& ,& '& 0/

%%&B/& ,& '1 0/

%'&B8& ,& '& 0/

%&&B/& 8& %, 0/

Kee!n6n '4 %&&B/& 8& %, 0/

Tu!un No!l Ni+ 6l '' Tu!un

Kee!n6n : %< Te+nn "!h en6li =enu!unn> e!u=+n slh su 6e2l nei< Din nei ini e!u=+n slh su ni3essi +linis SLE (Su"e*i> '&&)< '< RR en6li +eni+n =" n66l '' e=i sele5ihn# no!l ini un6+in "ise55+n +!en =sien en6li ses+ n3s<e=i sel n66l '0;'4 =sien RRn# no!l 2"i "isusi+n 5h* =sien no!l< 0< Suhu en6li se"i+i =enu!unn> e!u=+n 6e2l #n6 non s=esi3i+ =" SLE "in "en6n =enu!unn suhu 5is +!en +elelhn #n6 "ili =sien> 6e2l ini sn6 se!in6 "ili oleh =sien SLE e=i =" +sus ini =enu!unnn# i"+  si6ni3i+n hn# &>4 sehin66 i"+ "i5e!i+n e!=i o5 hn# "ionio!in6 suhun# s2 (Anoni> '&%%)< D L5o!o!iu : Pee!i+sn H5 Leu+osi H7 E!i!osi T!o5osi MCV MCH

Sun 6B"L B0  2uB0 B0 3L =6

Nili No!l %';%/ 1&&&;%&&&& 08;18 1>';4>1 %8&&&&;0,&&&& ,&;>/ '8;00

Tn66l '' '>, /4&& 0 &>' '0&&&& %'&>, %%/>8

Kee!n6n Tu!un No!l Tu!un Tu!un No!l Ni+   Ni+  

MCHC RDMPV

  3L

00;0/ %%>4;%1>1 8>';%%>%

/>/ '%>4 >/

Ni+   Ni+   No!l

Kee!n6n : %< Penu!unn H5 e!u=+n in"i+o! nei (KEMENKES RI> '&%%)< K"! H5 "i5*h 8 6B"L e!su+ nei 5e! (Anei 6!.is)< Anei e!u=+n slh su ni3essi +linis "!i =en#+i lu=us e!ieosus sisei+ (Su"e*i> '&&)< '< Penu!unn nili H7 e!u=+n in"i+o! nei< Penu!unn H7 se5es! 0& enun2u++n =sien en6li nei se"n6 hin66 =!h (KEMENKES RI> '&%%)< Anei e!u=+n slh su ni3essi +linis "!i =en#+i lu=us e!ieosus sisei+ (Su"e*i> '&&)< 0< Penu!unn 2ulh E!i!osi (sel "!h e!h) e!2"i =" =en#+i lu=us e!ieosus sisei+ (KEMENKES RI> '&%%)< Penu!unn 2ulh e!i!osi #n6 si6ni3i+n e!u=+n n" nei heolii+> #iu nei +!en =en6hn7u!n sel "!h e!h #n6 5e!le5ihn (Oeh"in> '&&,)< 1< Keni+n MCV enn"+n nei "e3isiensi 5i+ 3ol u 5esi< Te=i ="  5e5e!= =isen #n6 e!+en nei "e3isiensi> " MCVn# no!l (Ni7oll e l< '&&%)< Anei e!u=+n slh su ni3essi +linis "!i =en#+i lu=us e!ieosus sisei+ (Su"e*i> '&&)< 4< Keni+n MCHC enn"+n "n# heolisis< Seen! +eni+n MCH enn"+n "n# 7!osiosis> 7!osiosis e!u=+n n" nei (Ni7oll e l< '&&%)< Anei e!u=+n slh su ni3essi +linis "!i =en#+i lu=us e!ieosus sisei+ (Su"e*i> '&&)< /< Nili RD- enin6+ enn"+n "n# nisosiosis> e!u=+n +e"n e"is "i n u+u!n sel "!h e!h #6 5e!5e" 5e"< Hl ini e!u=+n slh su n" nei "e3isiensi (Ni7oll e l< '&&%)<

III. ASSESMENT Te!=i MRS

 N o5

Dosis

'%

''

'0

'1

'4

IVFD RL

'& =

.

.

.

.

.

Ce3!ione

'%

.

.

.

.

.

Deehsone

''

.

Rnin

'%

.

.

.

.

.

As< Fol

0%

.

.

.

.

.

PRC ' +ol3

.

.

.

.

MPB , 2

.

.

.

.

In2< De % A

'%

.

.

In2< Di3enhi"!in

%A

.

.

.

.

