LAPORAN TUTORIAL BLOK 7

SKENARIO D
Disusun Oleh:
Choiriah 04101001011
elani 0410100101!
Bella "a#illah $ai% 04101001014
Ronalisa Anri% 0410100101&
Dian Per'a(asari 041010010!0
Desi Anu)era Sari 041010010!!
Di(a "e*rian(i $anani 041010010!+
Essa A,rilia 041010010&-
Eu)enia .eni//er . 04101001071
0ohanes "e*rian(o 041010010+1
I2hsan 3us4ain 0410100101!
Kelo',o5 L!
Tu(or: #r6 Dalila
"AKULTAS KEDOKTERAN UNI7ERSITAS SRI8I.A0A
T6A !0109!011
KATA PEN:ANTAR
Pu;i #an s<u5ur su#ah se,a(u(n<a 5i(a a(ur5an 5eha#ira( Tuhan 0an) aha
Esa 5arena a(as *er5a( #n ,en<er(aan<alah 5a'i #a,a( 'en<elesai5an la,oran
(u(orial s2enario D ini6 Teri'a 5asih 5a'i u2a,5an 5e,a#a (u(or ,e'*i'*in) #r6
L<la <an) (elah 'e'*eri5an *i'*in)an se2ara (eori(is #an 5linis sela'a ,roses
(u(orial *erlan)sun)6 Teri'a 5asih ;u)a 5e,a#a seluruh (e'an sa(u 5elo',o5 <an)
(elah i5u( *er,arisi,asi #ala' #is5usi #an ,en<usunan la,oran ini= ;u)a 5e,a#a
se'ua oran) <an) *ai5 se2ara lan)sun) 'au,un (i#a5 lan)sun) (erli*a( #ala'
,en<elesaian la,oran6
Na'un= i*ara( (a5 a#a )a#in) <an) (a5 re(a5= *e)i(u ;u)a #en)an la,oran
ini <an) 'asih 'e'ili5i *an<a5 5e5uran)an #i sana>sini6,enulis #an 5elo',o5
'e'in(a 'aa/ a(as 5esalahan <an) 'asih (er;a#i #ala' la,oran ini6
Pale'*an)= !! .uni !011=
Ti'=
DA"TAR ISI
KATA PEN:ANTAR i
DA"TAR ISI ii
SKENARIO 1
KLARI"IKASI ISTILA$ 1
IDENTI"IKASI ASALA$ !
ANALISIS ASALA$ ?
$IPOTESIS !1
KERAN:KA KONSEP !1
LEARNIN: OB.ECTI7E ?0
SINTESIS ?1
DA"TAR PUSTAKA iii
SKENARIO
Nona S= u'ur 17 (ahun #a(an) 5e RS$ #en)an 5eluhan u(a'a (i'*ul *in(i5>
*in(i5 'erah #i 5a5i #an (an)an ! 'in))u se*elu' 'asu5 ru'ah sa5i(= ,anas
se;a5 1 'in))u <an) lalu= ,er#arahan #ari hi#un)@AB ! 5ali= ! hari <an) lalu6Sa(u
(ahun <an) lalu ,en#eri(a serin) 'en)eluh n<eri sen#i <an) hilan) (i'*ul
(eru(a'a ,a#a ;ari (an)an #an 5a5i6 Pen#eri(a ;u)a 'en)eluh #e'a' hilan) (i'*ul
<an) (i#a5 (erlalu (in))i= ra'*u( serin) ron(o5= saria4an serin) (i'*ul #i lan)i(>
lan)i( 'ulu( (an,a se*a* #an (i#a5 n<eri= 'u5a 5e'erahan (eru(a'a #i #aerah ,i,i
*ila (er5ena sinar 'a(ahari6Nona S 'inu' o*a( n<eri *ila 5eluhan 'un2ul (e(a,i
(i#a5 a#a ,eru*ahan6
Pe'eri5saan /isi5: 5ea#aan u'u' sa5i( se#an)= sensoriu' 5o',os 'en(is= $R:
100C9'eni(= re)ular= RR: !4CD'eni(= Te',: ?+=&OC6 TD: 1?09+0 ''$)
Kea#aan s,esi/i5: #i#a,a(5an ,e(e2hiae #i 5a5i #an (an)an= s(o'a(i(is @AB=
5e'erahan #i ,i,i @AB= *en)5a5 #i sen#i (an)an #an 5a5i @AB6
Pe'eri5saan la*ora(oriu' : $* +=& )rE= 8BC: !-009''?= (ro'*osi( 406000= R(:
7E= LED: 10&''9hour= ureu' ?- ')9#l= 5rea(inin 1=! ')9#l
I. Klarifikasi Istilah
16 Pe(i2hae: @*en(u5 ;a'a5B #ari *in(i5 'erah 5e2il a5i*a( 5eluarn<a se;u'lah
5e2il #arah
!6 Per#arahan #ari hi#un): ,er#arahan hiun) a5i*a( ,e2ahn<a ,e'*uluh #arah
5e2il #i *a)ian an(erior se,(u' nasal 5ar(ila)inosa
?6 N<eri sen#i: ,erasaan se#ih= 'en#eri(a9 a)oni <an) #ise*a*5an ran)san)an
,a#a u;un) sara/ 5husus #i sen#i6
46 De'a' hilan) (i'*ul: ,enin)5a(an suhu (u*uh #i a(as nor'al <an) (i#a5
*era(uran
&6 ra'*u( ron(o5 :@alo,e2iaB6 Bo(a5F (i#a5 a#an<a ra'*u( ,a#a #aerah 5uli( <an)
*iasan<a a#a6
-6 S(o'a(i(is: ra#an) )eneralisa(a 'u5osa 'ulu(
76 5e'erahan #i ,i,i: eru,si 5uli( <an) 'eli,u(i hi#un) #an #aerah se5i(arn<a
<an) *er*en(u5 se,er(i 5u,u>5u,u
+6 sensoriu' 5o',os 'en(is: 5esa#aran ,enuh94aras
16 *en)5a5: ,en)u',ulan 2arian se2ara a*nor'al #ala' ruan) ;arin)an
in(erseluler (u*uh <an) *isa #ise*a*5an oleh ,era#an)an6
106 Re(i5ulosis: ,enin)5a(an a*nor'al sel>sel <an) *rasal a(au *rhu*un)an
#en)an sel re(i5uloen#o(el
116 Ureu': hasil a5hir 'e(a*olis' ,ro(ein
1!6 5rea(inin: Ben(u5 anhi#ri#a 5ra(in= hasil a5hir 'e(a*olis' /os/o5rea(in6
II. Identifikasi masalah
16 Nona S= u'ur 17 (ahun #a(an) 5e RS$ #en)an 5eluhan u(a'a (i'*ul *in(i5>
*in(i5 'erah #i 5a5i #an (an)an ! 'in))u se*elu' 'asu5 ru'ah sa5i(= ,anas
se;a5 1 'in))u <an) lalu= ,er#arahan #ari hi#un)@AB ! 5ali= ! hari <an) lalu6
!6 Sa(u (ahun <an) lalu ,en#eri(a serin) 'en)eluh n<eri sen#i <an) hilan) (i'*ul
(eru(a'a ,a#a ;ari (an)an #an 5a5i6 Pen#eri(a ;u)a 'en)eluh #e'a' hilan)
(i'*ul <an) (i#a5 (erlalu (in))i= ra'*u( serin) ron(o5= saria4an serin) (i'*ul #i
lan)i(>lan)i( 'ulu( (an,a se*a* #an (i#a5 n<eri= 'u5a 5e'erahan (eru(a'a #i
#aerah ,i,i *ila (er5ena sinar 'a(ahari6
?6 Nona S 'inu' o*a( n<eri *ila 5eluhan 'un2ul (e(a,i (i#a5 a#a ,eru*ahan6
46 Pe'eri5saan /isi5: 5ea#aan u'u' sa5i( se#an)= sensoriu' 5o',os 'en(is= $R:
100C9'eni(= re)ular= RR: !4CD'eni(= Te',: ?+=&OC6 TD: 1?09+0 ''$)
&6 Kea#aan s,esi/i5: #i#a,a(5an ,e(e2hiae #i 5a5i #an (an)an= s(o'a(i(is @AB=
5e'erahan #i ,i,i @AB= *en)5a5 #i sen#i (an)an #an 5a5i @AB6
-6 Pe'eri5saan la*ora(oriu' : $* +=& )rE= 8BC: !-009''?= (ro'*osi( 406000=
R(: 7E= LED: 10&''9hour= ureu' ?- ')9#l= 5rea(inin 1=! ')9#l
III. Analisis masalah
16 a6 A,a5ah a#a hu*un)an an(ara usia #an ;enis 5ela'in #en)an 5eluhan nona SD
Lu,us serin)5ali #ise*u( se*a)ai penyakit wanita 4alau,un ;u)a *isa #i#eri(a
oleh ,ria6 Lu,us *isa 'en<eran) usia *era,a,un= *ai5 ,a#a ,ria 'au,un
4ani(a= 'es5i,un 10>1& 5ali le*ih serin) #i(e'u5an ,a#a 4ani(a6 "a5(or
hor'onal 'un)5in *isa 'en;elas5an 'en)a,a lu,us le*ih serin) 'en<eran)
4ani(a6 enin)5a(n<a )e;ala ,en<a5i( ini ,a#a 'asa se*elu' 'ens(ruasi #an
a(au sela'a 5eha'ilan 'en#u5un) 5e<a5inan *ah4a hor'on @(eru(a'a
es(ro)enB6 Per*an#in)an ,en<a5i( ini 1:1 5arena 4ani(a ,un<a res,on
an(i*o#i <an) le*ih 2e,a(= Seelain i(u= 4ani(a <an) 'en)onsu'si es(ro)en
oral 9 hor'on ,en))an(i es(ro)en ,un<a risi5o 1=!>! 5ali le*ih (in))i un(u5
(er5ena SLE
Teori lainn<a 'en<a(a5an au(oan(i*o#< lu,us eri(e'a(osus 'eru,a5an
lan;u(an #ari rea5si silan) an(i)en e5so)en se,er(i re(roGirus RNA6
"a5(or Resi5o (er;a#in<a SLE
16 "a5(or :ene(i5
.enis 5ela'in= /re5uensi ,a#a 4ani(a #e4asa + 5ali le*ih serin)
#ari,a#a ,ria #e4asa
U'ur= *iasan<a le*ih serin) (er;a#i ,a#a usia !0>40 (ahun
E(ni5= "a5(or 5e(urunan= #en)an "re5uensi !0 5ali le*ih serin)
#ala' 5eluar)a <an) (er#a,a( an))o(a #en)an ,en<a5i( (erse*u(
!6 "a5(or Resi5o $or'on
$or'on es(ro)en 'ena'*ah resi5o SLE= se#an)5an an#ro)en
'en)uran)i resi5o ini6
Usia : ,a#a 4ani(a serin) (er;a#i ,a#a usia 1&>40 (ahun6
Berhu*un)an #en)an 'asa su*ur seseoran)66
Karena ,en)aruh hor'on es(ero)en ,a#a 4ani(a #an 4ani(a 2en#erun)
'e'ili5i res,on i'uni(as <an) le*ih (in))i #arri,a#a la5i>la5i6
8ani(a 'enar2he #an 'eno,ause H ?:1
Karena ,a#a usia 'enar2he es(ro)en 'enin)5a( #i*an#in) saa( 'eno,ause
es(ro)en (elah 'en)ala'i ,enurunan6
*6 Ba)ai'ana 'e5anis'e u'u' #ari
>Pe(e2hiae
Pe(e2hiae a(au *in(i5>*in(i5 'erah <an) (er;a#i ,a#a 5uli( 'eru,a5an a5i*a(
#ari Gas5uli(is ,a#a ,e'*uluh #ara 5e2il a(au ,e'*uluh #ara 5a,iler <an)
*iasan<a (er;a#i ,a#a e5s(ri'i(as6 Bila #i5ai(5an se2ara u'u' ,e(e2hiae
(er;a#i a5i*a( a#an<a 5e*o2oran sel en#o(el ,e'*uluh #ara 5a,iler sehin))a
'en<e*a*5an (er;a#in<a ,en#arahan #i *a4ah 5uli( <an) *er'ani/es(asi
se*a)ai ,e(e2hiae6 Pa#a lu,us (er*en(u5n<a 5o',le5s an(i)en>an(i*o#i <an)
*eru5uran 2u5u, 5e2il 'e'*ua( 5o',le5si ini (er(ahan9(er;e*a59 'en)en#a,
,a#a ,e'*uluh #arah 5a,iler #an 'e'a2u res,on in/la'asi sehin))a
#i5eluar5an si(o5in se,er(i TN">al,ha <an) *isa 'erusa5 ;arin)an #ala' hal
ini en#o(el ,e'*uluh #arah@Gas5uli(isB= hal ini 'en)a5i*a(5an #arah 5eluar
#ari ,e'*ulih #arah 5e 5uli( <an) (a',a5 se*a)ai *in(i5>*in(i5 'erah6
> #e'a'
In/e5si 'i5ro*a ,en)le,asan ,iro)en si(o5in@IL>1FIL>-FTN"B #ari sel
'ononu5lear 'elelui sir5ulasi 'enu;u hi,o(ala'us an(erior
,en)le,asan asa' ara5i#ona(#an ,enin)5a(an sin(esis ,ros(a)lan#in E!
