Hubungan Penurunan Nilai Densitas Mineral Tulang dengan Kepatuhan Terapi Metilprednisolon Pasien Artritis Reumatoid dan Lupus Eritematosus Sistemik

Abstract

Metilprednisolon merupakan glukokortikoid yang memiliki efek samping penurunan densitas mineral tulang (DMT). Tingkat kepatuhan berhubungan dengan terjadinya efek. Penelitian ini bertujuan untuk mengetahui hubungan penurunan nilai DMT dengan kepatuhan terapi metilprednisolon pada pasien artritis reumatoid dan lupus eritematosus sistemik. Penelitian ini dilakukan pada 43 pasien di Poliklinik Rheumatologi RSUD dr. Saiful Anwar Malang pada bulan Desember 2016–Januari 2017 dan termasuk penelitian deskriptif noneksperimental dengan analisis kualitatif dan kuantitatif menggunakan metode cross-sectional. Data diambil dari rekam medis pasien dan wawancara. Kriteria inklusi pada penelitian ini adalah perempuan berusia 31–50 tahun, menggunakan terapi metilprednisolon minimal selama 3 bulan serta memiliki data DMT. Kriteria eksklusi adalah menopause, riwayat fraktur tulang, merokok, mengonsumsi alkohol, sindrom cushing, hipertiroidisme, hiperparatiroidisme, gangguan kelenjar pituitari, dan osteoartritis serta mengonsumsi obat bifosfonat, heparin, anti-konvulsan, dan thiazid. Analisis data menggunakan uji korelasi Pearson dan regresi linier. Terdapat hubungan antara kepatuhan dengan area DMT Spine-L1 (r= –0,313; p=0,041), Spine-L2 (r= –0,349; p=0,022), Spine-L3 (r= –0,375; p=0,013), dan total spine (r = -0,380; p = 0,012). Metilprednisolon sensitif pada jaringan tulang trabekular yang menyusun area lumbar spine dibandingkan tulang kortikal. Hubungan rendah (r) antara tingkat kepatuhan dan DMT disebabkan sosial ekonomi, perawatan kesehatan, karakteristik penyakit, dan genetik. Kepatuhan terapi metilprednisolon menurunkan nilai DMT (lumbar spine) yang berakibat meningkatkan osteoporosis.

Kata kunci: Artritis reumatoid, densitas mineral tulang, eritematosus sistemik, kepatuhan, lupus metilprednisolon

The Relationship of Lowering the Values of Bone Mineral Density in Methylprednisolone Medication Adherence on Rheumatoid Arthritis and Systemic Lupus Erythematosus Patients

Abstract
Methylprednisolone is a glucocorticoid which has a side effect of decreasing bone mineral density (DMT). The degree of compliance relates to the occurrence of effects. The objective of this study was to investigate the association of DMT impairment with adherence to methylprednisolone therapy in patients with rheumatoid arthritis (AR) and systemic lupus erythematosus (LES). The research was conducted to 43 patients in Rheumatology Polyclinic of dr. Saiful Anwar (RSSA) Malang. The study was conducted in December 2016–January 2017 and included nonexperimental description with qualitative and quantitative analysis using cross sectional method. The data were taken from the patient’s medical record and interview. The inclusion criteria in this research were women, aged 31–50 years, using metilprednisolon therapy for at least three months and have mineral bone density data. Exclusion criteria were menopause, history of bone fracture, smoking, alcohol consumption, cushing syndrome, hyperthyroidism, hyperparathyroidism, pituitary gland disorders, and osteoarthritis and taking drugs bisphosphonates, heparin, anti-convulsants, and thiazid. Data analysis used person correlation and linear regression. There was a significant correlation between adherence to the Spine-L1 DMT area (r= –0.313; p=0.041), Spine-L2 (r= –0.349; p=0.022), Spine-L3 (r = –0.375; p=0.013), and total spine (r= –0.380; p=0.012). Methylprednisolone is sensitive to trabecular bone tissue that makes up the lumbar spine area compared to cortical bone. The low association (r) between adherence and DMT is due to socioeconomic, health care, disease characteristics, and genetics. Compliance of methylprednisolone therapy decreases the value of DMT (lumbar spine) which increased in osteoporosis.

Keywords: Bone mineral density, medication adherence, methylprednisolone, reumathoid arthritis, systemic lupus eythematosus