In2< Lsi

DRP  No %

P!o5le -!on6 "ose

P=!n =!o5le Meil =!e"nisolon i"+ "i5e!i +ee!n6n

'<

"osis>

Re+oen"si Di6un+n =ulse

sehin66 eh#l=!e"nisolone "en6n "osis

+eun6+inn

"=

en6+i5+n

+eslhn

Du=li7e

"osis< Pen66unn

he!=#

"n eh#l =!e"nisolone #n6

%&&& 6Bh!<

"eehsone Deehsone "ihiln6+n

 5e!sn =" n66l '1;'4 "= en6+i5+ "u=li+si o5> 0

+!en

s;s

In==!o=!ie

6olon6n +o!i+ose!oi"< Psien i"+ enun2u++n

"!u6

"n#

6e2l

se!ius

#n6

u"e

#n6

e5uuh+n

"n# e!=i 3u!osei"< Selin iu 3u!osei" e3e+ s=in6n# "= eni5ul+n !u +uli #n6

"=

+e=!hn

!u +uli #n6

e!2"i =" SLE IV. PLAN %< Al6o!i Te!=i SLE

en5h

Te!=i in2e+si lsi i"+ "i6un+n

(Di=i!o>'&&,) Al6o!i e!=i =en66unn +o!i+ose!oi"

(PRI> '&%%) '< Tu2un Te!=i < Men6u!n6i 6e2l =en#+i  5< Men7e6h e!2"in# in3lsi "n +e!us+n 2!in6n 7< Me=e!5i+i +ulis hi"u= =sien "< Me=e!=n2n6 +ehnn =sien e< Meonio! ni3essi =en#+i 0< Te!=i Non 3!+olo6i Isi!h "n olh!6 se7! !uin "n sei5n6> sn6 5e!6un unu+ en7e6h • +elelhn

•

Men6hin"!i e!o+o+ +!en h#"!?ines "l s= !o+o+ 5is en2"i =ei7u "!i lin6+un6n unu+ e!2"in# lu=us< Me!o+o+ 2u6 elh "i+i+n "en6n

•

 =enin6+n +i.is =en#+i lu=us< Min#+ i+n 5is en7e6h +e6u6u!n "e!i.i3 =" *ni hil "en6n

•

ni5o"i ni3os3oli=i" Men6hin"!i +e75h l3l3 +!en en6n"un6 s ino L;7n.nine>

•

#n6 elh "i+i+n "en6n =e!+e5n6n 6e2l lu=us Me5si ==!n sin! h!i "n en66un+n 5i! su!# unu+  e5lo+i! +eun6+inn e=e!5u!u+ e3e+ sin! ul!.iole e!h"= +e"n lu=us =sien> "in 2ulh 5sn ==!n sin! h!i h!us "iu! se7!

in"i.i"ul e!6nun6 +on"isi =sien Men6+onsusi +nn #n6 5n#+ en6n"un6 s 3ol "n ? 5esi< •  (Del3uene n" C==u??o> '&&,)< 1< Te!=i MRS #n6 "is!n+n  N o5

Dosis

'%

''

'0

'1

'4

IVFD RL

'& =

.

.

.

.

.

In2
'%

.

.

.

.

.

Pulse Meh#l

%&&&6Bh!i

.

.

.

.

.

PRC

' +ol3

.

.

.

.

.

A?hio=!in

4& 6Bh!i

.

.

.

.

.

Di3enhi"!in

4& 6 0%

.

.

.

.

.

As 3ol

&>16Bh!i

.

.

.

.

.

Rnin

%4&6 '%

.

.

.

.

.

P!e"nisolone

4< Te!=i KRS #n6 "is!n+n  N o5

Re6ien Dosis

Tn66l Pen66unn O5 '/B%%B%0;'/B%'B%0

Meh#l P!e"nisolone

1 6 "en6n =e!in6 "ose s=i

.

"osis &>%'4 6B+6Bh!  As Fol

&>16Bh!i

.

Rnin

%4&6 '%

.

A?hio=!in

4& 6Bh!

.