,eru*ahan se( ,oin( ,eru*ahan ,en)a(uran au(ono' Gaso5on(ri5si
,eri/er ,en)eluaran ,anas 'enurun @#issi,a(ionB #e'a'
> E,is(a5sis
Lle,asn<a la,isan 'u5osa hi#un) <an) 'en)an#un) *an<a5 ,e'*uluh #arah
5e2il6 Le,asn<a 'u5osa a5an #iser(ai lu5a ,a#a ,e'*uluh #arah <an)
'en)a5i*a(5an ,en#arahan6 Kuran)n<a ;u'lah (ro'*osi( @(ro'*osi(o,eniB
,a#a ,en#eri(a SLE a5an 'en<e*a5an 'u#ahn<a (er;a#in<a ,er#arahan6
Salah sa(u ,er#arahann<a #a,a( (er;a#i #i hi#un)6 Per#arahan #ari hi#un)
inilah <an) #i5enal se*a)ai e,is(a5sis6
26 en)a,a Pe(e2hiae han<a (er;a#i #i 5a5i #an (an)an #an a#a5ah hu*un)ann<a
#en)an 5eluhan lain <an) #iala'i nona SD
Pa#a ,en<a5i( SLE= (er*en(u5 5o',le5s i'un <an) le*ih 'u#ah 'en)en#a,
,a#a #aerah #en)an (e5anan #arah 'enin))i <an) #iser(ai ,u(aran arus6 Salah
sa(u 2on(oh (e',a(n<a a#alah *i/ur5asi ,e'*uluh #arah6 Pe(e2hiae *isa
'un2ul ,a#a *an<a5 (e',a(= (e(a,i *iasan<a (er;a#i ,a#a ,e'*uluh #arah
5a,iler6 Pa#a 5a5i #an (an)an (er#a,a( *an<a5 ,e'*uluh #arah 5a,iler
sehin))a 'ani/es(asi ,e(e2hiae serin) 'un2ul ,a#a (an)an #an 5a5i6
Be*era,a su'*er 'en<e*u(5an *in(i5 'erah serin) (er;a#i ,a#a 5a5i 5arena
a#an<a ,en)aruh )a<a *era(= (e(a,i 'e5anis'e se2ara 5hususn<a *elu' #a,a(
#i,as(i5an 5e*enarann<a6
#6 en)a,a 5eluhan u(a'a nn6 S (i#a5 (er;a#i *ersa'aan D
Keluhan>5eluhan u'u' <an) (er;a#i ,a#a seoran) ,en#eri(a lu,us *iasan<a
*erGariasi #an 5uran s,esi/i56 Sa(u in#iGi#u *isa 'e'ili5i )e;ala <an) sa'a
se5ali *er*e#a #en)an in#iGi#u lain <an) 'en)ala'i ,en<a5i( <an) sa'a6
A5i*a( *erGariasin<a )e;ala>)e;ala <an) (er;a#i 'a5a 5i(a (i#a5 #a,a(
'e'u(us5an 'en)a,a )e;ala <an) sa(u (er;a#i le*ih #ulu #ari )e;ala <an) lain
5arena 'ani/es(asin<a sen#iri *er*e#a an(ar oran) <an) 'en)i#a, lu,us6
Se2ara i'unolo)i 'un)5in #ise*a*5an 4a5(u <an) #i*u(uh5an un(u5
'asin)>'asin) 5o',le5s i'un un(u5 'en)en#a, #an 'e'*eri5an
'ani/es(asi un(u5 se(ia, )e;ala= hal ini ;u)a #i,en)aruhi ole /a2(or luar <an)
#a,a( 'e'i2u (er;a#in<a )e;ala6 Se,er(i e,is(a5sis <an) 'un)5in #i#ahului
oleh (rau'a a(au iri(asi <an) 'en<e*a*5an 5erusa5an ,e'*uluh #arah #i
se,(u' nasal <an) #i,er,arah #en)an (ro'*osi(o,eni sehin))a (er;ai
e,is(a5sis= *isa ;u)a a5i*a( 5o',le5s i'un <an) 'en)en#a, #i ar(eri
e(h'oi#alis an(erior 'en<e*a*5an Gas5uli(is= 5e*o2oran en#o(el= #an
(er;a#ilah 'i'isa6
!6 IN<eri
a6 Ba)ai'ana 'e5anis'e n<eri sen#iD
Dala' /ase lu,us a5(i/ = sinoGiu' (u'*uh #an 'e'a#a( se*a)ai ,roses
,era#an)an6 $al ini 'en)a5i*a(5an ,ele,asan *er*a)ai 5i'ia <an) 'a',u
'en)i5is (ulan)= a(au 'en)han2ur5an 2ar(ila)e @ (ulan) 'u#a B <an)
'en)a5i*a(5an n<eri sen#i #i,er)elan)an ;ari 5a5i #an (an)an6
Se2ara (eori(is ,era#an)an ,a#a sen#i ini #a,a( #i(ulis5an se*a)ai *eri5u(:
li'/osi( B ,a#a #aerah s<noGial a(au ,ela,is sen#i a5an 'en)eluar5an I)
a*nor'al <an) seru,a ,o#u5si /a2(or rheu'a(oi#6 A5i*a( (er*en(u5n<a
an(i*o#< a*nor'al ini= a5an *eri5a(an #en)an ;arin)an a(au an(i)en <an) a#a
,a#a (u*uh sehin)a 'e'*en(u5 5o',le5s i'un ,a#a s<noGial a(au 5ar(ila)o 6
5e'u#ian a5an (er;a#i a5(iGasi 5o',le'en 'elalui ;alur al(erna(iGe #an
5lasi5= #i'ana 5i(a 5e(ahui *ah4a 5o',le'en *er/un)si un(u5 'enin)5a(5an
a5(iGasi /a)osi(osis 5arena *er,eran #ala' o,sonisasi6 A5i*a( (er*en(u5n<a
5o',le5s #an #iselu*un)i oleh 5o',le'en (erse*u( a5an 'e'u#ah5an sel
/a)osi( un(u5 'e'a5an an(i)en (u*uh6 Saa( ,roses /a)osi(osis a5an
#i5eluar5an 'e#ia(or in/la'asi se,er(i haln<a his(a'ine= *ra5i#inin= #an
,ros(a)lan#in <an salah sa(u e/e5n<a a#alah ,era#an)an6 Sen<a4a (erse*u(
a5an #i#e(e5si oleh u;un) sera*u( sara/ n<eri <ai(u sera*u( sara/ (a5 *er'ielin
C #an *er'ielin A>#el(a <an) selan;u(n<a a5an nai5 5e 5ornu #orsalis
'e#ulla s,inalis 5e'u#ian 5e 5or(e5s 2ere*ri <an) a5an #i,resen(asi5an
se*a)ai ,enrasaan n<eri <an su*;e5(i/6
Se2ara s5e'a(is #a,a( #i(ulis5an se*a)ai *eri5u(:
Pa#a ,en#eri(a SLE= sel ,las'a #ala' sinoGiu' @,a#a sen#iB 'e'*en(u5
an(i>I): @"R *eru,a I)B J 'eni'*ul5an 5o',le5s i'un #i sen#i6
Ko',le5s i'un ini a5an 'e'i2u a5(i/n<a 'e#ia(or in/la'asi @neu(ro/il= #55B
sehin))a a5an 'en<e*a*5an in/la'asi6 Selain i(u a5an (er;a#i ,ele,asan
ana/ila(o5sin @C?a=C&aB'e'a2u sel 'as(his(a'in n<eri6
*6 en)a,a n<eri ,rsen#ian serin) hilan) (i'*ul (eru(a'a #i ;ari #an (an)anD
Karena *erhu*un)an #en)an /ase #ari ,en<a5i( SLE6 Pa#a SLE a#a /ase
rela,s #an re'isiF n<eri ser(a )e;ala lainn<a a5an (i'*ul ,a#a /ase rela,s #an
a5an 'e'*ai5 ,a#a /ase re'isi6 Sehin))a (er5esan n<erin<a hilan) (i'*ul6
> #e'a'
26 a,a ;enis #e'a' <an) #i#eri(a Nn6 SD
Se2ara e5s,lisi( 5i(a (i#a5 #a,a( 'enen(u55an ;enis #e'a' a,a <an)
'un)5in #i#eri(a nona S 5arena (i#a5 a#a #a(a 'en)enai 5enai5an a(au
,enurunan suhu <an) 5on5re( un(u5 'ene)a55an 5ri(eria #e'a' re'i((en=
in(errre'i(en( a(au 2on(inius <an) #iala'i6 Dari 5asus ini 5i(a #a,a(
'en<i',ul5an *ah4a nona S 'en)ala'i #e'a' a5i*a( non in/e5si
5arena ,enin)5a(an suhu (u*uh (i#a5 #ise*a*5an 'i5roor)anis'e (a,i
le*ih 5e,a#a si(o5in <an) #i5eluar5an oleh sel /a)osi( 5e(i5a 'elaha'
5o',le5s an(i)en an(i*o#< <an) 'en)en#a, ,a#a ;arin)an
@hi,ersensi(i/i(as (i,e IIIB
#6 *a)ai'ana 'e5anis'e #ari ;enis #e'a' <an) #i#ri(a Nn6SD
au(oi'uni(as 5o',le5s i'un sis(e' 5o',le'en #an ,ele,asan
'e#ia(or ,era#an)an si(o5in IL 1= IL-= TN"a ,iro)en e5so)en
,iro)en en#o)en 'eran)san) sel en#o(el hi,o(ala'us asa' ara5i#ona(
#i*an(u oleh en%i' si5loo5si)enase ,ros(a)lan#in E! P:E!
*erea5si #en)an ,usa( n<eri #an *e5er;a ,a#a ,usa( Gaso'o(or se( ,oin(
'enin)5a( #e'a'
> Ra'*u( ron(o5
e6 en)a,a ra'*u(Nona S serin) ron(o5D
Ra'*u( serin) ron(o5 *erhu*un)an #en)an 5o',le5s i'un <an) #a,a(
'en<u'*a( /oli5el ra'*u( <an) a5an 'en<e*a*5an ra'*u( ron(o56 Selain
i(u= rash ,a#a ,asien #en)an SLE *isa 'en<e*ar #ari 'u5a hin))a 5e s2al, 9
(e',urun) 5e,ala6 .i5a rash su#ah sa',ai 5e (e',urun) 5e,ala= 'a5a *isa
(er*en(u5 ;arin)an ,aru( #isana <an) a5an 'en<e*a*5an ra'*u( 'en;a#i
ron(o56
/6 *a)ai'ana 'e5anis'en<aD
Ra'*u( ron(o5 'eru,a5an salah sa(u )e;ala <an) 2u5u, s,esi/i5 ,a#a
LSE6 e5anis'en<a sen#iri 'asih 'en;a#i se*uah hi,o(esis6 Se,er(i ,a#a
analisis se*elu'n<a #i5e(ahui *ah4a 5eron(o5an ini (er;a#i a5i*a(
,en<e',i(an /oli5el ra'*u( sehin))a ,er(u'*uhan ra'*u( (erha'*a( #an
,en#eri(a 'en;a#i a)a5 *o(a5 a(au alo,e2ia6 $i,o(esis lain 'en<e*u(5an
rua' <an) (er;a#i ,a#a lu,us selain #i 5uli( #an 4a;a ;u)a #a,a( 'en)enai
*a)ian s2al, a(au (e',urun) 5e,ala6 Bila rua' ini 'e'asau5i 'asa
5a'*uh <an) (in))i a(au #ise*u( K/lareL= rua' ini #a,a( *eru*ah 'en;a#i
;arin)an ,aru(6 Se,er(i <an) 5i(a 5e(ahui *ila (er*en(u5 ;arin)an ,aru(
'a5a (elah (er;a#i 5erusa5an ;arin)an #an s(ru5ur 'en;a#i rusa56
A5i*a(n<a /oli5el ra'*u( #an ra'*u( i(u sen#iri a5an (er5elu,as a(au
ron(o5 <an) 'en<e*a*5an (er;a#in<a 5e*o(a5an @alo,e2iaB
> saria4an
)6 A,a sa;a <an) #a,a( 'eni'*ul5an saria4an se2ara u'u'D
Pen<e*a* saria4an se2ara u'u' a#alah:
16 5uran) Gi(a'in 2
!6 5uran) 'en;a)a 5e*ersihan 'ulu(
?6 asu,an nu(risi 5uran)
46 lu5a
&6 i'uni(as <an) 'enurun
Se2ara le*ih (eori(is a#a *er*a)ai (eori <an) #a,a( 'elan#asi (i'*uln<a
saria4an6
16 A5i*a( Girus
Saria4an ini #ise*a*5an oleh *e*era,a *en(u5 Girus <an) a#a #i #ala' (u*uh=
(er'asu5 5asus>5asus 5husus se,er(i <an) 'en<e*a*5an #e'a' ,a#a
5elen;ar= her,es #an ,en<a5i( 'ulu( lainn<a6
!6 A5i*a( *a5(eri6
Saria4an ;enis ini *iasan<a su5a (er;a#i ;i5a seseoran) 'en#eri(a sa5i(
(en))oro5an a(au ,en<a5i( lain <an) #ise*a*5an oleh *a5(eri6
?6 A5i*a( ;a'ur6
Saria4an ini (i'*ul saa( seseoran) 'e'ili5i sis(e' 5e5e*alan (u*uh <an)
san)a( ren#ah a(au 'asalah 5eseha(an lainn<a <an) 'un)5in 'e'erlu5an
,en))unaan an(i*io(i5 #osis (in))i6
46 Non>in/e5si6
Pen<e*a* ,alin) u'u'n<a a#alah (er;a#in<a lu5a #i 'ulu( <an) *erulan)=
'es5i,un (i#a5 #i5e(ahui ,en<e*a*n<a (a,i *iasan<a a5an hilan) #ala'
4a5(u ! 'in))u6 Saria4an ini ;u)a *isa #ise*a*5an a#an<a 'asalah #ala'
sis(e' ,en2ernaan= 5e5uran)an Gi(a'in= ri*o/laGin= 'ia2in #an B1!6
Selain 5ee',a( ,en<e*a* #i a(as= a#a ;u)a hal lain <an) #i#u)a
#a,a('en<e*a*5an saria4an se,er(i 5uran) 'en;a)a 5e*ersihan 'ulu(=
,e'asan)an5a4a( )i)i a(au )i)i ,alsu #an ;u)a 5onsu'si 'a5anan a(au
'inu'an <an) ,anas6 Selain i(u ,en<e*a* saria4an ;u)a #a,a( #i*a)i
'en;a#i #ua /a2(or u(a'a:
"a5(or :eneral : $or'onal 'au,un ,en<a5i( sis(e'i56 S(res6
"a5(or Lo5al: OGerhan) (a'*alan a(au 5aries= ,ro(esa @)i)i (iruanB Lu5a ,a#a
*i*ir a5i*a( (er)i)i(9*en(uran6 De/isiensi @5e5uran)anB Gi(a'in B1! #an %a(
*esi6 #ll <an) 'en<e*a*5an (rau'a ,a#a )usi a(au 'u5osa 'ulu(6 In/e5si
Girus #an *a5(eri ;u)a #i#u)a se*a)ai ,en2e(us (i'*uln<a Saria4an ini6 A#a
,ula <an) 'en)a(a5an *ah4a saria4an 'eru,a5an rea5si i'unolo)i5
a*nor'al ,a#a ron))a 'ulu(6 Nah <an) 2u5u, serin) (er;a#i ,a#a 5i(a=
(eru(a'a 4ar)a 5o(a <an) si*u5= a#alah s(ress6 "a5(or ,sil5olo)is ini @s(ressB
(elah #iseli#i5i *erhu*un)an #en)an (i'*uln<a Saria4an6
h6 'en)a,a Nona S serin) (i'*ul saria4an #i lan)i(>lan)i( 'ulu( #an (an,a
n<eriD
Sari4an ,a#a ,en#eri(a SLE #a,a( *eru,a ul2er #i 'ulu(6 Ciri 5has un(u5
ul2er ini a#alah (i#a5 a#an<a rasa n<eri #i #aerah ul2er #an #a,a( ins,e5si6
I6 *a)ai'ana 'e5ansi'e s(o'a(i(isD
S(oa'(i(is a(au saria4an (er;a#i a5i*a( a#an<a ,era#an)an ,a#a 'u5osa
,ela,is 'ulu(6 Pen<e*a*n<a *isa *erane5a ra)a' se,er(i in/e5si *a5(eri #an
Girus <an) 'asu5 5e lu5a <an) (er*en(u5 ,a#a 'ulu(= ;a'ur= a(au,un 5arena
