Protesa obturator definitif resin akrilik pada pasien systemic lupus erythematosus (SLE) pasca maksilektomi

ABSTRAKPendahuluan: Systemic lupus erythematosus (SLE) merupakan inflamasi kronis yang dapat melibatkan sistem saraf, membran mukosa, dan organ lain dalam tubuh. Avascular bone necrosis (AVN) merupakan gejala yang muncul pada penderita SLE. Maksilektomi dilakukan pada tulang maksila yang mengalami AVN. Penutupan celah pasca maksilektomi tersebut dilakukan dengan cara menggunakan protesa maksilofasial intraoral yaitu obturator. Tujuan laporan kasus ini mengkaji rehabilitasi prostetik menggunakan protesa obturator definitif resin akrilik pada penderita SLE pasca maksilektomi. Laporan kasus: Seorang wanita berusia 21 tahun datang ke Poli Gigi dan Mulut RSUP Dr. Sardjito dengan keluhan bau mulut, hilangnya gusi pada langit-langit, dan kegoyahan gigi rahang atas. Pasien didiagnosis SLE sejak lebih dari 1 tahun yang lalu. Pada pemeriksaan intraoral, selain lesi pada mukosa palatum, ditemukan juga nekrosis pada tulang palatum, kehilangan gigi 14, 15, 16, dan 25, serta kegoyahan derajat 3 pada seluruh gigi rahang atas yang tersisa. Pasien dirawat dengan obat Myfortic (2 x 180 mg/hari) dan Fluconazole (1x150 mg/hari) kemudian dirujuk ke Poli Bedah Mulut untuk dilakukan maksilektomi, dilanjutkan dengan pembuatan protesa obturator oleh tim prostodonti. Pasien dibuatkan obturator pasca bedah untuk menutup celah palatum pasca maksilektomi. Pencetakan menggunakan bahan hydrocolloid irreversible sebelum operasi untuk pembuatan obturator pasca bedah. Insersi obturator menunjukkan celah palatum tertutup rapat oleh plat akrilik. Retensi didapatkan menggunakan kawat stainless pada titanium wire mesh pengganti tulang maksila. Tidak ada keluhan saat kontrol, penelanan baik. Tiga bulan pasca pemakaian obturator pasca bedah dilakukan pemasangan obturator definitif resin akrilik rahang atas. Pemeriksaan klinis menunjukkan suara sengau berkurang, estetis, dan pengunyahan baik. Simpulan: Protesa obturator definitif resin akrilik pada pasien SLE pasca maksilektomi dapat mengembalikan fungsi estetik, mengurangi suara sengau (mengembalikan fungsi bicara), mengembalikan fungsi penelanan, dan pengunyahan.

Associations Between Antiretroviral Treatment and Avascular Bone Necrosis: The Swiss HIV Cohort Study

Background HIV-infected individuals have an increased risk of avascular bone necrosis (AVN). Antiretroviral therapy (ART) and particularly protease inhibitors (PI) have been implicated as a risk factor. We aimed to study the associations of ART with the occurrence of AVN among Swiss HIV Cohort Study participants (SHCS). Methods We used incidence density sampling to perform a case control study within the Swiss HIV Cohort Study (SHCS) comparing prospectively collected AVN cases and controls by conditional logistic regression analysis. To evaluate the effect of ART, multivariable models were adjusted for HIV transmission risk group, age, alcohol consumption, use of corticosteroids, CD4 nadir, maximum viral load, and pancreatitis. Results We compared 74 AVN cases and 145 controls. Associations with AVN were shown for heterosexual HIV acquisition (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.1–10), alcohol consumption (OR, 2.7; 95% CI, 1.3–5.7), and hyperlipidemia (OR, 3.6; 95% CI, 1.4–9.6). After adding ART substances to the multivariable base model, there was evidence of an association for treatment with tenofovir (TDF) >1 year (OR, 4.4; 95% CI, 1.4–14) with AVN. Neither exposure to specific frequently prescribed ART combinations or ART drug classes nor cumulative ART exposure showed any associations with AVN. Conclusions In the HIV-infected population, a combination of risk factors such as heterosexual HIV acquisition, moderate to severe alcohol intake, and hyperlipidemia seem to contribute to AVN. ART does not seem to be a relevant risk factor for AVN. The association of prolonged TDF exposure with AVN needs to be confirmed.

Time trend and risk factors of avascular bone necrosis in patients with systemic lupus erythematosus

Objectives The objective of this paper is to study the time trend and risk factors of avascular bone necrosis (AVN) in patients with systemic lupus erythematosus (SLE). Methods Between 1999 and 2014, patients who fulfilled the ACR criteria for SLE and developed symptomatic AVN were identified from our cohort database and compared with those without AVN, matched for age, sex and SLE duration. The standardized incidence ratios (SIRs) of AVN in different SLE age groups were calculated from data derived from our hospital registry and population census. Risk factors for AVN were studied by logistic regression, adjusted by a propensity score for ever use of high-dose glucocorticoids (GCs). Results Fifty-five SLE patients with AVN and 220 SLE patients without AVN were studied. There were 104 AVN sites involved, with the hips being most commonly affected (82%). The point prevalence of AVN in our SLE cohort was 7.4%. The SIRs of AVN in our SLE patients were 131 (86.6–199; p < 0.001) and 56.0 (34.3–91.4; p < 0.001), respectively, in the periods 1995–2004 and 2005–2014. In both decades, the age-stratified SIR was highest in the youngest age group (<19 years). AVN patients were more likely to be treated with GCs and had received a significantly higher cumulative dose of prednisolone since SLE diagnosis (16.5 vs 10.7 grams; p = 0.001). The SLE damage score (excluding AVN) was also significantly higher in AVN than non-AVN patients (2.5 vs 0.4; p < 0.001). Logistic regression revealed that preceding septic arthritis of the involved joint (odds ratio (OR) 17.7 (1.5–205); p = 0.02), cushingoid body habitus (OR 2.4 (1.1–5.2); p = 0.04), LDL cholesterol level (OR 1.4 (1.0–1.9); p = 0.04), maximum daily dose of prednisolone (OR 6.4 (1.2–33.3); p = 0.03) and cumulative dose of prednisolone received in the first six months of the first lupus flare (OR 1.3 (1.0–1.8); p = 0.046) were independently associated with AVN. Conclusions AVN is prevalent in SLE, particularly in younger patients. The use of GCs remains the strongest independent risk factor. A trend of reduction in the SIR of AVN in our SLE patients is observed over the past two decades.