< IVFD RL Psien en6li +eluhn hn# les "i+!en+n un6+in +ehiln6n ele+!oli +i5 =en#+i #n6 "i"e!in# #iu SLE< Pe5e!in Rin6e! L+ =" =sien +i5 6n66un hoeosis "n h!us se6e! "i5e!i+n in3us RL unu+ en6e5li+n +esei5n6n i! "n ele+!oli =sien< In2e+si Rin6e! l+ "lh l!un se!il en6n"un6 Klsiu +lo!i"> Kliu +lo!i"> N!iu +lo!i" "n N!iu l+ "l Ai! unu+ in2e+si i= %&& l se"in (MIMS> '&%%)< •

L!un In3us Unu+ Pe+in In!.en< Sei= lie! l!un en6n"un6 : ; N!iu L+< C0H4 NO0 0>%& 6 ; N!iu Klo!i"< NCl />&& 6 ; Kliu Klo!i"0& 6 ; Klsiu Klo!i"'& 6 ; Ai! unu+ In2e+si "< %<&&& l Osol!is : '8& OsBl Se! "en6n ion;ion :  N@ : %0& EBl K@ : 1 EBl L+ (HCO0;) : '8>4 EBl C@@ : '>8 EBl Cl : %&>4 EBl

•

C! +e!2 o5 : ; Me!u=+n l!un isooni N!iu Klo!i"> Kliu Klo!i"> Klsiu Klo!i"> "n  N!iu L+ #n6 +o=osisin# i!i= "en6n 7i!n e+s!selule!< ; Me!u=+n 7i!n =en66ni =" +sus;+sus +ehiln6n 7i!n e+s!selul!< ; Me!u=+n l!un non;+oloi"> en6n"un6 ion;ion #n6 e!"is!i5usi +e"l 7i!n in!.s+ule! "n ine!ssel (e+s!.s+ule!)

•

In"i+si : Unu+ en6e5li+n +esei5n6n ele+!oli =" "ehi"!si<

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C! =e5e!in : In!.en ("isesui+n "en6n +on"isi =en"e!i)

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Kon! in"i+si : Hi=e!n!ei> +elinn 6in2l> +e!us+n sel hi> si"osis l+<

•

E3e+ s=in6 :

; Re+si;!e+si #n6 un6+in e!2"i +!en l!unn# u 7! =e5e!inn# e!su+ i5uln# =ns> in3e+si =" e= =en#uni+n> !o5osis .en u 3le5iis #n6 elus "!i e= =en#uni+n> e+s!.ssi< ; 9il e!2"i !e+si e3e+ s=in6> =e+in h!us "iheni+n "n l+u+n e.lusi e!h"= =en"e!i<  5< In2e+si Ce3!ione Ce3!ione e!u=+n 7e=hlos=o!in s=e+!u lus seisinei+ #n6 "i5e!i+n se7! IV u IM< K"! =ls !;! 7e!ione seelh =e5e!in se7! un66l in3us in!.en &>4% u ' 6! "l *+u 0& eni "n IM se5es! &>4 u % 6 =" o!n6 "e*s seh< Ce3!ione e=un#i *+u =!uh #n6 sn6 =n2n6 sehin66 "i5e!i+n se+li B "u +li seh!i< E3e+ 5+e!isi" 7e3!ione "ihsil+n +i5  =en6h5n sinesis "in"in6 +un< Ce3!ione e=un#i s5ilis #n6 in66i e!h"= 5e;l+nse> 5i+ e!h"= =enisilinse u=un se3los=o!inse #n6 "ihsil+n oleh +un 6!;ne6i3> 6!;=osii3< P" +sus =sien #n6 en6li SLE "i=e!lu+n ni5ioi+ e=i!is unu+ en7e6h in3e+si #n6 e!2"i< Ani5ioi+  "i6un+n unu+ en7e6h =enin6+n o!5i"is "n o!lis =sien +!en in3e+si ($illiln" n" Tso+os> '&&')< Menu!u T!o ('&&0) Ce3!ione le5ih "i=ilih +!en in"i+sin# #n6 sesui =" SLE +!en 5e!hu5un6n "en6n in3e+si =" +uli "n  2!in6n lun+< Nun =en66unn ni5ioi+ 7e3!ione =e!lu "ionio!in6 "n i"+   5oleh le5ih "!i 4 h!i +!en "= ei7u i5uln# Toi7 e=i"e!l ne7!ol#sis (TEN) =" SLE (Lee e l<> '&%0)< 7< Meh#l P!e"nisolone Psien en6li SLE "en6n +e6o!i 5e! +!en "ise!i 6e2l nei heolii+  sehin66 =sien +n ene!i e!=i eil =!e"nisolon "en6n =en5hn 6en sioo+si+> "in 65un6n n! +o!i+ose!oi" "n iunosu=!esn B sioo+si+ +n e5e!i+n hsil =en6o5n #n6 le5ih 5i+ (PRI> '&%%)< Ko!i+ose!oi" se!in6 "i6un+n se56i !e6ien e!=i unu+ SLE< Tu2un =e5e!in +o!i+ose!oi" =" SLE "lh unu+ ene+n =en#+i +i3n#< Ko!i+ose!oi" #n6 se!in6 "i6un+n "lh eh#l=!e"nisolone (Di=i!o> '&&,)< Dosis #n6 "i6un+n =" e!=i ini "lh % 6!  +!en "osis sn"! =ulse #n6 "i6un+n "lh 4&& sB" %&&& 6 #n6 "i6un+n unu+