(rau'a <an) (er;a#i a5i*a( )i)i(an a(au hal>hal <an) lain se,er(i (elah
#ise*u(5an #i a(as6 Be*era,a su'*er 'en<e*u(5an *ah4a saria4an (er;a#i
a5i*a( rs,on i'un <an) a*nor'al a,a# ,en#eri(a u'un<a6 Saria4an serin)
'un2ul se*a)ai *en(u5 ,erluna5an #an ,erlu,asan a(au ulserasi <an)
*iasan<a 'eni'*ul5an n<eri ,a#a ,en#eri(a6 e5anis'e se2ara u'u'n<a
ha',er sa'a #en)an 'e5anis'e ,era#an)an 5arena saria4an #i5a(a5an
se*a)ai in/la'asi ,a#a 'u5osa 'ulu(6 B*era,a hi,o(esis 'en<e*u(5an (ia5
n<erin<a saria4an ,a#a 5asus lu,us #i5arena5an salah sa(un<a oleh inerGasi
a(au 5uran)nn<a ,ersara/an sehin))a 'e#ia(or se,er(i ,ros(a)lan#in=
*ra5i#inin #an hisa('in (i#a5 #a,a( #i#e(e5si oleh u;un) sera*u( sara/ n<eri6
> 5e'erahan #i ,i,i
.6 a,a 'a5na ,i,i <an) 5e'erahan saa( (er5ena 'a(ahariD
A#an<a an(i*o#< an(i>Ro ,a#a ,en#eri(a SLE a5an se'a5i 'en)e'*an)a5an
rua' /osensi(i/i(as ,a#a Nn6S6 hal ini s,esi/i5 'enun;u55an a#an<a lu,us
eri(enasus sis(e'i56
K6 *a)ai'ana 'e5anis'e ,i,i 'erah *ila (er5ena 'a(ahariD
a(ahari 'e'an2ar5an ra#iasi ul(raGiole( #ala' ? 5u',ulan <an) #i5enal
se*a)ai A B C= han<a ,er(a'a #an 5e#ua <an) se2ara lan)sun) *er*aha<a
*a)i lu,us= 5e(i5a 5e(i)a )elo'*an) sinar U7 (erse*u( 'en<en(uh 5uli(
,asien lu,us = 'ere5a 'erusa5 5u',ulan DNA <an) *er#e5a(an #en)an
,er'u5aan 5uli(6 Sehin))a 5uli( 'erah ;i5a (er5ena ,a,aran 'a(ahari6
Pa#a 5uli( 'u5a sel>sel <an) su#ah (ua a5an 'a(i 'elalui 'e5anis'e
a,o,(osis se2ara 5on#ensasi #an /ra)'en(asi ,a#a in(i6 "ase ini (r;a#i ,a#a sel
<an) nor'al6 Saa( a,o,(osis a5an #i5eluar5an ,hos,a(i#<lsreine <an) se2ara
nor'al ,a#a 'e'*rane sel6 Ke(i5a a,o,(osis sen<a4a ini a5an 'en)i5a(
CRP= TSP= SAP= #an 5o',le'en #an (er;a#i in(eras5i #en)an sel /a)osi(
'elalui rese,(or 'e'*rane <ai(u (rans,or(er ABC 1= 5o',le'en rese,(or
@CR1=?=4B= al,ha 7 *e(a ?= CD?-= CD14= le5(in #an 'anose rese,(or <an)
5e'u#ian a5an 'en)eluar5an 'e#ia(or an(iin/la'asi6
Na'un= ,a#a SLE= sen<a4a ini ;us(ru *eri5a(an #en)an au(oan(i*o#< <an)
a5an erin(era5si #en)an "C )a''a R #an ;us(ru 'en)eluar5an si(o5in
in/la'asi <an) 'e'i2u ,era#an)an6 Di(a'*ah la)i ,a#a SLE a#a )an))uan
a,o,(osis oleh 'a5ro/a) #an oleh "as #an BCL!6 $al ini #i'un)5in5an
5arena ,a#a ,en#eri(a SLE a#a 'u(asi )en ,en<an#i DNAse1 <an) *er/un)si
un(u5 'ense)'en(asi sel <an) su#ah 'a(i6 u(asi ini 'en)a5i*a(5an
5e'a',uan *er5uran) sehinn))a a5an (er;a#i (u',u55an sel <an) 'a(i6
Sinar U7 *ersi/a( an(i)eni2 'en)uran)i su,resi i'un sel 5uli(
'en)eluar5an si(o5inin #an ,ros(a)lan#in Gaso#ila(asi ,e'*uluh #arah
in/la'asi #i (e',a( M'u5a 6
A(au66
Sinar U7 a,o,(osis 5era(inosi( 'en)arah ,a#a sel/>i''uni(< #an
hilan) (oleransi 6
L6 a,a #ia)nosis se'en(ara #ari 5eluhan>5eluhan <an) #iala'i Nn6 SD
Dia)nosis se'en(ara:
16 SLE @*er#asar5an a#an<a )e;ala #e'a'= 'alar rash= ,e(e2hiae=
ar(hri(is #an a(hral)ia= he'a(olo)i= #an e,is(a5sisB6
!6 DBD @*er#asar5an )e;ala #e'a'= ,e(e2hiae= #an e,is(a5sisB6
?6 Re'a(hoi# ar(hri(is @*er#asar5an )e;ala ar(hri(is= a(hral)ia= #an
#e'a'B6
?6 a6 'en)a,a 5eluhan (i#a5 hilan) se(elah #i*eri o*a( n<eriD
Keluhan u(a'a <an) (i#a5 hilan) ,a#a 5asus ini a#alah 5eluhan n<eri
sen#i6 N<eri (er;a#i 5arena (er*en(u5n< 5o',le5s i'un <an) 5e'u#ian a5an
'en)en#a, ,a#a sen#i #an 'eni'*ul5an rea5si in/la'asi6 Pele,asan
'e#ia(or>'e#ia(or in/la'asi nan(in<a a5an 'e',en)aruhi u;un) sara/ *e*as
sehin))a 'eni'*ul5an n<eri6 O*a( n<eri 9 anal)esi5 *e5er;a #en)an
'en)ha'*a( ,e'*en(u5an 'e#ia(or in/la'asi (erse*u(6 Te(a,i= ,e'*en(u5an
5o',le5s i'un (e(a, *er;alan #an *isa 'en)en#a, #an 'eni'*ul5an rea5si
,era#an)an la)i sehin))a 'en<e*a*5an n<eri *erulan)6
*6 *a)ai'ana 'e5anis'e 5er;a o*a( anal)esi2D
OAINS se2ara u'u' (i#a5 'en)ha'*a( *iosin(esis leu5o(rien <an)
#i5e(ahui i5u( *er,eran #ala' in/la'asi6 :olon)an o*a( ini 'en)ha'*a(
en%i' si5loo5si)enase sehin))a 5onGersi asa' ara5hi#ona( 'en;a#i P::!
(er)an))u6 Se(ia, o*a( 'en)ha'*a( si5loo5si)enase #en)an 2ara <an)
*er*e#a6Khusus ,arase(a'ol= ha'*a(an *iosin(esis ,ros(a)lan#in han<a
(er;a#i *ila lin)5un)ann<a ren#ah 5a#ar ,ero5si# se,er(i #i
hi,o(ala'us6Lo5asi in/la'asi *iasan<a 'en)an#un) *an<a5 ,ero5si# <an)
#ihasil5an oleh leu5osi(6Ini 'en;elas5an 'en)a,a an(i>in/la'asi ,arase(a'ol
,ra5(is (i#a5 a#a as,irin sen#iri 'en)ha'*a( #en)an 'en)ase(iliasi )u)us
a5(i/serin #an en%i' ini6Tro'*osi( san)a( ren(an (erha#a, ,en)ha'*a(an ini
5arena selain (i#a5 'a',u 'en)a#a5an re)enerasi en%i' sehin))a #osis
(un))al as,irin 40 ') sehari (elah 2u5u, un(u5 'en)ha'*a( si5loo5si)enase
(ro'*osi( 'anusia sela'a 'asa hi#u, (ro'*osi( <ai(u +>11 hari
Anal)esi5 Nono,ioi#9Peri/er @NON>OPIOID ANAL:ESICSB
O*a(>o*a(an #ala' 5elo',o5 ini 'e'ili5i (ar)e( a5si ,a#a en%i'= <ai(u
en%i' si5loo5si)enase @CONB6 CON *er,eran #ala' sin(esis 'e#ia(or n<eri=
salah sa(un<a a#alah ,ros(a)lan#in6 e5anis'e u'u' #ari anal)e(i5 ;enis ini
a#alah 'en)e*lo5 ,e'*en(u5an ,ros(a)lan#in #en)an ;alan 'en)inhi*isi
en%i' CON ,a#a #aerah <an) (erlu5a #en)an #e'i5ian 'en)uran)i
,e'*en(u5an 'e#ia(or n<eri 6 e5anis'en<a (i#a5 *er*e#a #en)an NSAID
#an CON>! inhi*i(ors6
Anal)e(i5 o,ia# 'e',un<ai #a<a ,en)halan) n<eri <an) san)a( 5ua( #en)an
(i(i5 5er;a <an) (erle(a5 #i susunan s<ara/ ,usa( @SSPB6 U'u'n<a #a,a(
'en)uran)i 5esa#aran #an 'eni'*ul5an ,erasaan n<a'an @eu/oriaB66
Anal)e(i5 o,ioi# ini 'eru,a5an ,ere#a n<eri <an) ,alin) 5ua( #an san)a(
e/e5(i/ un(u5 'en)a(asi n<eri <an) he*a(6
Tu*uh se*enarn<a 'e'ili5i sis(e' ,en)ha'*a( n<eri (u*uh sen#iri
@en#o)enB= (eru(a'a #ala' *a(an) o(a5 #an su'su' (ulan) *ela5an) <an)
'e',ersuli( ,enerusan i',uls n<eri6 Den)an sis(e' ini #a,a( #i'en)er(i
'en)a,a n<eri #ala' si(uasi (er(e5an= 'isaln<a lu5a ,a#a 5e2ela5aan lalu
lin(as 'ula>'ula (i#a5 (erasa #an *aru #isa#ari *e*era,a saa( 5e'u#ian6
Sen<a4a>sen<a4a <an) #i5eluar5an oleh sis(e' en#o)en ini #ise*u( o,ioi#
en#o)en6 Be*era,a sen<a4a <an) (er'asu5 #ala' ,en)ha'*a( n<eri
en#o)en an(ara lain: en5e/alin= en#or/in= #an #inor/in6
O,ioi# en#o)en ini *erhu*un)an #en)an *e*era,a /un)si ,en(in) (u*uh
se,er(i /lu5(uasi hor'onal= ,ro#u5si anal)esia= (er'ore)ulasi= 'e#iasi s(ress
#an 5e)elisahan= #an ,en)e'*an)an (oleransi #an 5e(er)an(un)an o,ioi#6
O,ioi# en#o)en 'en)a(ur ho'eos(a(is= 'en)a,li/i5asi sin<al #ari ,er'u5aan
(u*u5 5e o(a5= #an *er(in#a5 ;u)a se*a)ai neuro'o#ula(or #ari res,on (u*uh
(erha#a, ran)san) e5s(ernal6
46 a6 a,a in(e,re(asi #ari ,e'eri5saan /isi5 Nona SD
> Ko',os 'en(is= *erar(i 5esa#arann<a nor'al6 $al ini 'enun;u55an *ah4a
'ani/es(asi SLE *elu' sa',ai 5e sis(e' sara/ ,usa(6
> $R= nilai nor'al -0>100 C9 'eni(6 Nilain<a 'asih nor'al (e(a,i a)a5 (in))iF
hal ini #i5arena5an (er;a#in<a #es(ru5si RBC <an) a5an 'en<e*a*5an
,enurunan ;u'lah $e'o)lo*in sehin))a ,er/usi O5si)en 5e ;arin)an ,un
a5an 'enurun6 a5a= (u*uh a5an 'ela5u5an 5o',ensasi #en)an
'enin)5a(5an hear( ra(e6 Selain i(u= suhu (u*uh <an) 'enin)5a( ;u)a *isa
'e'i2u 5enai5an hear( ra(e6
> RR= nilai nor'al 1->!4 C9'eni(6 Nilain<a 'asih nor'al (e(a,i *era#a #i
*a(as (in))i6 e5anis'e <an) 'en#asarin<a ha',ir sa'a #en)an 5enai5an
$R <an) #i#asari oleh ,enurunan he'o)lo*in <an) a5an 'enurun5an ,er/usi
o5si)en 5e ;arin)an6 Sehin))a (u*uh a5an 'ela5u5an res,irasi se2ara anaero*
<an) a5an 'en<e*a*5an (u',u5an asa' la5(a( sehin))a (er;a#i asi#osis #an
(u*uh 'en)5o',ensasin<a #en)an ,enin)5a(an RR6
> Suhu (u*uh= nor'al ?-=& I ?7=!
O
C6 Suhu (u*uh Nona S a#alah ?+=&
O
C
'a5a #i5a(a5an 'en)ala'i /er*ris @O?+
O
CB6 $al ini #i5arena5an 5o',le5s
i'un <an) 'en)en#a, sehin))a a5an 'eni'*ul5an rea5si ,era#an)an6 0an)
nan(in<a a5an 'e'a2u ,e'*en(u5an ,ros(a)lan#in #an 'eru*ah (er'os(a( #i
h<,o(hala'us @e5anis'e #e'a' le*ih rin2i ,a#a *a)ian !#B6
>TD= nor'al 1!09+0 ''$)6 TD 1?09+0 ''$) #i5a(e)ori5an se*a)ai ,re>
h<,er(ensi6 $al ini 'un)5in #i5arena5an 'ani/es(asi #ari SLE (elah sa',ai
5e )in;al <an) a5an 'en<e*a*5an )in;al 'en;a#i rusa5 sehin))a a5an
'en<e*a*5an re(ensi air 9 (er)an))un<a ,roses ,e'*en(u5an #an
,e'*uan)an urin sehin))a a5an 'enin)5a(5an Golu'e 2airan #an (e5anan
#arah6
&6 a6 a,a in(e,re(asi #ari 5ea#aan s,esi/i5 nona SD
Kea#aan s,esi/i5:
> ,e(e2hiae #i 5a5i #an (an)an: 'enun;u55an (elah (er;a#i ,en#arahan #i
*a4ah 5uli( a(au Gas5uli(is a5i*a( ,en)en#a,an 5o',le5s an(i)en an(i*o#i
> s(o'a(i(is @AB: 'enun;u55an (er;a#i ulserasi ,a#a 'u5osa 'ulu( a5i*a(
5o',le5s an(i)en an(i*o#< <an) 'en)en#a, ,a#a 'u5osa 'ulu( a(au,un
a5i*a( ,roses ,en)a(uran a,o,(osis <an) a*nor'al ,a#a Lu,us <an) a5an
*er'ani/es(asi se*a)ai s(o'a(i(is6
>5e'erahan #i ,i,i @AB: a#an<a *u((er/l< rash a5i*a( in/la'asi ,a#a 5uli(
4a;ah a5i*a( ,en)a(uran a,o,(osis <an) a*nor'al sehin))a ;us(ru
'en)eluar5an si(o5in' in/la'asi #an #a,a( #i,er,arah #en)an snar u7
(eru(a'a U7B
> *en)5a5 #i sen#i (an)an #an 5a5i @AB: 'enun;u55an a#an<a (u'or a(au
*en)5a5 se*a)ai 'ani/es(asi ,era#an)an6 Ben)5an (er;a#i a5i*a( in/il(rasi
;arin)an oleh sel N #an PN #an ;u)a oleh 2airan sel <an) (elah lisis
a5i*a( ,en)eluaran si(o5in oleh sel PN6
-6 a6 a,a in(e,re(asi #ari ,e'eri5saan la* nona SD
$asil In(erGal nilai nor'al in(er,re(asi
$* +=& )rE 1!>1- )rE Di*a4ah nor'al : in#i5asi
ane'ia= ,er#arahan he*a(= sirosis
ha(i= leu5e'ia= (alase'ia
8BC !6-009''
?
46&00>1060009''
?
Leu2o,enia : in#i5asi ,en<a5i(
he'a(o,oie(i2= in/e5si Girus=
'alaria= SLE= RA
Tro'*osi( 4060009''
?
1&06000 I 4006000
9''
?
Tro'*osi(o,enia : *er5ai(an
#en)an ane'ia= 5an5er= SLE=
,en<a5i( )in;al= leu5e'ia
Re(i5ulosi( 7E 0.5 I 16&E Re(i5ulosis : #a,a( #ise*a5an
oleh ane'ia he'oli(i5=
,er#arahan= res,on (h#,
,en)o*a(an @,e'*erian %a( *esi=
asa' /ola(= eri(ro,oie(inB
LED 10&
''9hour
P&0 ''9hour @'e(o#e
4es(er)renB
Dia(as nor'al : Ter;a#i in/e5si
a5u(95ronis= ne5rosis
Ureu' ?- ')9#l + I !& ')9#l Dia(as nor'al : in#i5asi
(er;a#in<a #ehi#rasi= )a)al
,rarenal= )a)al )in;al
Krea(inin 1=! ')9#l 0=? I 0=1 ')9#l Dia(as nor'al : in#i5asi
(er;a#in<a )a)al )in;al= #ehi#rasi=
)lo'erulone/ri(is= #ia*e(i2
neuro,ha(<
76 a6 a,a #ia)nosis #i//erensial #ari nona SD
DIA:NOSIS BANDIN:
16 Der'a(o'iosi(is6
eru,a5an ,en<a5i( au(oi'un <an) 'en<eran) o(o( #an 5uli(6 7asl5uli(is #an
5alsinosis 'eru,a5an )e;ala <an) (i'*ul la'*a( ,a#a ana5>ana5= ,a#a oran)
#e4asa a#a hu*un)ann<a #an 5e)anasan sis(e'i56 a#an<a 5eun)uan ,a#a
5uli( #iser(ai e#e'a ,erior*i(al= #orsu' 'anus= #an eri(e'a linier ,a#a
#orsu' /alan)6
!6 Eri(e'a ul(i/or'e
Lesi <an) 5lasi5 a#alah lesi <an) *er*en(u5 se,er(i iris a(au sasaran (e'*a56
Eri(e'a <an) *ula( a(au oGal #en)an ,usa( 4arna 5eun)uan6 Dis(ri*usin<a
5has ,a#a ,er'u5aan e5s(ensor len)an #an (un)5ai= (e(a,i se2ara #ia)nos(i5
<an) ,en(in) a#alah (er#a,a( ,a#a (ela,a5 (an)an #an 5a5i6
?6 Li5en Planus
Li5en ,lanus 'eru,a5an 5elainan <an) a)a5 *erGariasi *en(u5n<a #an *en(u5
<an) ,alin) serin) a#alah ,a,ula <an) )a(al6 Pre#ile5sin<a #i ,er)elan)an
(an)an= 5a5i #an ,un))un)6 Per'u5aann<a ra(a #an (a',a5 se,er(i an<a'an
halus #ari *in(i5>*in(i5 #an )aris>)aris se*a)ai 8i25ha'Qs s(riae= 'en)5ila(
#an ,oli)onal=
46 Psoriasis
Beru,a 'a5ula eri(e'a(osa <an) *esarn<a *erGariasi #ari 'iliar sa',ai
nu'ular= ,en<a5i( 5ronis ini resi#i/ #en)an s5ua'a6 Lesi (erse*u( *er4arna
,u(ih 'en)5ila(6 A#an<a s5ua'a <an) *ila #i)ores 'enun;u55an (an#a
(e(esan lilin= )oresan #i(erus5an= (i'*ul aus,i(% #en)an *in(i5 #arah #an
/eno'ena 5oe*ner6
*6 a,a #ia)nosis 5er;aD
.i5a a#a e',a( 2ri(eria se,er(i <an) #i a(as= 'a5a #a,a( #i5a(a5an se*a)ai
SLE6 Ber#asar5an hasil ,e'eri5saan= la*= #an 5ea#aan s,esi/i5= #a,a(
#isi',ul5an *ah4a Nona S 'en#eri(a SLE6
26 *a)ai'ana ,ena(ala5sanaan 5asus ini6D @#ian= ;eni= 'elaniB
16 Rua' 5uli(
R Sun *lo259(a*ir sur<a
R To,i5al 5or(i5os(eroi#s
!6 N<eri #an*en)5a5 ,a#a sen#i
R Anal)esi5 se#erhana se,er(i: Parase(a'ol= NSAID
R To,i5al anal)esi2
?6 Saria4an #an 5e5erin)an ron))a 'ulu(
R A'i(ri,(iline: )olon)an an(i#e,resan <an) #irese,5an *ersa'a anal)esi5
,a#a ,asien se5un#er /i*ro'<al)ia un(u5 'en)a(asi s(ress a5i*a( rasa n<eri
<an) *er5e,an;an)an
R SaliGar< su*s(i(u(e : air liur *ua(an #ala' *en(u5 2air a(au se',ro( *er*ahan
#asar 'e(h<l2ellulose a(au )as(ri2 'u2in
R O*a( 5u'ur s(eroi#
46 Tro'*osi(o,eni
R Dana%ol @Dano2rineB a(au Gin2ris(ine @On2oGinB a#alah (era,i ;an)5a ,an;an)
*a)i ,en#eri(a (ro'*osi(o,enia *era(
#6 *a)ai'ana ,ro)nosis = ,en2e)ahan #an 5o',li5asi #ari 5asus iniD
,ro)nosis un(u5 ,en#eri(a lu,us *er*e#a>*e#a6 Se(en)ah #ari ,en#eri(a <an)
'e'asu5i 'asa re'isi= a5an (e(a, #ala' 'asa re'isi sela'a *e*era,a
#e2a#e= (e(a,i 10E ,en#eri(a a5an 'en)ala'i 5o',li5asi6
,a#a 4ani(a= )e;ala <an) (i'*ul #a,a( 'e'*ai5 se(elah 'asa 'eno,ause6
10 E ,en#eri(a lu,us 'e'ili5i surGiGal ra(e sela'a 10 (ahun= -?>7& E
'e',un<ai surGiGal ra(e sela'a !0 (ahun6 Pen#eri(a lu,us #en)an
5o',li5asi (er(en(u 'e'ili5i ,ro)nosis <an) *uru5
#6 *a)ai'ana ,ro)nosis = ,en2e)ahan #an 5o',li5asi #ari 5asus iniD
Komplikasi
$i,er(ensi @41EB
:an))uan ,aru>,aru 5roni5 @?1EB
A*nor'ali(as 'a(a @?1EB
Kerusa5an )in;al ,er'anen @!&EB
:e;ala neuro,si5ia(ri @!!EB
Kerusa5an 'us5ulos5ele(a @1EB
:an))uan /un)si )ona# @?EB6
16 Seran)an ,a#a :in;al
S Kelainan )in;al rin)an @in/e5si )in;alB
S Kelainan )in;al *era( @)a)al )in;alB
S Ke*o2oran )in;al @,ro(ein (er*uan) se2ara *erle*ihan 'elalui urinB @7B6
!6 Seran)an ,a#a .an(un) #an Paru
S Pleuri(is
S Peri2ar#i(is
S E/usi ,leura
S E/usi ,eri2ar#
S Ra#an) o(o( ;an(un) a(au io2ar#i(is
S :a)al ;an(un)
S Per#arahan ,aru @*a(u5 #arahB @7B6
?6 Seran)an Sis(e' Sara/
a6 Sis(e' sara/ ,usa(
S Co)ni(iGe #<s/un2(ion
S Sa5i( 5e,ala ,a#a lu,us
S Sin#ro' an(i>,hos,holi,i#
S Sin#ro' o(a5
S "i*ro'<al)ia @7B6
*6 Sis(e' sara/ (e,i
S a(i rasa a(au 5ese'u(an #i len)an #an 5a5i
26 Sis(e' sara/ o(ono'
S :an))uan su,lai #arah 5e o(a5 #a,a( 'en<e*a*5an 5erusa5an ;arin)an
o(a5= #a,a( 'en<e*a*5an 5e'a(ian sel>sel o(a5 #an 5erusa5an o(a5 <an)
si/a(n<a ,er'anen @s(ro5eB6 S(ro5e #a,a( 'eni'*ul5an ,en)aruh sis(e' sara/
o(ono' @7B6
46 Seran)an ,a#a Kuli(
S Lesi ,aru( *er*en(u5 5oin ,a#a #aerah 5uli( <an) (er5ena lan)sun) 2aha<a
#ise*u( lesi #is5oi#
S Ciri>2iri lesi s,esi/i5 #i(e'u5an oleh Son(hie'er #an :illia' ,a#a a5hir
70>an :
> Ber,aru(= *er4arna 'erah @er<(he'a(osusB= *er*en(u5 5oin san)a( sensi(i/
(erha#a, sen)a(an 'a(ahari6 .enis lesi ini *eru,a lu,us 5ul( su*a5u(92u(aneus
lu,us su*a2u(e6 Ka#an) 'en<eru,ai lu5a ,soriasis a(au lesi (i#a5 *er,aru(
*er*en(u5 5oin6
> Lesi #a,a( (er;a#i #i 4a;ah #en)an ,ola 5u,u>5u,u a(au #a,a( 'en2a5u,
area <an) luas #i *a)ian (u*uh
S Lesi non s,esi/i5
> Ra'*u( ron(o5 @alo,e2iaB
> 7as5ulli(is : *eru,a )aris 5e2il 4arna 'erah ,a#a u;un) li,a(an 5u5u #an
u;un) ;ari6 Selain i(u= *isa *eru,a *en;olan 'erah #i 5a5i <an) #a,a( 'en;a#i
*oro5 @7B6
> "o(osensi(iGi(as : ,i,i 'en;a#i 5e'erahan ;i5a (er5ena 'a(ahari #an 5a#an)
#i ser(ai ,usin)6
&6 Seran)an ,a#a Sen#i #an O(o(
> Ra#an) sen#i ,a#a lu,us
> Ra#an) o(o( ,a#a lu,us
-6 Seran)an ,a#a a(a
76 Seran)an ,a#a Darah
S Ane'ia
S Tro'*osi(o,enia
S :an))uan ,e'*e5uan
S Li'/osi(o,enia
+6 Seran)an ,a#a $a(i
Pro)nosis :
Be*era,a (ahun (era5hir ini ,ro)nosis ,en#eri(a lu,us se'a5in 'e'*ai5=
*an<a5 ,en#eri(a <an) 'enun;u55an ,en<a5i( <an) rin)an6
8ani(a ,en#eri(a lu,us <an) ha'il #a,a( *er(ahan #en)an a'an sa',ai
'elahir5an *a<i <an) nor'al= (i#a5 #i(e'u5an ,en<a5i( )in;al a(au,un
;an(un) <an) *era( #an ,en<a5i(n<a #a,a( #i5en#ali5an6
An)5a hara,an hi#u, 10 (ahun 'enin)5a( sa',ai +&E6
Pro)nosis <an) ,alin) *uru5 #i(e'u5an ,a#a ,en#eri(a <an) 'en)ala'i
5elainan o(a5= ,aru>,aru= ;an(un) #an )in;al <an) *era(6
PENCEGAHAN
Pen2e)ahan a)ar (i#a5 (er5ena ,en<a5i( ini 'eli,u(i 'a5anan *er)i%i=
'e'*iasa5an #iri #en)an hi#u, seha(= 'en)5onsu'si nu(risi <an) sei'*an)=
olahra)a #an is(iraha( <an) 2u5u,= ser(a 'en)hin#ari si(uasi a(au 5ea#aan
<an) 'e'*ua( oran) 'u#ah s(res un(u5 an(isi,asi
Pa#a ,en#eri(a <an) su#ah (er5ena= ,en2e)ahan 'asa K/lareL #ila5u5an
#en)an 'en2e)ah s(ress= 'en)hin#ari /a2(or lua# #an #ala' ,en<e*a* 'asa
a5(i/ 5a'*uh= 'en;auhi sinar 'a(ahari #an 'en;auhi o*a( )olon)an sul/a #an
,ensilin6
e6 *a)ai'ana hu*un)an ,en<a5i( ini #en)an sis(e' i'unD
:a'*ar 16 Patogenesis SLE. In(era5si )en>lin)5un)an
'en)hasil5an res,on i'un a*nor'al <an) 'en)hasil5an au(oan(i*o#<
,a(ho)en #an #e,osisi 5o',le5s i'un ,a#a ;arin)an= 5o',le'en a5(i/=
'en<e*a*5an in/la'asi #an la'a 5ela'aan 'en)a5i*a(5an 5erusa5an
or)an irreGersi*le6A)= an(i)enF C1T= 2o',le'en( s<s(e'F C?= 2o',le'en(
2o',onen(F CNS= 2en(ral nerGous s<s(e'F DC= #en#ri(i2 2ellF EB7=
E,s(ein>Barr GirusF $LA= hu'an leu5o2<(e an(i)enF "2R= i''uno)lo*ulin
"2>*in#in) re2e,(orF IL= in(erleu5inF BL= 'annose>*in#in) li)an#F CP=
'ono2<(e 2he'o(a2(i2 ,ro(einF PTPN= ,hos,ho(<rosine ,hos,ha(aseF U7=
ul(raGiole(
Pa#a ,en#eri(a LES= )an))uan i'unore)ulasi seluler se,er(i ,enin)5a(an
a5(i/i(as sel T ,enolon) #an inhi*isi sel T ,ene5an a5an 'en<e*a*5an
,enin)5a(an ,roli/erasi #an a5(i/i(as sel B sehin))a 'eni'*ul5an
hi,era5(i/i(as res,on i'uni(as hu'oral6 Penin)5a(an a5(i/i(as res,on
i'uni(as hu'oral a5an 'en<e*a*5an (er;a#in<a ,ro#u5si au(o an(i*o#i
,oli5lonal <an) *erle*ihan (erha#a, an(i)en (u*uh sen#iri se,er(i an(i*o#i
(erha#a, 5o',onen in(i sel= s(ru5(ur si(o,las'a= sel 'ononu5lear @NB=
,oli'or/onu5lear @PNB= (ro'*osi(= eri(rosi( #an *er*a)ai *en(u5 'ole5ul
an(i)eni5 (u*uh lainn<a se,er(i i'uno)lo*ulin (er(en(u #an ,hos,oli,i#6
Au(oan(i*o#i <an) *eri5a(an #en)an an(i)enn<a a5an 'en<e*a*5an
(er*en(u5n<a 5o',le5 i'un6

Ko',le5s i'un selan;u(n<a a5an
'en)a5(i/asi sis(e' 5o',le'en un(u5 'ele,as5an C?a #an C&a <an)
'eran)san) sel *aso/il un(u5 'e'*e*as5an a'ina Gasoa5(i/ se,er(i
his(a'in <an) 'en<e*a*5an (er;a#in<a ,enin)5a(an ,er'ea*ili(as
Gas5uler (eru(a'a ,a#a ar(eri 5e2il #an ar(eriol6 Penin)5a(an ,er'ea*ili(as
Gas5uler ini a5an 'en<e*a*5an (er;a#in<a ,en)en#a,an 5o',le5s i'un
,a#a sel en#o(el ar(eri #an ar(eriol ;arin)an <an) selan;u(n<a a5an
'en)in#u5si (er;a#in<a a)re)asi (ro'*osi( 'e'*en(u5 'i5ro (ro'*us
,a#a ;arin)an 5ola)en 'e'*ran *asalis sel en#o(el6 Sel ra#an) se,er(i
PN= N= *aso/il= #an sel 'as(= <an) (er(ari5 5earah lesi oleh ,e,(i#a
5e'o(a5(i5 5o',le'en= (i#a5 'a',u un(u5 'ela5u5an /a)osi(osis
(erha#a, seluruh en#a,an 5o',le5 i'un ini #an a5an 'e'*e*as5an
en%i' lisoso'al <an) 'eru,a5an 'e#ia(or in/la'asi <an) a5an
'en<e*a*5an (er;a#in<a 5erusa5an Gas5uler <an) le*ih ;auh6 ani/es(asi
5linis <an) 'un2ul (er)an(un) ,a#a lo5asi 'en)en#a,n<a 5o',le5s
an(i*o#< an(i)en6
Pa#a ,asien SLE (er;a#i )an))uan res,on i'un <an) 'en<e*a*5an
a5(iGasi sel B= ,enin)5a(an ;u'lah sel <an) 'en)hasil5an an(i*o#i=
hi,er)a'a)lo*uline'ia= ,ro#u5si au(oan(i*o#i= #an ,e'*en(u5an
5o',le5s i'un @o5 #an Lau= !00?B6 A5(iGasi sel T #an sel B #ise*a*5an
5arena a#an<a s(i'ulasi an(i)en s,esi/i5 *ai5 <an) *erasal #ari luar se,er(i
*ahan>*ahan 5i'ia= DNA *a5(eri= an(i)en Girus= /os/oli,i# #in#in) sel a(au
<an) *erasal #ari #ala' <ai(u ,ro(ein DNA #an RNA6 An(i)en ini #i*a4a
oleh an(i)en ,resen(in) 2ells @APCsB a(au *eri5a(an #en)an an(i*o#i ,a#a
,er'u5aan sel B6 Ke'u#ian #i,roses oleh sel B #an APCs 'en;a#i
,e,(i#a #an #i*a4a 5e sel T 'elalui 'ole5ul $LA <an) a#a #i ,er'u5aan6
Sel T a5an (era5(iGasi #an 'en)eluar5an si(o5in <an) #a,a( 'eran)san)
sel B un(u5 'e'*en(u5 au(oan(i*o#i <an) ,a(o)en6 In(era5si an(ara sel B
#an sel T ser(a APCs #an sel T (er;a#i #en)an *an(uan si(o5in= 'ole5ul CD
40= CTLA>4
Ber#asar5an ,ro/il si(o5in sel T #i*a)i 'en;a#i ! <ai(u Th1 #an Th!6 sel
Th1 *er/un)si 'en#u5un) 2ell>'e#ia(e# i''uni(<= se#an)5an Th!