0;/ h!i

(Di=i!o>

'&&,)< Selin iu> =en66unn

"osis !en"h

=ulse

eh#l=!e"nisolone J %4&& 6 e3e+i3 "i6un+n =" e!=i SLE "en6n =enu!unn !esi+o in3e+si +o=li+si (9"sh e l<> '&&')< Te!=i KRS eil=!e"nisolon #n6 "i5e!i+n "lh , 6 "en6n =e!in6 "ose s=i "osis &>%'4 6B+6Bh! (PRI> '&%%)< P" +sus> se5elun# =sien en"=+n e!=i +o5insi +o!i+ose!oi" n!

eil =!e"nisolon "n "eeson =" n66l '1 "n '4< Kelo=o+ +i le5ih en#!n+n =en66unn slh su "!i +o!i+ose!oi" e!se5u +!en "i+u+n "n# ' o5 "l su 6olon6n "= en#e55+n "u=li+si o5 "n enin6++n e3e+ s=in6 #n6 e!2"i> selin iu 2u6 su"h " =en5hn 6en sioo+si+ 5e!u= ?io=!in< Meil =!e"nisolon le5ih "i=ilih +!en eil =!e"nisolon "n "eeson eili+i +ee3e+i3n #n6 s (H!i n" S!i.s.> %,)> eil =!e"nisolon en2"i  =ilihn e!=i u 5e!"s!+n Pe!hi=unn Reuolo6i In"onesi ('&%%)> "n eil  =!e"nisolon eili+i e3e+ s=in6 #n6 le5ih +e7il "i5n"in6+n "eeson (Sinh n" 966> '&&,)< "< PRC PRC "i6un+n se56i e!=i unu+ en6si 6e2l nei> "in =sien eili+i nili H5 '>, 6B"l< Su uni R9C "= enin6++n heo6lo5in =sien se5es! % 6B"l u HCT se5n#+ 0 (-einsein> '&%')< PRC e3e+i3 "i6un+n unu+ en66ni+n .olue "!h n= eili+i e3e+ +o6ulo=i (Sh7+3o!" e l<> %,%)< e< A?hio=!in A?hio=!in "lh nlo6 =u!in #n6 se7! lus "i6un+n "l e!=i SLE< A?hio=!in se!in6 "i+o5insi+n "en6n +o!i+ose!oi"< Selin iu =sien 2u6 enun2u++n "n# 6e2l nei heolii+> "n ?hio=!in ini e3e+i3 e5nu 6e2l nei heolii+ ini (Sh+! n" Shoen3el"> '&&%)< Se"in #n6 "i5e!i+n "lh =e!o!l "en6n "osis 4& 6> "in "osis #n6 "is!n+n "lh %;'6B+6 99Bh! (PRI> '&%%)< 3< Di3enhi"!in Fi!s;line e!=i #n6 "i6un+n unu+ nihisin "lh nihisin 6olon6n H%> slh sun# "i3enhi"!in< Di3enhi"!in eili+i e3e+ nihisin "n e3e+ se"i3  #n6 "= en6u!n6i +eun6+inn 6e2l 6l +i5 SLE #n6 "i"e!i =sien (In"in  De!ol< '&&> n6een O3 Di33i7ul U!i7!i> In"in ou!nl o3  • •

• •

De!olo6#)< E3e+ s=in6 : =usin6> en6nu+> ulu +e!in6 Kon! in"i+si : Hi=e!sensii3 =" "i3enhi"!in> s +u "n i"+ 5oleh unu+  neones< Dosis De*s : O!l : '4;4& 6 i= /;, 2 Me+nise +si "!i "i3enhi"!in: Ke!2 nihisini+ H% +n eni"+n se7! +o=eii3 +e!2 hisin =" !ese=o! H%> "n i"+ e=en6!uhi hisin #n6 "ii5ul+n +i5 +e!2 =" !ese=o! H'< Rese=o! H% e!"= "i slu!n =en7e!nn> =e5uluh "!h> "n slu!n  =e!n=sn< Di3enhi"!in 5e+e!2 se56i 6en ni+oline!6i+ (e5lo+ 2lnn#

i=uls;i=uls #n6 ellui s!3 =!si=i+)> s=solii+> nesei+ lo+l "n e=un#i e3e+ se"i3 e!h"= sise s!3 =us< (T!o> '&&0) 6< As Fol Pen66unn s 3ol 5le "i=ilih +!en =sien en6li nei #n6 5e! 5is "ilih "!i " l5o!o!iun#< =" =en"e!i nei e!2"i "e3isiensi s 3ol "n ? 5esi sehin66 5is en6h5 =e5enu+n sel "!h< Pe5e!in s 3ol "i5e!i+n unu+ =e5enu+n sel "!h #n6 elh !us+ +!en nei< •