'ene5an sel (erse*u( #an 'e'*an(u sel B un(u5 'e',ro#u5si an(i*o#i6
Pa#a ,asien SLE #i(e'u5an a#an<a IL>10 <ai(u si(o5in <an) #i,ro#u5si
oleh sel Th! <an) *er/un)si 'ene5an sel Th1 sehin))a 'en))an))u
2ell>'e#ia(e# i''uni(<6
Sel T ,a#a SLE ;u)a 'en)ala'i )an))uan *eru,a *er5uran)n<a ,ro#u5si
IL>! #an hilan)n<a res,on (erha#a, ran)san)an ,e'*en(u5an IL>! <an)
#a,a( 'e'*an(u 'enin)5a(5an e5s,resi sel T
A*nor'ali(as #an #isre)ulasi sis(e' i'un ,a#a (in)5a( seluler #a,a(
*eru,a )an))uan /un)si li'/osi( T #an B= NKC= #an APCs6 $i,era5(iGi(as
sel B (er;a#i seirin) #en)an li'/osi(o,enia sel T 5arena an(i*o#i
an(ili'/osi( T6 Penin)5a(an sel B <an) (era5(iGasi 'en<e*a*5an (er;a#in<a
hi,er)a'a)lo*uline'ia <an) *erhu*un)an #en)an rea5(iGi(as sel/>an(i)en6
Pa#a sel B= rese,(or si(o5in= IL>!= 'en)ala'i ,enin)5a(an se#an)5an CR1
'enurun @SilGia an# Isen*er)= !001B6 $al ini ;u)a 'enin)5a(5an hea(
sho25 ,ro(ein 10 @hs, 10B ,a#a sel B #an CD4A6 Kele*ihan hs, 10 a5an
(erlo5alisasi ,a#a ,er'u5aan sel li'/osi( #an a5an 'en<e*a*5an
(er;a#in<a res,on i'un6 Sel T 'e',un<ai ! su*se( <ai(u CD+A
@su,resor9si(o(o5si5B #an CD4A @in#u2er9hel,erB6 SLE #i(an#ai #en)an
,enin)5a(an sel B (eru(a'a *erhu*un)an #en)an su*se( CD4A #an
CD4&RA6 CD4A 'e'*an(u 'en)in#u5si (er;a#in<a su,resi #en)an
'en<e#ia5an si)nal *a)i CD+A @Isen*er) an# $ors/all= 111+B6 Ber5uran)
;u'lah (o(al sel T ;u)a 'en<e*a*5an *er5uran)n<a su*se( (erse*u(
sehin))a si)nal <an) sa',ai 5e CD+A ;u)a *er5uran) #an 'en<e*a*5an
5e)a)alan sel T #ala' 'ene5an sel B <an) hi,era5(i/6 Ber5uran)n<a
5e#ua su*se( sel T ini <an) u'u' #ise*u( #ou*le ne)a(iGe @CD4>CD+>B
'en)a5(i/5an sin(esis #an se5resi au(oan(i*o#i @o5 an# Lau= !00?B6 Ciri
5has au(oan(i*o#i ini a#alah *ah4a 'ere5a (i#a5 s,esi/i5 ,a#a sa(u
;arin)an (er(en(u #an 'eru,a5an 5o',onen in(e)ral #ari se'ua ;enis sel
sehin))a 'en<e*a*5an in/la'asi #an 5erusa5an or)an se2ara luas @Al*ar=
!00?B 'elalui ? 'e5anis'e <ai(u ,er(a'a 5o',le5s i'un @'isaln<a
DNA>an(i DNAB (er;e*a5 #ala' 'e'*ran ;arin)an #an 'en)a5(i/5an
5o',le'en <an) 'en<e*a*5an 5erusa5an ;arin)an6 Ke#ua= au(oan(i*o#i
(erse*u( 'en)i5a( 5o',onen ;arin)an a(au an(i)en <an) (er;e*a5 #i #ala'
;arin)an= 5o',le'en a5an (era5(iGasi #an (er;a#i 5erusa5an ;arin)an6
e5anis'e <an) (era5hir a#alah au(oan(i*o#i 'ene',el ,a#a 'e'*ran
#an 'en<e*a*5an a5(iGasi 5o',le'en <an) *er,eran #alan 5e'a(ian sel
a(au au(oan(i*o#i 'asu5 5e #ala' sel #an *eri5a(an #en)an in(i sel #an
'en<e*a*5an 'enurunn<a /un)si sel (e(a,i *elu' #i5e(ahui
'e5anis'en<a (erha#a, 5erusa5an ;arin)an @E,s(ein= 111+B6
:an))uan sis(e' i'un ,a#a SLE #a,a( *eru,a )an))uan 5lirens 5o',le5s
i'un= )an))uan ,e'rosesan 5o',le5s i'un #ala' ha(i= #an ,enurunan
u,>(a5e 5o',le5s i'un ,a#a li',a @Al*ar= !00?B6 :an))uan 5lirens
5o',le5s i'un #a,a( #ise*a*5an *er5uran)n<a CR1 #an ;u)a /a)osi(osis
<an) ina#e5ua( ,a#a I):! #an I):? 5arena le'ahn<a i5a(an rese,(or
"2URIIA #an "2URIIIA6 $al ini ;u)a *erhu*un)an #en)an #e/isiensi
5o',onen 5o',le'en C1= C!= C46 A#an<a )an))uan (erse*u(
'en<e*a*5an 'enin)5a(n<a ,a,aran an(i)en (erha#a, sis(e' i'un #an
(er;a#in<a #e,osisi 5o',le5s i'un @,a#a *er*a)ai 'a2a' or)an sehin))a
(er;a#i /i5sasi 5o',le'en ,a#a or)an (erse*u(6 Peris(i4a ini 'en<e*a*5an
a5(iGasi 5o',le'en <an) 'en)hasil5an 'e#ia(or>'e#ia(or in/la'asi
<an) 'eni'*ul5an rea5si ra#an)6 Rea5si ra#an) inilah <an) 'en<e*a*5an
(i'*uln<a 5eluhan9)e;ala ,a#a or)an a(au (e',a( <an) *ersan)5u(an
se,er(i )in;al= sen#i= ,leura= ,le5sus 5oroi#eus= 5uli(= #an se*a)ain<a
IV. Hipotesis
Nona S= 17 (ahun= 5e'un)5inan 'en#eri(a Lu,us er(e'a(osus sis(e'i5
5arena rea5si au(oi'un #an a#an<a /a2(or ,e'i2u #ari luar #an #ala'6
V. Kerangka Konsep
Reaksi
Autoimun
genetik Lingkungan
Defek T
supresor
Peningkatan
aoutoantibodi
Menyerang antigen
tubuh
Kompleks antigen-
antibodi
Sitokin
infamasi
Pembuluh
darah keil
!"askulitis#
Pendarahan
ba$ah kulit
Petehiae
%idung&li
ngkungan
'pistaks
is
Mukos
a
Stomati
tis
Sino"ial(
kartilago
Reaksi
Autoimun
)nfamasi
*engkak
dan nyeri
Prostagla
ndin
Merubah set
point
Demam
Sumbat folikel
rambut(+aringan
parut pada salp
Rambut
rontok
Alopei
a
L'S
P, -sik dan keadaan
spesi-k
%asil
Lab
.bat nyeri/
tidak
sembuh
VI. Learning O!e"ti#e
LI $hat I kno% $hat I don&t
kno%
$Hat sho'ld
I pro#e
$here I "an
find
LES #e/inisi Pa(ho)enesis=
e(iolo)i=
sis(e' i'un=
,en)o*a(an=
5o',li5asi=
#e/e5
Nona S
'en#eri(a
)e;ala a5i*a(
Lu,us
.urnal= *u5u
(eC(= in(erne(
E,is(a5sis #e/inisi e5anis'e=
)e;ala=
,a(ho)enesis=
5ai(an #en)an
LES
E,is(a5sis
se*a)ai *a)ain
#ari LES
.urnal= *u5u
(eC(= in(erne(
S(o'a(i(is #e/inisi :e;ala=
'e5anis'e=
,a(ho)enesis =
5ai(an #en)an
LES
S(o'a(i(is
*erhu*un)an
#en)an LES
.urnal= *u5u
(eC(= in(erne(
Pe(e2hiae > De/inisi=
,a(ho)enesis=
5ai(an
BErhu*nun)an
#en)an LES
.urnal= *u5u
(eC(= in(erne(
Alo,e2ia > De/inisi=
,a(ho)enesis=
5ai(an
BErhu*nun)an
#en)an LES
.urnal= *u5u
(eC(= in(erne(
Ben)5a5=
#e'a' #an
n<eri sen#i
#e/inisi :e;ala=
'e5anis'e=
5ai(an
Berhu*un)an
#en)an LES
.urnal= *u5u
(eC(= in(erne(
Pe'eri5saan
/isi5 #an la*
In(e,re(asi
a4al
e5anis'e=
hu*un)an=
#asar= 5ai(an
#en)an i'un
eru,a5an
hasil #ari LES
.urnal= *u5u
(eC(= in(erne(
7I6 SINTESIS
A6 Lu,us eri(e'a(osus sis(e'i5
Lu,us eri(e'a(osus 'eru,a5an sua(u ,en<a5i( salah sa(u ,en<a5i( #en)an #asar
rea5si au(o i'un6 E(iolo)i se*enarn<a *elu' #i5e(ahui6 Se2ara 5linis #i(e'u5an !
*en(u5 lu,us eri(e'a(osus= <ai(u :
A6 Ben(u5 #is5oi# <an) (i#a5 *er*aha<a #an (er*a(as ,a#a 5uli(=;aran)'en)enai
or)an lain= (i#a5 'e',un<ai ,en)aruh (i'*al *ali5 #en)an 5eha'ilanF
B6 Ben(u5 (erse*ar luas @sis(e'i5B <an) selain 'en)enai 5uli( ;u)a 'en)enai
or)an lain #ala' (u*uhF *er*aha<a #an 'e',un<ai ,en)aruh (i'*al *ali5 #en)an
5eha'ilan6
Lu,us eri(e'a(osus sis(e'i5 @LESB a#alah ,en<a5i( ra#an) 'ul(i sis(e' a5i*a(
,en)en#a,an 5o',le5s i'un <an) (i#a5 s,esi/i5 ,a#a *er*a)ai or)an <an)
,en<e*a*n<a *elu' #i5e(ahui se2ara ;elas6 Di(e'u5an le*ih *an<a5 ,a#a 4ani(a
#ari,a#a ,ria61=!=?=4=& Be*era,a sis(e' or)an <an) *iasan<a (er5ena a#alah o(a5
#an sis(e' s<ara/ ,eri/er=,aru>,aru= ;an(un)=)in;al=5uli(='e'*ran serosa #an
5o',onen #arah6 Ban<a5 sis(e' lain <an) #a,a( (er5ena 4alau,un /e5uensin<a
le*ih ;aran)61
Pen<a5i( ini (elah #i5enal 1&0 (ahun <an) lalu #en)an *er*a)ai na'a <an)
'eru,a5an sinoni' #ari lu,us= se,er(i <an) #i5e'u5a5an oleh $i,,o2ra(es @4-0>
?70 s6'B se*a)ai her,es es(hio'enos #an her,es ul2erosus #ari A'a(us Lusi(anus
@1&10>1&-+B6 $e*ra ,a#a (ahun 1+4& (elah 'ene'u5an a#an<a sua(u se*orhea
5on)es(i/ <an) #i<a5ini a#alah sua(u lu,us eri(e'a(osus #en)an )a'*aran se,er(i
5u,u>5u,u @*u((er/l< rash B ,a#a #aerah ,i,i #an hi#un)6 A#an<a 'ani/es(asi
sis(e'i5 #an 5o',li5asi sere*ral <an) serius #i,er5enal5an oleh 8illia' Osler
@1+1&>110?B6 Ke(erli*a(an 5ar#ioGas5uler se,er(i a#an<a Gas5uli(is #an
en#o5ar#i(is 'ural #ila,or5an oleh Li*'an #an Sa25s @11!?B= se#an)5an
)a'*aran ,a(olo)i )lo'elurus )in;al #i,er5enal5an oleh Baehr= Kle',erer #an
S2hi/rin ser(a :ross=Kei(h #an Ro4n(ree6 Reins(ein #55 ,a#a (ahun117+
'en)ai(5an hu*un)an $LA DR! #an DR? #en)an LES6 0an) 'eru,a5an ,i;a5an
lan)5ah selan;u(n<a un(u5 ,eneli(ian *io'ole5uler #an )ene(i5a (erha#a, ,en<a5i(
ini6
PreGalensi SLE #i,er5ira5an 4>!&0 5asus un(u5 se(ia, 1006000 ,en#u#u5= <an)
'enun;u55an a#an<a ,er*e#aan *esar ,a#a *er*a)ai ,o,ulasi @La4ren2e #55=
11+1B6 Di A'eri5a Seri5a( ,reGalensin<a le*ih serin) ,a#a oran)>oran) asia @ 1+>
!4 (ia, 1006000B #ari,a#a oran) 5uli( hi(a' @4 (ia, 1006000B a(au Puer(o Ri2o @ 1
#ian(ara 1006000 B le*ih lan;u( #ila,or5an *ah4a ,reGalensi LES le*ih serin) ,a#a
oran)>oran) 2ina #an Asia Ten))ara @"en) #55=11+!B6- Se#an)5an #ala' 5urun
4a5(u 1171 sa',ai #en)an117& a#alah 1&=0! ,er 106000 ,era4a(an 6- Se#an)5an
#ala' 5urun 11+&>1114 #i*a)ian ,en<a5i( #ala' RSUD6 Dr6 Sai/ul An4ar=
alan)= (elah #ira4a( 5asus LES se*an<a5 71 5asus= #i'ana se*a)ian *esar
,en#eri(a @17=1 EB a#alah 4ani(a #en)an u'ur #i*a4ah ?0 (ahun6- Dala' *i#an)
o*s(e(ri ,en<a5i( ini #ian))a, ,en(in) 5arena LES #a,a( 'eru,a5an sa(u ,en<uli(
5eha'ilan= #i'ana 'e',un<ai ,o(ensi un(u5 'en)a5i*a(5an 5e'a(ian ;anin=
5elahiran ,re(er' 'au,un 5elainan ,er(u'*uhan ;anin67 Ba<i <an) lahir #ari i*u
<an) 'en)in#a, LES #a,a( 'en<e*a*5an lu,us eri(e'a(osus neona(al= 4alau,un
5e;a#iann<a ;aran) @1:!06000 5elahiran hi#u,B6
II6 ETIOLO:I DAN PATO:ENESIS
E(iolo)i #an ,a(o)enesis LES 'asih *elu' #i5e(ahui #en)an ;elas 'es5i,un
#e'i5ian (er#a,a( *an<a5 *u5(i= ini 'en2a5u, ,en)aruh /a5(or )ene(i5=
lin)5un)an #an hor'onal (erha#a, res,on i'un6 Kerusa5an ;arin)an #ise*a*5an
oleh au(oan(i*o#i= 5o',le5s i'un #an li'/osi( T6 Se,er(i haln<a ,en<a5i(
au(oi'un <an) lain= suse,(i*il(as LES (er)an(un) oleh )en <an) 'ul(i,el6
"a5(or lin)5un)an 'e'e)an) ,eranan ,en(in)= 'ela5u5an in(era5si #en)an sel
<an) suse,(i*el sehin))a a5an 'en)hasil5an res,on i'un <an) a*nor'al #en)an
se)ala a5i*a(n<a6 "a5(or )ene(i5 'e',un<ai ,eran ,en(in)= 10>!0E ,asien
,en#eri(a LES 'e',un<ai 5era*a( ,en#eri(a LES6 A#a,un )en <an) *er,eran
(eru(a'a )en <an) 'en)5o#e unsur>unsur sis(e' i'un6 Kai(an #en)an ha,lo(i,
$C (er(en(u (eru(a'a $LA> DR! #an $LA>DR? ser(a #en)an 5o',onen
5o',le'en <an) *er,eran ,a#a /ase a4al rea5si i5a( 5o',le'en (elah (er*u5(i6
:en>)en lain <an) *er,eran ialah )en <an) 'en)5o#e rese,(or sel T=
i''uno)lo*ulin #an si(o5in6
Sis(e' neuroen#o5rin #ala' *e*era,a ,eneli(ian *erhasil #i(e'u5an *ah4a
hor'on ,rola5(in #a,a( 'eran)san) res,on i'un6
Pa#a SLE= 2irin<a a#alah a#an<a )an))uan sis(e' i'un ,a#a sel T #an sel B ser(a
,a#a in(era5si an(ara 5e#ua sel (erse*u(= hal ini a5an 'eni'*ul5an a5(iGasi sel B
,oli5lonal6+ Di #ala' (u*uh se*enarn<a (er#a,a( 5elo',o5 li'/osi( <an) rea5(i/
(erha#a, an(i)en sen#iri= *ai5 sel li'/osi( B <an) 'e',ro#u5si au(oan(i*o#i
'au,un sel T <an) *ersi/a( si(o(o5si5 (erha#a, #iri sen#iri6
Po,ulasi sel <an) au(orea5(i/ ini #ia(ur #an #i5en#ali5an oleh sel li'/osi( T
su,resor6 Ke)a)alan 'e5anis'e 5en#ali ini 'en)a5i*a(5an (er*en(u5n<a
au(oan(i*o#i <an) 5e'u#ian 'en)a5i*a(5an (er*en(u5n<a au(oan(i*o#i <an)
5e'u#ian 'e'*en(u5 5o',le5s i'un a(au *er5ai(an #en)an ;arin)an6 Ko',le5
an(i)en an(i*o#i ini 'en)a5(i/asi sis(e' 5o',le'en #an ,ele,asan 'e#ia(or
,era#an)an #en)an a5i*a( ,er'ia*ili(as 5a,iler 'enin)5a(= 5e'o(a5sis neuro,il
#ansel /a)osi(osis lain #an 'en)a5i*a(5an (er;a#in<a 5erusa5an ;arin)an6
Sel T si(o(o5si5 #a,a( 'en<eran) sel (u*uh se2ara lan)sun)= sa'*il 'en)eluar5an
'e#ia(or <an) 'enin)5a(5an rea5si ,era#an)an6 An(i*o#i #an 5o',le'en <an)
'ela,isi sel (erse*u( 'en)a5i*a(5an ,erusa5an sel oleh /a)osi( #an sel Killer6
Ba)ian <an) ,en(in) #ala' ,a(o)enesis ini ialah (er)an))un<a 'e5anis'e
re)ulasi <an) #ala' 5ea#aan nor'al 'en2e)ah au(oi'uni(as ,a(olo)is ,a#a
in#iGi#u <an) resis(en6 Dala' 5ea#aan nor'al= 5o',le5s i'un #i'usna5an oleh
sel /a)osi( 'ononu5lear= (eru(a'a #iha(i= li',a #an ,aru (an,a *an(uan
5o',le'en6 Dala' ,roses (erse*u(= u5uran 5o',le5s 'eru,a5an /a5(or <an)
,en(in)6 Pa#a u'u'n<a 5o',le5s <an) *esar #a,a( #en)an 'u#ah #i'usna5an
oleh 'a5ro/a) #ala' ha(i6 Ko',le5s 5e2il #an laru( suli( un(u5 #i'usna5an=
5arenan<a #a,a( le*ih la'a *era#a #ala' sir5ulasi6
Di#u)a *ah4a )an))uan /un)si /a)osi( 'eru,a5an salah sa(u ,en<e*a* 'en)a,a
5o',le5s (erse*u( suli( #i'usnah5an6 es5i,un 5o',le5s i'un *era#a
#isir5ulasi #ala' ;an)5a 4a5(u <an) la'a= *iasan<a (i#a5 *er*aha<a6
Per'asalahan a5an (i'*ul *ila 5o',le5s (erse*u( 'en)en#a, #i;arin)an6
Ter;a#in<a ,en)en#a,an 5o',le5s i'un #i5arena5an u5uran 5o',le5s i'un <an)
5e2il #an ,er'ea*ili(as Gas5uler <an) 'enin))i= an(ara lain #ise*a*5an oleh
,ele,asan his(a'in6 Ko',le5s i'un le*ih 'u#ah #ien#a,5an ,a#a (e',a(>(e',a(
#en)an (e5anan #arah <an) (in))i <an) #iser(ai (ur*ulensi = 'isaln<a #ala'
5aGiler )lo'erulus= *i/ur5asi ,e'*uluh #arah= ,le5sus 5oroi# #an #an siliar
'a(a61= #en)an a5i*a( (er;a#in<a /i5sasi 5o',le'en ,a#a or)an (erse*u(6
Peris(i4a ini 'en<e*a*5an a5(iGasi 5o',le'en <an) 'en)hasil5an su*s(ansi
,en<e*a* (i'*uln<a rea5si ra#an)6 Rea5si ra#an) inilah <an) 'en<e*a*5an
(i'*uln<a 5eluhan9)e;ala ,a#a or)an a(au (e',a( <an) *ersan)5u(an se,er(i
)in;al= sen#i= ,leura= ,le5sus 5oroi#eus= 5uli( #an se*a)ain<a6
III6 KRITERIA DIA:NOSIS
Pa#a (ahun 1171= A'eri2an rheu'a(is' asso2ia(ion @ARAB 'en)u'u'5an
5ri(eria un(u5 5lasi/i5asi LES <an) 'en)an#un) 14 i(e'6 Na'u' 5arena
sensiGi(asn<a san)a( *erGariasi @&7=!E>1+EB= 'a5a #ila5u5an reGisi ulan) ,a#a
(ahun 11+! #en)an 5ri(eria reGisi ini #i#a,a(5an sen(iGi(as se*esar 1-E #an
s,esi/isi(asn<a an(ara 7+>+7E 6& Se#an)5an #ala' 5e,us(a5aan lain #i5a(a5an
sensi(iGisi(as #an s,esi/i(asn<a 'en2a,ai 1-E ;i5a 'en))una5an 2ri(eria ini6 ?
Den)an 'en))una5an 5ri(eria ini #ia)nosis LES #a,a( #i(e)a5an ;i5a #i(e'u5an 4
a(au le*ih 5ri(eria610
Kri(eria reGisi un(u5 5lasi/i5asi LES @11+!B #i5u(i,lah Lahi(a
Kri(eria De/inisi
16 alar rash rua' *eru,a eri(he'a (er*a(as= ra(a a(au 'enin))i= le(a5n<a
#i#aerah 'a5lar= *iasan<a (i#a5 'en)enai li,a( nasola*ialis6
!6 Dis2oi# rash Lesi ini *eru,a *er2a5 eri(e'a(osa <an) 'enin))i #en)an sisi5
5era(in <an) 'ele5a( #iser(ai ,en<u'*a(an /oli5el6 Pa#a lesi <an) la'a 'un)5in
(er*en(u5 si5a(ri5s6
?6 Pho(osensi(iGi(< Ter;a#i lesi 5uli( se*a)ai a5i*a( rea5si a*nor'al (erha#a,
2aha<a 'a(ahari6 $al ini #i5e(ahui 'elalui ana'nesis a(au 'elalui ,en)a'a(an
#o5(er
46 Oral ul2ers Ulserasi #i'ulu( a(au naso/arin)= *iasan<a (i#a5 n<eri= #i5e(ahui
'elalui ,e'eri5saan #o5(er
&6 Ar(hri(is Ar(ri(is non>erosi/ <an) 'en)enai ! sen#i ,eri/er #i(an#ai oleh n<eri=
*en)5a5 a(au e/usi
-6 Serosi(is a6 Pleuri(is : a#an<a ri4a<a( n<eri ,leural a(au (er#en)arn<a *un<i
)ese5an ,leura oleh #o5(er a(au a#an<a e/usi ,leura
*6 Peri5ar#i(is : #i,eroleh #ari )a'*aran EK: a(au (er#en)arn<a *un<i )ese5an
,eri5ar# a(au a#an<a e/usi ,eri5ar#6
76 Renal #isor#er a6Pro(einuria <an) selalu O 0=&)9hari a(au O?A a(au
*6Di(e'u5an sili#er sel= 'un)5in eri(rosi(=he'o)lo*in=)ranular= (u*ular a(au
2a',uran
+6Neurolo)i2 #isor#er a6 Ke;an) <an) (i'*ul s,on(an (an,a a#an<a o*a(>o*a( <an)
#a,a( 'en<e*a*5an a(au 5elainan 'e(a*oli2 se,er(i ure'ia= 5e(o5si#osis #an
)an))uan 5esei'*an)an ele5(roli( a(au
*6 Psi5osis <an) (i'*ul s,on(an (an,a a#an<a o*a(>o*a( <an) #a,a( 'en<e*a*5an
a(au 5elainan 'e(a*oli2 se,er(i ure'ia= 5e(o5si#osis #an )an))uan 5esei'*an)an
ele5(roli(6
16 $e'a(olo)i2 #isor#er a6 Ane'ia he'oli(i5 #en)an re(i5ulosi(osis a(au
*6 Leu5o,enia= 5uran) #ari 40009''? ,a#a !C ,e'eri5saan a(au le*ih a(au
26 Li'/o,enia= 5uran) #ari 1&009''? ,a#a !C ,e'eri5saan a(au le*ih a(au
#6 Tro'*osi(o,enia= 5uran) #ari 10060009''? (an,a a#an<a o*a( <an) 'un)5in
'en<e*a*5ann<a6
106 I'unolo)i2 #isor#er a6 A#an<a sel LE a(au
*6 An(i DNA : an(i*o#i (erha#a, na(iGe DNA #en)an (i(er a*nor'al a(au
26 An(i S' : a#an<a an(i*o#i (erha#a, an(i)en in(i a(au o(o( ,olos a(au
#6 U;i serolo)is un(u5 si,ilis <an) ,osi(i/ se'u sela'a ,alin) se#i5i( - *ulan #an
#i,er5ua( oleh u;i i'o*ilisasi Tre,one'a ,alli#u' a(au u;i /luoresensi a*sor*si
an(i*o#i (re,one'a6
116 An(inu2lear an(i*o#i Ti(er a*nor'al an(i*o#i an(inu2lear <an) #iu5ur #en)an
2ara i'uno /luoresensi a(au 2ara lain <an) se(ara ,a#a 4a5(u <an) sa'a #an
#en)an (i#a5 a#an<a o*a(>o*a( <an) *er5ai(an #en)an sin#ro'a lu,us 5arena o*a(6
I76 PEERIKSAAN ANTIBODI PADA LES
Dia)nosis LES #i#asar5an ,a#a )e;ala 5linis <an) 'en#u5un)= #i,as(i5an #en)an
a#an<a au(oan(i*o#i <an) a#a #ala' sir5ulasi= *an<a5 se5ali au(oan(i*o#i <an)
(elah #i5enal #an *erhu*un)an #en)an LES 6 Au(oan(i*o#i <an) *ai5 #ala'
'en#ia)nosis LES a#alah <an) *erhu*un)an lan)sun) (erha#a, nu2lear an(i)en=
<ai(u an(inu5lear an(i*o#i @ANAB6 "eno'ena sel LE (i#a5 la)i ,en(in) #ala'
#ia)nosis LES= (elah #i)an(i5an #en)an i'uno/luores2en( assa<s /or ANA6 Nilai
ANA <an) ,osi(i/ #a,a( #iin(er,re(asi5an ,a#a *er*a)ai (in)5a(an (er)an(un) ,ola
i5a(ann<a6 E',a( ,ola #asar i5a(an (erse*u( a#alah
ho'o)enous=,eri,heral=s,e25le# #an nu2leolar6 I5a(an ho'o)enous #i(e'u5an
,a#a -&E ,en#eri(a LES= se#an)5an i5a(an ,eri,heral a#alah i5a(an <an) ,alin)
s,esi/i5 un(u5 LES 4alau,un (i#a5 (erlalu sensi(iGe6 Pola i5a(an s,e25le# #an
nu2leolar le*ih s,esi/i5 (erha#a, ,en<a5i( au(oi'un <an) lain
An(i*o#i (erha#a, #ou*le s(ran#e# @na(iGeB DNA @#sDNAB a#alah <an) ,alin)
s,esi/i5 (erha#a, LES #an #i(e'u5an ,a#a +0>10>E ,en#eri(a <an) (i#a5 #io*a(i6
Keha#iran a(au,un (i(er an(i >#sDNA #i5ai(5an #en)an a5(i/i(as LES *e*era,a
,eneli(ian (elah 'e'*u5(i5an *ah4a ,enin)5a(an (i(er an(i>DNA 'en#ahuluin
lu,us /lares ,a#a le*ih #ari +0E ,en#eri(a ,enin)5a(an 5a#ar an(i*o#i ini (elah
#i5ai(5an #en)an e5saser*asi ,en<a5i( #an ,re'a(uri(as #ala' 5eha'ilan6 &=11
An(i*o#i (erha#a, sin)le>s(ran#e# DNA @ssDNAB ;u)a #i(e'ui ,a#a ,ersen(ase
<an) 2u5u, (in))i ,a#a ,en#eri(a LES <an) (i#a5 #io*a(i= (e(a,i 5uran) s,esi/i5
;i5a #i*an#in)5an #en)an an(i>#s DNA6 Pen#eri(a LES ;@nRNPB= Ro9SSA ;u)a
'e',un<ai an(i*o#i (erha#a, RNA <an) 'eli,u(i S' an(i)en= nu2lear
ri*onu2leo,ro(ein @nRNPB=Ro9SSA an(i)en #an La9SSB an(i)en6&=11
76 :E.ALA KLINIS
A6 Kelelahan
Kelelahan 'eru,a5an 5eluhan <an) u'u' #i;u',ai ,a#a ,en#eri(a LES #an
*iasan<a 'en#ahului *er*a)ai 'ani/es(asi 5linis lainn<a6 Kelelahan ini a)a5 suli(
#inilai 5arena *an<a5 5on#isi lain <an) #a,a( 'en<e*a*5an 5elelahan se,er(i
a#an<a ane'ia= 'enin)5a(n<a *e*an 5er;a= 5on/li5 5e;i4aan= ser(a ,e'a5aian
o*a( se,er(i ,re#nison6
B6 Penurunan *era( *a#an
Keluhan ini #i;u',ai ,a#a se*a)aian ,en#eri(a LES #an (er;a#i ,a#a *e*era,a
*ulan se*elu' #ia)nosis #i(e)a55an6 Penurunan *era( *a#an ini #a,a( #ise*a*5an
oleh 'enurunn<a na/su 'a5an a(au <an) #ia5i*a(5an oleh )e;ala )as(roin(es(inal6
C6 De'a'
De'a' se*a)ai )e;ala 5ons(i(usional suli( #i*e#a5an #en)an ,en<a5i( lain se,er(i
in/e5si= 5arena suhu (u*uh #a,a( le*ih #ari 40oC (an,a a#an<a *u5(i in/e5si lain
se,er(i leu5osi(osis6 De'a' a5i*a( LES *iasan<a (i#a5 #iser(ai 'en)i)il6
D6 Lain>lain
:e;ala>)e;ala lain <an) serin) #i;u',ai ,a#a ,en#eri(a LES #a,a( (er;a#i se*elu'