Dosis =e5e!in o5 Anei (o!l> i> i.> s7): in3n &<%6Bh!i> n+1 hun s=i "en6n &<06Bh!i> n+1hun "n "e*s &<16Bh!i< *ni hil "n en#usui &<,6Bh!i<  =en7e6hn neu!l u5e "e3e7: "!i i5u "6n =oensil s lhi! 1&&76Bh!i "!i i5u "6n 5e!isi+o in66iB+!en !i*# +elu!6 neu!l u5e "e3e7 16Bh!i<

•

Me+nise +si As 3ol "i=e!lu+n unu+ =e5enu+n +oen?i "l =!oses sise e5olise e!u sinesis =u!in "n =i!ii"in> sinesis nu+leo=!oein "n =eelih!n e!i!o=oesis> ensiulsi =!o"u+si sel "!h =uih "n =lele =" nei "e3esiensi 3ol< As 3ol enin6++n eliinsi s 3o!> e5oli+ o+si+  enol<

•

Kon! in"i+si Hi=e!sensii3is e!h"= s 3ol "n +o=onen lin "l 3o!ulsi<

•

E3e+ s=in6 Re+si le!6i> 5!on+os=se> *2h ee!h> 6l> e!u=si seen!<

•

Ine!+si o5 P" +e"n "e3isiensi 3ol> e!=i "en6n s 3ol un6+in enin6++n e5olise

3enioin>

en#e55+n

=enu!unn

+onsen!si

se!u

3enioin<

 =en66unn 5e!sn +lo!3eni+ol "n s 3ol =" =sien "e3isiensi 3ol "= en#e55+n n6onise e!h"= !es=on heo=oii+ e!h"= s 3ol< unu+ iu> !es=on heolo6i e!h"= s 3ol =" =sien #n6 en66un+n s 3ol "n +lo!3eni+ol h!us "ionio! se7! 5i+< (T!o> '&&0) h< Rnin Pe5e!in !nin #n6 5e!isi !nii"ine ini "iin"i+si+n se56i =elin"un6 slu!n 7e!n "l ene+n e3e+ s=in6 o5 +o!i+ose!oi"< Sehin66 +ei+ =e5e!in o5

+o!i+ose!oi"> !nii"in ini +n en6+o.e! e3e+ #n6 i"+ "iin6in+n =e5e!in +o!i+ose!oi"< In"i+si: • Tu++ l5un6 "n usus %' 2!i > Hi=e!se+!esi =olo6i+ sehu5un6n "en6n sin"!o •

•

•

• •

ollin6e!;Ellison Kon! In"i+si: ; Pen"e!i 6n66un 3un6si 6in2l ; *ni hil "n en#usui Ko=osisi : Ti= 5le slu sel=u en6n"un6 Rnii"ine hi"!o+lo!i" se! "en6n !nii"ine  5s %4& 6< F!+olo6i : Rnii"ine en6h5 +e!2 hisin =" !ese=o!;H' se7! +o=oii3> se! en6h5 se+!esi s l5un6< Dosis : Dosis #n6 5is "i6un+n "lh %4&6 ine!.l ' +li seh!i E3e+ S=in6 : E3e+ s=in6 !nii"ine "lh 5e!u= "i!e> n#e!i oo> =usin6> "n i5ul !u +uli> lise>nuse> Konsi=si> Penu!unn 2ulh sel "!h =uih "n =lele ( =" 5e5e!= =en"e!i )> Se"i+i =enin6+n +"! se!u +!einin ( ="  5e5e!= =en"e!i) >9e5e!= +sus ( 2!n6 ) !e+si hi=e!sensii.is (5!on+os=se>

•

"e> !u> u!i+!i> eosino3ili< Ine!+si O5 : Hsil =eneliin e!h"= , =en"e!i #n6 "i5e!i+n !nii"in enun2u++n  =e!5e"n "en6n siei"ine> !nii"ine i"+ en6h5 3un6si o+si"si o5 =" i+!oso he=!<e!h"= 4 =en"e!i no!l #n6 "i5e!i+n "osis *!3!in h!in se7! su5e!=eui+> "en6n =en5hn "osis !nii"ine en2"i '&&6> ' +li seh!i sel %1 h!i i"+ enun2u++n "n# =e!u5hn =" *+u =!o!o5in u =" +onsen!si *!3!in =ls< (T!o> '&&0)

V.

MONITORING Jadwal

No

Parameter

Nilai Normal

"#

""

"$

"%

"&

%

Suhu

0/>4;08>4 oC

Ti= h!i

.

.

.

.

.

'

TD

%'&B,& H6

Ti= h!i

.

.

.

.

.

0

RR

%/;'&

Ti= h!i

.

.

.

.

.

1

E!i!osi

1>';4>1 2uB0

' h!i se+li

.

Pemata!a

.

.

4

H5

%';%/ 6B"L

' h!i se+li

.

.

.

/

H7

08;18 

' h!i se+li

.

.

.

8

MCV

,&;>/ 3L

' h!i se+li

.

.

.

,

MCH

'8;00 =6

' h!i se+li

.

.

.



MCHC

00;0/ 

' h!i se+li

.

.

.

%&

RD-

%%>4;%1>1 

' h!i se+li

.

.

.

VI. KIE < Konselin6 unu+ en6 e"is #n6 e!* =sien %< Men2els+n 2"*l =en66unn e!=i 3!+olo6i =sien< '< Pe!lu "il+u+n =en6e7e+n in3us sei= h!i< 0< Pe!lu "il+u+n =en6e7e+n TD> RR "n suhu u5uh sei= =6i< 1< Pe!lu "il+u+n =en6e7e+n +"! +o=onen "!h sei= "u h!i se+li<  5< Konselin6 unu+ =sien %< Me5e!i+n =en2elsn en6eni Lu=us E!ieosus Sisei+ "n

 =en#e55n#< '< Me5e!i+n in3o!si en6eni 3un6si> u!n> "n 7! =+i o5 (e!u o5 KRS)< 0< Me5e!i+n in3o!si en6eni e!=i non 3!+olo6i #n6 "= enun2n6 +e5e!hsiln e!=i =sien< 7< Konselin6 unu+ +elu!6 =sien %< Me5e!i+n in3o!si en6eni 3un6si> u!n> "n 7! =+i o5 +e=" +elu!6 =sien sehin66 "= en6on!ol "n en6*si +e=uhn =sien "l inu o5> e!u o5 KRS< '< Men6n2u!+n +e=" +elu!6 =sien unu+ el=o!+n +e=" =eu6s e"is =5il =sien en6li 6e2l;6e2l lin #n6 en66n66u +en#nn  =sien< 0< Men6n2u!+n +e=" +elu!6 =sien unu+ e5e!i+n =e!hin "n eoi.si =sien "l en2lni e!=i<

EVIDENCE 9ASE •

Ce3!ione

•

Meh#l =!e"nisolone

(Di=i!o>'&&,)

(9"sh e l<> '&&')

(H!i> P<> and S!i.s.> R %,)

(Sinh> A<> and  966> A<> '&&,) •

PRC

(Sh7+3o!" e l<> %,%)

(-einsein> R<> '&%') •

A?hio=!in

•

Di=henh#"!ine

(In"in  De!ol> '&&) •

As Fol

(Uh!in> u?n> '&%&)

DISKUSI DOSEN %<

Perta'aa( 96in =ene6++n "i6nos SLE seen! =sien hn# en6li

6e2l les s2 (Sini# Ui) Jawa)a( Di6nosis LES> "= "ie6++n 5e!"s!+n 65!n +lini+ "n l5o!o!iu< Ae!i7n Colle6e o3 Rheuolo6# (ACR)> =" hun %8> en62u+n %% +!ie!i unu+ +lsi3i+si LES> n! lin:

%< '< 0< 1< 4< /< 8<

Ru l!< Ru ninu7< Foosensii.is< Ul+us "i ulu< A!h!iis non ninu7< Pleu!iis u ninu7le!< $n66un !enl> #iu =!oeinu!i =e!sisen  &>46!B h!i> u silin"e! sel "=

 5e!u= e!i!osi> ninu7le!> 6!nul!> u5ul! u 65un6n< ,< $n66un neu!olo6i> #iu +e2n6;+e2n6 u =si+osis< < $n66un ninu7le!> #iu nei heolii+ "en6n !ei+ulosis> u leu+o=eni u li3o=eni u !o5osio=eni< %&< $n66un iunolo6i+> #iu ni DNA =osisi3> u ni S =osii3 u es ninu7le unu+ si3ilis #n6 =osii3 =lsu< %%< Ani5o"i ninu7le! (Aninu7le! ni5o"#> ANA) =osii3  (Uoo> -<> '&%') P" +sus ini> =ene6++n "i6nos SLE "= "ilih "!i 6e2l les "n " l5o!o!iu #n6 enun2u++n 5h* =sien en6li nei< Anei e!u=+n '<