a(au,un seirin) #en)an a5(i/i(as ,en<a5i(n<a se,er(i ra'*u( ron(o5= hilan)n<a
na/su 'a5an= ,e'*esaran 5elen;ar )e(ah *enin)= sa5i( 5e,ala= 'ual #an 'un(ah6
E6 ani/es(asi 'us2ulos5ele(al
Keluhan 'us2ulos5ele(al 'eru,a5an 'ani/es(asi 5lini5 <an) ,alin) serin)
#i;u',ai ,a#a ,en#eri(a LES= le*ih #ari 10E6 Keluhana #a,a( *eru,a n<eri o(o(
@'<al)iaB= n<eri sen#i @ar(ra)iaB a(au 'eru,a5an sua(u ar(hri(is #i'ana (',a5
a#an<a in/la'asi sen#i6 Keluhan ini serin) 5ali #ian))a, se*a)ai 'ani/es(asi
ar(hri(is rheu'a(oi# 5arena 5e(erli*a(an sen#i <an) *an<a5 #an si'e(ris6 Pa#a Les=
5e(erli*a(an sen#i ,a#a u'u'n<a (i#a5 a5an 'en<e*a*5an #e/or'i(as6
"6 ani/es(asi 5uli(
Rua' 5uli( 'eru,a5an 'ani/es(asi LES <an) (elah la'a #i5enal6 Lesi
'u5o5u(aneus <an) (a',a5 se*a)ai *a)aian #ari LES #a,a( *eru,a sua(u rea5si
/o(osensi(i/i(as=#is2oi# LE @DLEB= su*a2u(e 2ua(aneous lu,us er<(he'a(osus
@SCLEB= lu,us ,ro/un#us9,ani2uli(is= alo,esia= lesi Gas5uler *eru,a eri(e'a
,eriun)ual= liGe#o re(i5ularis= (elan)ie5(asia= /eno'ena Ra<nau#Qs #an lain>lain6
:6 ani/es(asi ,aru
Ber*a)ai 'ani/es(asi 5linis ,a#a ,aru>,aru #a,a( (er;a#i *ai5 *eru,a ra#an)
in(ers(i(ial ,aren5i' ,aru @,neu'oni(isB= e'*oli ,aru= hi,er(ensi ,ul'onu'=
,er#arahan ,aru a(au shrin5in) lun) s<n#ro'e6 Pneu'oni(is lu,us #a,a( (er;a#i
se2ara a5u( a(au *erlan;u( 'en;a#i 5roni56 Pa#a 5ea#aan a5u( ,erlu #i*e#a5an
#en)an ,neu'onia *a2(erial6 A,a*ila (er;a#i 5era)uan un(u5 #ia)nosis #a,a(
#ila5u5an (in#a5an inGasiGe se,er(i *ilas *ron5oalGeolar6 Pneu'ioni(is lu,us
'e'*eri5an res,ons <an) *ai5 (erha#a, ,e'*erian 5or(i5os(eroi#6
$6 ani/es(asi Kar#iolo)i
Bai5 ,eri5ar#iu'= 'io5ar#iu'= en#o5ar#iu' a(au,un ,e'*uluh #arah
5oroner #a,a( (erli*a( ,a#a ,en#eri(a LES= 4alau,un <an) ,alin) *an<a5
(er5ena a#alah ,eri2ar#iu'6 Peri5ar#i(is harus #i2uri)ai a,a*ila #i;u',ai
a#an<a 5eluhan n<eri Su*s(ernal=/ri2(ion ru*= silhouette sign ,a#a /o(o #a#a=
a(au,un 'elalui )a'*aran EK: #an e5o5ar#io)ra/i6 Pen<a5i( ;an(un)
5oroner #a,a( ,ula #i;u',ai ,a#a ,en#eri(a LES #an *er'ani/es(asi se*a)ai
an)ina ,e5(oris= in/ar5 'io5ar# a(au )a)al ;an(un) 5on)es(i/6 7alGuli(is=
)an))uan 5on#u5si ser(a hi,er(ensi 'eru,a5an 5o',li5asi lain <an) ;u)a
serin) #i(e'u5an6
I6 ani/es(asi Renal
Ke(erli*a(an )in;al #i;u',ai ,a#a 40>7&E ,en#eri(a <an) se*a)ian *esar
(er;a#i se(elah & (ahun ,en#eri(a LES6 8ani(a le*ih serin) 'en#eri(a 5e;a#ian
ini @10:1B #i*an#in)5an ,ria= ,un2a5 insi#ensi an(ara usia !0>?0 (ahun6 :e;ala
a(au (an#a 5e(erli*a(an renal ,a#a u'u'n<a (i#a5 (a',a5 se*elu' (er;a#i
5e)a)alan )in;al a(au sin#ro' ne/ro(i56 Pe'eri5saan (erha#a, ,<uria
@O&9LPBB (an,a #iser(ai *u5(i a#an<a in/e5si ser(a ,enin)5a(an 5a#ar seru'
5rea(inin 'enun;u55an a#an<a 5e(erli*a(an )in;al ,a#a ,en#eri(a LES6
10=11=1!
.6ani/es(asi )as(roin(es(inal
ani/es(asi )as(roin(es(inal (i#a5 s,esi/i5 ,a#a ,en#eri(a LES= 5arena #a,a(
'eru,a5an 2er'inan le(erli*a(an *er*a)ai or)an ,a#a ,en<a5i( ini a(au
se*a)ai a5i*a( ,en)o*a(an6 Se2ara 5linis vasculitis,(a',a5 a#an<a 5eluhan
,en<a5i( ,a#a eso,ha)us= mesenteric inflammatory bowel disease (IBSB=
pankreatitis #an ,en<a5i( ha(i
K, Manifestasi neuropsikiatrik
Ke(erli*a(an neuro,si5ia(ri5 a5i*a( LES suli( #i(e)a55an 5arena )a'*aran
5linisn<a *e)i(u luas6 Kelainan ini #i5elo',o5an se*a)ai 'ani/es(asi neurolo)i5
#an ,si5ia(ri56 Dia)nosis le*ih *an<a5 #i#asar5an ,a#a (e'uan 5linis #en)an
'en<in)5ir5an 5e'un)5inan lain se,er(i se,sis= ure'ia= #an hi,er(ensi *era(6
Pe'*u5(ian a#an<a 5e(erli*a(an s<ara/ ,usa( (i#a5 (erlalu *an<a5 'e'*an(u
,roses ,ene)a5an #ia)nosis LES6 Ke(erli*a(an susunan s<ara/ ,usa( #a,a(
*er'ani/es(asi se*a)ai e,ile,si= he'i,aresis= lesi s<ara/ 5ranial= lesi *a(an) o(a5=
'enin)i(is ase,(i5 a(au '<eli(is (ransGersal6 Se#an)5an lesi ,a#a susunan s<ara/
(e,i #a,a( *er'ani/es(asi se*a)ai neuro,a(i ,eri/er= '<as(henia )raGis a(au
'ononeuri(is 'ul(i,le5s6 Dari se)i ,si5ia(ri5= )an))uan /un)si 'en(al #a,a(
*ersi/a( or)ani5 'au,un non or)ani56
L6 ani/es(asi he'i5>li'/a(i5
Li'/a#eno,a(i *ai5 'en<eluruh 'au,un (erlo5alisir serin) #i;u',ai ,a#a
,en#eri(a LES6 Or)an Li'/oi# lain <an) serin) (er5ena a#alah li'/a <an)
*iasan<a #iser(ai ,e'*esaran ha(i6 Kelainan he'a(olo)i5 san)a( *erGariasi #an
*ah5an #a,a( 'en<eru,ai )an))uan #arah ,eri/er6 Ane'ia #a,a( #i;u',ai ,a#a
sa(u ,erio#e #ala' ,er5e'*an)an ,en<a5i( LES
:AN::UAN IONORE:ULASI PADA LES
Pa#a ,en#eri(a LES= )an))uan i'unore)ulasi seluler se,er(i ,enin)5a(an a5(i/i(as
sel T ,enolon) #an inhi*isi sel T ,ene5an a5an 'en<e*a*5an ,enin)5a(an
,roli/erasi #an a5(i/i(as sel B sehin))a 'eni'*ul5an hi,era5(i/i(as res,on
i'uni(as hu'oral6 Penin)5a(an a5(i/i(as res,on i'uni(as hu'oral a5an
'en<e*a*5an (er;a#in<a ,ro#u5si au(o an(i*o#i ,oli5lonal <an) *erle*ihan
(erha#a, an(i)en (u*uh sen#iri se,er(i an(i*o#i (erha#a, 5o',onen in(i sel=
s(ru5(ur si(o,las'a= sel 'ononu5lear @NB= ,oli'or/onu5lear @PNB= (ro'*osi(=
eri(rosi( #an *er*a)ai *en(u5 'ole5ul an(i)eni5 (u*uh lainn<a se,er(i
i'uno)lo*ulin (er(en(u #an ,hos,oli,i#6 Au(oan(i*o#i <an) *eri5a(an #en)an
an(i)enn<a a5an 'en<e*a*5an (er*en(u5n<a 5o',le5 i'un61&
Ko',le5s i'un selan;u(n<a a5an 'en)a5(i/asi sis(e' 5o',le'en un(u5
'ele,as5an C?a #an C&a <an) 'eran)san) sel *aso/il un(u5 'e'*e*as5an a'ina
Gasoa5(i/ se,er(i his(a'in <an) 'en<e*a*5an (er;a#in<a ,enin)5a(an
,er'ea*ili(as Gas5uler (eru(a'a ,a#a ar(eri 5e2il #an ar(eriol6 Penin)5a(an
,er'ea*ili(as Gas5uler ini a5an 'en<e*a*5an (er;a#in<a ,en)en#a,an 5o',le5s
i'un ,a#a sel en#o(el ar(eri #an ar(eriol ;arin)an <an) selan;u(n<a a5an
'en)in#u5si (er;a#in<a a)re)asi (ro'*osi( 'e'*en(u5 'i5ro (ro'*us ,a#a
;arin)an 5ola)en 'e'*ran *asalis sel en#o(el6 Sel ra#an) se,er(i PN= N=
*aso/il= #an sel 'as(= <an) (er(ari5 5earah lesi oleh ,e,(i#a 5e'o(a5(i5
5o',le'en= (i#a5 'a',u un(u5 'ela5u5an /a)osi(osis (erha#a, seluruh en#a,an
5o',le5 i'un ini #an a5an 'e'*e*as5an en%i' lisoso'al <an) 'eru,a5an
'e#ia(or in/la'asi <an) a5an 'en<e*a*5an (er;a#in<a 5erusa5an Gas5uler <an)
le*ih ;auh6 Pa#a LES a5(i/ #a,a( #i;u',ai in/il(rasi ,eriGas5uler oleh sel N61&
Selan;u(n<a sis(e' 5o',le'en a5an 'e'*en(u5 'e'*ran a(((a25 2o',leC <an)
a5an 'en<e*a*5an (er;a#in<a lisis sela,u( sel sehin))a a5an 'e',er*era(
5erusa5an ;arin)an <an) (elah (er;a#i6 Pa#a ,lasen(a ,roses ini a5an 'en<e*a*5an
(er;a#in<a Gas5uli(is #esi#ual6
(anifestasi Klinis
Da,a( #i*a)i #ala' *e*era,a *a)ian= <ai(u :
). Ge!ala konstit'sional
Perasaan lelah
Penurunan *era( *a#an
Ka#an)>5a#an) #e'a' (an,a 'en))i)il <an) (i'*ul selaa
*er*ulan>*ulan se*elu' a#a )e;ala lain
*. Kelainan di k'lit dan m'kosa
Kelainan #i 5uli(
Lesi se,er(i 5u,u>5u,u #i area 'alar #an nasal #en)an se#i5i(
e#e'a= eri(e'a= sisi5= (elan)ie5(a5is
Eru,si 'a5ulo>,a,ular= ,oli'or/ #an eri(e'a(osa *ulosa #i ,i,i
"o(osensi(iGi(as #i #aerah <an) (i#a5 (er(u(u, ,a5aian
Lesi ,a,ular #an ur(i5arial 5e2o5ela(>2o5ela(an
Ka#an)>5a#an) (er#a,a( lesi L6E6D a(au no#us>no#us su*5u(an
<an) 'ene(a,
7a5uli(is san)a( 'enon;ol
Alo,esia #an ,eni,isan ra'*u(
Si5a(ri5sasi #en)an a(ro/i ,ro)resi/ #an hi,er,i)'en(asi
Ul2us (un)5ai
Kelainan 'u5osa
Pa#a 'u5osa 'ulu(= 'a(a= #an Ga)ina #a,a( (i'*ul s(o'a(i(is=
5era(o5on;un)(iGi(is #an 5ol,i(is #en)an ,e(e2hiae= erosi *ah5an ulserasi6
+. Kelainan di alat dalam
0an) (erserin) a#alah l'p's nefritis6 Tan,a ne/ri(is a(au,un ne/rosis
serin)5ali (er#a,a( ,ro(einuri6 Selain i(u #a,a( ,ula (i'*ul
,leuri(is=,eri5ar#i(is #an e/usi ,a#a ,eri(oneu'6 Koli(is ulsera(iGa ser(a
he,a(os,leno'e)ali #a,a( ,ula #i(e'u5an6
,. Kelainan di sendi- t'lang- otot- kelen!ar getah ening- dan sistem
saraf
Ar(ri(is= *iasan<a (an,a #e/or'i(as= *ersi/a( e,iso#i5 #an 'i)ra(ori5=
ne5rosis 5e,ala /e'ur #an a(ro/i 'us2ulos5ele(al #en)an 'ial)ia (elah
#ila,or5an6 Li'/a#eni(is #a,a( *ersi/a( re)ional a(au )eneralisa(a6
Neuri(is ,eri/er= ense/ali(is= 5onGulsi #an ,si5osis #a,a( (er;a#i6
4616 Pe'*an(u Dia)nosis
Pe'eri5saan La*ora(oriu'
Kelainan la*ora(oriu' <an) #a,a( #i(e'u5an a#alah :
a6 Ane'ia he'oli(i5 #an ane'ia nor'osi(er
*6 Leu5o,enia
26 Tro'*osi(o,enia
#6 Penin))ian LED
e6 $i,er)lo*uline'ia
/6 Penurunan al*u'in
)6 Krio)lo*ulin= 5elainan /aal he,ar= #an ,enurunan 5o',le5s seru'
h6 :ross ,ro(einuria
i6 "a5(or re'a(oi# @AB ,a#a se5i(ar ??E 5asus
;6 Tes serolo)i5 si/ilis @AB han<a se5i(ar ,a#a 10E 5asus6
An(i*o#i An(iNu5lear @ANAB
A#alah sua(u ,e'eri5saan #arah 'en)hi(un) an(i*o#i <an)
(er*en(u5 <an) se2ara lan)sun) 'ela4an *er*a)ai 5o',onen #ari
nucleus @in(i selB6
ANA (es ini 'eru,a5an ,e'eri5saan a4al un(u5 ,en<a5i( L6E6S Pasien
L6E6S u'u'n<a 'e',un<ai ANA ,a#a ,e'eri5saan i'uno/luoresens (a5
lan)sun) =ha',ir 10E ,asien6
Ter#a,a( 4 ,ola ANA= <ai(u 'e'*ranosa @anular=,eri,heralB=
ho'o)en<= *er*in(i5= #an nu2lear6 0an) #ian))a, s,esi/i5 un(u5 L6E6S
a#alah ,ola 'e'*ranosa= (eru(a'a ;i5a (i(ern<a (in))i6
.aran) se5ali ,asien L6E6S 'e'ili5i hasil (es <an) ne)a(i/6
8alau,un ini (er;a#i= 5e'un)5inan i(u han<a se'en(ara se*elu' (es ini
'en;a#i ,osi(i/6