slh su +!ie!i =en#+i SLE< Perta'aa( A=+h =e5e!in PRC "n s 3ol su"h e= unu+ enn6ni nei #n6 "ili =sien (E!n Tu6i!i) Jawa)a( PRC en6n"un6 sel "!h e!h s2 n= sel "!h lin unu+  en6hin"!i =enol+n sise iun sehin66 le5ih n unu+ =sien SLE< PRC "i6un+n se56i e!=i unu+ en6si 6e2l nei> "in =sien eili+i nili H5 '>, 6B"l< Su uni R9C "= enin6++n heo6lo5in =sien se5es! % 6B"l u HCT se5n#+ 0 (-einsein> '&%')< PRC e3e+i3 "i6un+n unu+ en66ni+n .olue "!h n= eili+i e3e+ +o6ulo=i (Sh7+3o!" e l<> %,%)< As 3ol "i5e!i+n unu+ e5nu !e6ene!si sel "!h> sehin66 enin6++n e3e+i.is

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e!=i =" =sien e!se5u< Perta'aa( Alsn =en66unn Ce3!ione "n 56in e+nisen# (Nu!in Khius) Jawa)a( E3e+ 5+e!isi" 7e3!ione "ihsil+n +i5 =en6h5n sinesis "in"in6 +un< Ce3!ione e=un#i s5ilis #n6 in66i e!h"= 5e;l+nse> 5i+  e!h"= =enisilinse u=un se3los=o!inse #n6 "ihsil+n oleh +un 6!;ne6i3> 6!;=osii3< P" +sus =sien #n6 en6li SLE "i=e!lu+n ni5ioi+ e=i!is unu+ en7e6h in3e+si #n6 e!2"i< Ani5ioi+ "i6un+n unu+ en7e6h =enin6+n o!5i"is "n o!lis =sien +!en in3e+si ($illiln" n" Tso+os> '&&')< Menu!u T!o ('&&0) Ce3!ione le5ih "i=ilih +!en in"i+sin# #n6 sesui =" SLE +!en  5e!hu5un6n "en6n in3e+si =" +uli "n 2!in6n lun+< Nun =en66unn

ni5ioi+ 7e3!ione =e!lu "ionio!in6 "n i"+ 5oleh le5ih "!i 4 h!i +!en "= 1<

ei7u i5uln# Toi7 e=i"e!l ne7!ol#sis (TEN) =" SLE (Lee e l<> '&%0)< Perta'aa( A=+h "is!i5usi o5 i"+ e!6n66u ="hl =sien en6li nei  5e! "in +on"isi "!hn# i"+ no!l (-in"hin S=i) Jawa)a( P" e!=i #n6 "i5e!i+n +e=" =sien e!"= o5 +o!i+ose!oi" "n ?hio=!ine #n6 e3e+ +e!2n# sine!6is "en6n PRC> #iu enin6++n =!o"u+si sel "!h< Sehin66 "isusi+n sei!in6 =en66unn e!=i + "is!i5usi o5 2u6 +n

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se+in 5i+< Perta'aa( Alsn =eilihn eh#l =!e"nisolone "i5n"in6 "eehsone (9u Esi) Jawa)a( P" +sus> se5elun# =sien en"=+n e!=i +o5insi +o!i+ose!oi" n! eil =!e"nisolon "n "eeson =" n66l '1 "n '4< Kelo=o+ +i le5ih en#!n+n =en66unn slh su "!i +o!i+ose!oi" e!se5u +!en "i+u+n "n# ' o5 "l su 6olon6n "= en#e55+n "u=li+si o5 "n enin6++n e3e+ s=in6 #n6 e!2"i> selin iu 2u6 su"h " =en5hn 6en sioo+si+ 5e!u= ?io=!in< Meil =!e"nisolon le5ih "i=ilih +!en eil =!e"nisolon "n "eeson eili+i +ee3e+i3n #n6 s (H!i n" S!i.s.> %,)> eil =!e"nisolon en2"i  =ilihn e!=i u 5e!"s!+n Pe!hi=unn Reuolo6i In"onesi ('&%%)> "n eil  =!e"nisolon eili+i e3e+ s=in6 #n6 le5ih +e7il "i5n"in6+n "eeson (Sinh n" 966> '&&,)<

DAFTAR PUSTAKA A+o6i> <> e l<> '&&%> In!.enous 7#7lo=hos=hi"e he!=# in  7se *ih !e3!7o!# h!o5oi7 i7!on6io=hi7 heol#i7 nei n" SLE> Clin Rheuol< '&&1 De7'0(/):41%;0< Anoni> '&%%> M+lh Pen#+i Lu=us> h=:BB***<7"ei "i+ses n66l 1 No.e5e! '&%1< 9"sh e l<> '&&'> Lo*;"ose =ulse eh#l=!e"nisolone 3o! s#sei7 lu=us e!#heosus 3l!es is e33i77ious n" hs  "e7!ese" !is+ o3 in3e7ious 7o=li7ions>  Lupus  %%(,):4&,;%0< Del3uene>  n" C==u??o> K '&&,> Systemic Lupus Erythematosus> In : Di=i!o>  -ells> 9<$<> Tl5e!> R Yee> $ M?+e> $ Pose#> L (E"s)>  Pharmacotherapy, A Pathophysiologic Approach, 7th ed <> Ne* Yo!+ : M7$!* Hill Co=nies<

$illin"> -< R<> Tso+os> $ '&&'> P!o=h#l7i7 use o3 ni5ioi7s n" iunisions in  =iens *ih SLE> Ann Rheum Dis> *#: %%;%' H!i> P<> n" S!i.s.> R %,> Pulse 7o!i7ose!oi" he!=# *ih eh#l=!e"nisolone o!  "eehsone> The In"in ou!nl o3 Pe"i!i7s> Volue /4> Issue 1> 448;4/&< In"in  De!ol< '&&> n6een O3 Di33i7ul U!i7!i> In"in ou!nl o3 De!olo6#< Ks=e! DL> 9!un*l" E> Fu7i AS et al < '&&/< S#sei7 Lu=us E!#heosus (SLE)< In : H!!isons Mnul o3 Me"i7ine< %/h e"< Ne* Yo!+ : M7$!*;Hill Me"i7l Pu5lishin6 Di.ision< 88;,4< Keene!in Kesehn Re=u5li+ In"onesi> '&%%> Pe"on Ine!=!esi D Klini+> +!< Lee>  u> I Cho> H<<> Min> H Hon6> Y<> '&%0> Toi7 E=i"e!l Ne7!ol#sis 5# Ce3!ione in Pien *ih Ne*l# Di6nose" S#sei7 Lu=us E!#heosus>  Journal of Rheumatic Disease, "+ (/)< MIMS> '&%%> MIMS In"onesi Peun2u+ Konsulsi> 9hun Ilu Po=ule!> +!  Ni7oll e l., '&&%> Pocet !uide to Diagnostic "est > Thi!" E"iion> M7 $!* Hill Co=n#> Unie" Ses Ae!i7< Oeh"in> A<> '&&,> #elainan Darah pada Lupus Eritematosus Sistemi > FK UNPAD> 9n"un6< Pe!hi=unn !euolo6i In"onesi> '&%%>  Diagnosis dan Pengelolaan Lupus Eritematosus Sistemi > Pe!hi=unn !euolo6i In"onesi> IS9N 8,;8;080&;%/;4< Sh7+3o!" e l<> %,%> -hole 5loo" .e!sus =7+e";7ell !ns3usions:  =h#siolo6i7 7o=!ison> Annals of Surgery %0(0): 00801&< Sh+! n" Shoen3el"> '&&%> A?hio=!ine he!=# 3o! =iens *ih s#sei7 lu=us e!#heosus> Lu=us M!7h '&&% .ol< %& no< 0 %4';%40 Sinh> A<> and  966> A<> '&&,> Pulse Se!oi" The!=#>  $ndian Journal of Pediatrics > Volue 84O7o5e!> '&&,< Su"e*i> Ni Puu e l<> '&&> K!+e!isi+ Klinis Lu=us E!ieosus Sisei+ =" An+> S!i Pe"i!i> Vol< %%> No< '> A6usus '&&< T!o> '&&0> A to % Drug &acts, F7s n" Co=!isson> USA< Uh!in> u?n> '&%&> 'lood Disorder, The Lu=us Su==o! Ne*o!+> USA Uoo> -i7+sono> '&%'> Hu5un6n n! A+i.is Pen#+i "en6n Sus Kesehn =" Psien LES (Lu=us E!ieosus Sisei+) "i RSUP "!< K!i"i Se!n6>  #arya "ulis $lmiah> Uni.e!sis Di=one6o!o> Se!n6<

-einsein> R<> '&%'> '&%' Clini7l P!7i7e $ui"e on Re" 9loo" Cell T!ns3usion>  American Society of (ematology )*)+ L Street  > Suie && *shin6on> DC '&&0/< ee!le"e!> S<> '&%%> Auoiune heol#i7 nei   =!7i7l 6ui"e o 7o=e *ih  "i6nosi7 n" he!=eui7 7hllen6e> The ou!nl o3 Me"i7ine> . o l < /  > hl : %88; %,1<