Te(a,i hasil (es ANA <an) ,osi(i/ ini (i#a5 lan)sun) 'e'*eri5an hasil
#ia)nosa ,osi(i/ S6L6E= (a,i ini han<a salah sa(u in#i5a(or6
Lu,us Ban# Tes(
Pa#a ,e'eri5saan i'uno/luoresens lan)sun) #a,a( #iliha( ,i(a <an)
(er#iri a(as #e,osi( )ranular i''uno)lo*ulin := a(au A #an 5o',le'en
C? ,a#a (au( e,i#er'al>#er'al <an) #ise*u( Lu,us *an#6 Cara ini #ise*u(
Lu,us Ban# Tes(=s,esi'en #ia'*il #ari 5uli( <an) nor'al6 Tes ini
'e'*eri hasil @AB ,a#a 10>100E 5asus L6E6D

An(i>#s>DNA
An(i au(oan(i*o#i <an) lain <an) s,esi/i5 un(u5 L6E6S selain ANA a#alah
an(i #s>DNA6 Na'un han<a #i(e'u5an ,a#a 40>&0E 5asus6 An(i*o#i ini
'e',un<ai hu*un)an #en)a )lo'erulone/ri(is6A#an<a an(i*o#i (erse*u(
#an 5a#ar 5o',le'en <an) ren#ah #a,a( 'era'al5an a5an (er;a#in<a
he'a(uria a(au ,ro(einuria6
An(i>s'
$an<a (er#a,a( ,a#a !0>?>E 5asus #an (i#a5 #i(e'u5an ,a#a ,en<a5i(
lain6
Tes Sel L6E
Sel L6E (er#iri a(as )ranulosi( neu(ro/ili5 <an) 'en)an#un) *ahan nu2lear
*aso/ili5 <an) (elah #i/a)osi(osis= se)'en nu5learn<a *er,in#ah 5e
,eri/er6 "eno'ena ini #ise*a*5an oleh /a5(or an(inu2lear @/a5(or L6E #an
<an) lainB <an) 'en<eran) *ahan nu2lear #i #ala' sel <an) rusa56
BAhan nu2lear <an) *eru*ah #i5elilin)i neu(ro/il @*en(u5 rose((eB <an)
'e'/a)osi(osis *ahan (erse*u(6 Tes sel L6E 5ini (i#a5 ,en(in) 5arena
,e'eri5saan an(i*o#i an(inu5lear le*ih sensi(i/6

46!6 Dia)nosis
Dia)nosis #a,a( #i*ua(= *ila 5ri(eria ARA @(he A'eri2an
Rheu'a(is' Aso2ia(ionB #i,enuhi=<ai(u :
16 Eri(e'a /asial @*u((er/l< rashB
!6 Lesi Dis5oi#
?6 Si5a(ri5 hi,o(ro/i5
46 "o(osensi(iGi(as
&6 Ulserasi #i 'ulu( #an rhino/arin)
-6 Ar(hri(is @non erosi/= 'en)enai #ua a(au le*ih sen#i ,eri/erB
76 Serosi(is @,leuri(is #an ,eri5ar#i(isB
+6 Kelainan )in;al @,ro(einuria V 0=&)r ,er hari F 2ellular 2as(s
16 Kelainan neurolo)i5 @5elelahan #an ,si5osisB
106 Kelainan #arah= <a5ni ane'ia he'oli(i5= le5o,enia= li'/o,enia=
a(au (ro'*osi(o,enia
116 :an))uan i'unolo)i5
.i5a (er#a,a( 4 #ari 11 5ri(eria (erse*u( 'a5a #ia)nosis L6E6S su#ah #a,a(
#i(e)a55an6 $arus #iin)a(= *ah4a ,en)u',ulan *er*a)ai )e;ala #an 5elainan
la*ora(ori5 ser(a i'unolo)i5 harus #ia#a5an un(u5 'e'as(i5an L6E6S
46?6 Dia)nosis Ban#in)
Den)an a#an<a )e;ala #i *er*a)ai or)an= 'a5a ,en<a5i(>,en<a5i(
<an) harus #i#ia)nosis *an#in) *an<a5 se5ali6 Be*era,a ,en<a5i( <an)
*erasosiasi #en)an L6E6S6 'e',un<ai )e;ala>)e;ala <an) #a,a( 'en<eru,ai
L6E6S= <a5ni ar(hri(is reu'a(i5a= s5lerosis sis(e'i5= #er'a(o'iosis= #an
,ur,ura (ro'*osi(o,eni56
4646 Pen)o*a(an
Pen#eri(a harus #ira4a(
Kor(i5os(eroi# sis(e'i5
In#i5asi :
Bila ,en#eri(a sa5i( 5ri(is= 'isaln<a (er#a,a( 5risis lu,us ne/ri(is= ,leuri(is=
,eri5ar#i(is= a(au 'en)ala'i *an<a5 ,er#arahan
Dosis:
Pre#nison 1 ')95)BB a(au -0>+0 ') ,er hari6 Ke'u#ian #i(urun5an &
')9'in))u #an #i2ari #osis ,e'eliharaan <an) #i*eri5an selan) sehari
An(i*io(i5= an(iGiral= #an ani/un)al
$arus #i*eri5an *ila (er#a,a( 5o',li5asi= 'isaln<a in/e5si se5un#er=
,neu'onia *a5(erial a(au in/e5si Girus= #an 'i5osis sis(e'i56
Tera,i si(os(a(i5
Di*eri5an ,a#a ,en#eri(a L6E6S #en)an ane'ia he'oli(i5 a(au lu,us
ne/ro,a(ia <an) (i#a5 e/e5(i/ #en)an 5or(i5os(reroi# #osis (in))i6 Da,a(
#i*eri5an A%a((io,rin &0>1&0 ') ,er hari= #en)an #osis 'a5si'al !00 ')
,er hari6 Da,a( ,ula #i*eri5an si5lo/os/a'i# #en)an #osis sa'a6
PA.OGENESIS
E(iolo)i ,en<a5i( LES 'asih *elu' (erun)5a, #en)an ,as(i (e(a,i
#i#u)a 'eru,a5an in(era5si an(ara /a5(or )ene(i5= /a5(or <an) #i#a,a( #an
/a5(or lin)5un)an6
:an))uan i'uni(as <an) #i(an#ai oleh ,ersis(ensi li'/osi( B #an T
<an) *ersi/a( au(orea5(i/6 Au(oan(i*o#i <an) (er*en(u5 a5an *eri5a(an
#en)an au(oan(i)en 'e'*en(u5 5o',le5s i'un <an) 'en)en#a, *eru,a
#e,o( #ala' ;arin)an6 A5i*a(n<a a5an (er;a#i a5(iGasi 5o',le'en
sehin))a (er;a#i rea5si in/la'asi <an) 'eni'*ul5an lesi #i (e',a(
(erse*u(6
"a5(or 5eluar)a <an) 5ua( (eru(a'a ,a#a 5eluar)a #e5a(6 Resi5o
'enin)5a( !&>&0E ,a#a 5e'*ar i#en(i5 #an &E ,a#a 5e'*ar #i%<)o(i2=
#i#u)a 'enun;u55an 5ai(ann<a #en)an /a5(or )ene(i56 Pen<a5i( lu,us
#iser(ai oleh ,e(an#a ,en<a5i( )ene(i5 se,er(i #e/isiensi here#i(er
5o',le'en @se,er(i C1T= C1r= C1s= C4 #an C!B #an i'uno)lo*ulin @I)AB=
a(au 5e2en#erun)an ;enis /eno(i, $LA @>DR! #an >DR?B6 "a5(or
i'uno,a(o)eni5 <an) *er,eran #ala' LES *ersi/a( 'ul(i,el= 5o',le5s
#an in(era5(i/6
.u'lah sel B 'enin)5a( ,a#a ,asien #en)an lu,us <an) a5(i/ #an
'en)hasil5an ,enin)5a(an 5a#ar an(i*o#i #an hi,er)a'a)lo*uline'ia6
.u'lah sel B <an) 'e',ro#u5si I): #i #arah ,eri/er *er5orelasi #en)an
a5(iGi(as ,en<a5i(6 A5(iGasi sel B ,oli5lonal #ise*a*5an oleh an(i)en
e5so)en= an(i)en <an) 'eran)san) ,roli/erasi sel B a(au a*nor'ali(as
in(rinsi5 #ari sel B6 An(i*o#i I): an(i>#sDNA #en)an a/ini(as (in))i ;u)a
'eru,a5an 5ara5(eris(i5= <an) #ise*a*5an oleh hi,er'u(asi so'a(i5
sela'a a5(iGasi sel B ,oli5lonal <an) #iin#u5si oleh /a5(or lin)5un)an
se,er(i Girus a(au *a5(eri6
Selain 'e',ro#u5si au(oan(i*o#i= sel B ;u)a 'e',en)aruhi
,resen(asi an(i)en #an res,on #i/erensiasi sel Th6 :an))uan ,en)a(uran
,ro#u5si au(oan(i*o#i #ise*a*5an )an))uan /un)si CD+A= na(ural 5iller
2ell #an ine/isiensi ;arin)an i#io(i,>an(ii#io(i,6 I'uno)lo*ulin 'e',un<ai
s(ru5(ur (er(en(u ,a#a *a)ian #e(er'inan an(i)eni5 <an) #ise*u( i#io(i,=
<an) 'a',u 'eran)san) res,ons ,e'*en(u5an an(i*o#i an(ii#io(i,6
Se*a)ai res,ons (u*uh (erha#a, ,enin)5a(an 5a#ar i#io(i, 'a5a a5an
#i*en(u5 an(ii#io(i, <an) *ersi/a( s,esi/i5 (erha#a, *er*a)ai ;enis s(ru5(ur
#e(er'in an(i)en sesuai #en)an ;enis i#io(i, <an) a#a6 Se2ara (eori(is
'un)5in sa;a salah sa(u #ari an(ii#io(i, 'e',un<ai si/a( s,esi/i5 an(i)en
#iri hin))a #en)an ,e'*en(u5an *er*a)ai an(ii#io(i, #a,a( (i'*ul
a5(iGi(as au(oi'un6 Persis(ensi an(i)en #an an(i*o#i #ala' *en(u5
5o',le5s i'un ;u)a #ise*a*5an oleh ,e'*ersihan <an) 5uran) o,(i'al
#ari sis(e' re(i5uloen#o(elial6 $al ini #ise*a*5an an(ara lain oleh
5a,asi(as sis(e' re(i5uloen#o(elial #ala' 'e'*ersih5an 5o',le5s
in(era5si an(ara au(oan(i*o#i #an an(i)en <an) (erlalu *an<a56 Den)an
a#an<a 5a#ar au(oan(i*o#i <an) (in))i= ,en)a(uran ,ro#u5si <an)
(er)an))u #an 'e5anis'e ,e'*ersihan 5o',le5s i'un <an) (er)an))u
a5an 'en<e*a*5an 5erusa5an ;arin)an oleh 5o',le5s i'un6
Sela'a ,er;alanan ,en<a5i( lu,us (u*uh 'e'*ua( *e*era,a ;enis
au(oan(i*o#i (erha#a, *er*a)ai an(i)en #iri6 Di an(ara *er*a)ai ;enis
au(oan(i*o#i <an) ,alin) serin) #i;u',ai ,a#a ,en#eri(a lu,us a#alah
an(i*o#i an(inu5lear @au(oan(i*o#i (erha#a, DNA= RNA= nu5leo,ro(ein=
5o',le5s ,ro(ein>asa' nu5lea(B6 U'u'n<a (i(er an(iDNA 'e',un<ai
5orelasi #en)an a5(iGi(as ,en<a5i( lu,us6
Be*era,a an(i*o#i an(inu5lear 'e',un<ai a5si ,a(olo)is #ire5= <ai(u
*ersi/a( si(o(o5si5 #en)an 'en)a5(i/5an 5o',le'en= (e(a,i #a,a( ;u)a
#en)an 'e',er'u#ah #es(ru5si sel se*a)ai ,eran(ara *a)i sel 'a5ro/a)
<an) 'e',un<ai rese,(or "2 i'uno)lo*ulin6 Con(oh 5linis 'e5anis'e
(era5hir ini (erliha( se*a)ai si(o,enia au(oi'un6 A#a ,ula au(oan(i*o#i
(er(en(u <an) *ersi/a( 'e'*aha<a5an 5arena #a,a( *erin(era5si #en)an
su*s(ansi an(i5oa)ulasi= #ian(aran<a an(i,ro(ro'*inase= sehin))a #a,a(
(er;a#i (ro'*osis #iser(ai ,er#arahan6 An(i*o#i an(inu5lear (elah #i5enal
,ula se*a)ai ,e'*en(u5 5o',le5s i'un <an) san)a( *er,eran se*a)ai
,en<e*a* Gas5uli(is6
Au(oan(i*o#i ,a#a lu,us (i#a5 selalu *er,eran ,a#a ,a(o)enesis
a(au,un *ernilai se*a)ai ,e(an#a i'unolo)i5 ,en<a5i( lu,us6 An(i*o#i
an(inu5lear #a,a( #i(e'u5an ,a#a *u5an ,en#eri(a lu,us= a(au ;u)a #ala'
#arah *a<i seha( #ari seoran) i*u ,en#eri(a lu,us6 Selain i(u #i5e(ahui ,ula
*ah4a ,en<a5i( lu,us (ern<a(a (a5 #a,a( #i(ular5an se2ara ,asi/ #en)an
seru' ,en#eri(a lu,us6
A#an<a 5e(erli*a(an 5o',le5s i'un #ala' ,a(o)enesis LES
#i#asar5an ,a#a a#an<a 5o',le5s i'un ,a#a seru' #an ;arin)an <an)
(er5ena @)lo'erulus renal= (au(an #er'is>e,i#er'is= ,le5sus 5oroi#B #an
a5(iGasi 5o',le'en oleh 5o',le5s i'un 'en<e*a*5an
hi,o5o',le'ene'ia sela'a /ase a5(i/ #an a#an<a ,ro#u5 a5(iGasi
5o',le'en6
Be*era,a 5o',le5s i'un (er*en(u5 #i sir5ulasi #an (er#e,osi( #i
;arin)an= *e*era,a (er*en(u5 insi(u @sua(u 'e5anis'e <an) serin) (er;a#i
,a#a an(i)en #en)an a/ini(as (in))i= se,er(i #sDNAB6 Ko',onen C1T
#a,a( (eri5a( lan)sun) ,a#a #sDNA #an 'en<e*a*5an a5(iGasi
5o',le'en (an,a *an(uan au(oan(i*o#i6
Ko',le5s i'un 'en<e*a*5an lesi in/la'asi 'elalui a5(iGasi 5as5a#e
5o',le'en6 A5i*a(n<a (er#a,a( /a5(or 5e'o(a5(i5 @C?a= C&aB= a#an<a
)ranulosi( #an 'a5ro/a) sehin))a (er;a#i in/la'asi= se,er(i Gas5uli(is6
Be*era,a /a5(or (erli*a( #ala' #e,osi( 5o',le5s i'un ,a#a LES= an(ara
lain *an<a5n<a an(i)en= res,on au(oan(i*o#i <an) *erle*ih #an ,enurunan
,e'*ersihan 5o',le5s i'un 5arena ine/isiensi a(au 5elelahan sis(e'
re(i5uloen#o(elial6 Penurunan /un)si ini #a,a( #ise*a*5an oleh ,enurunan
rese,(or 5o',le'en CR1 ,a#a ,er'u5aan sel6 Pa#a lu,us ne/ri(is= lesi
)in;al 'un)5in (er;a#i 5arena 'e5anis'e ,er(ahanan #i #aerah 'e'*ran
*asal )lo'erulus= <ai(u i5a(an lan)sun) an(ara an(i*o#i #en)an 'e'*ran
*asal )lo'erulus= (an,a in(erGensi 5o',le5s i'un6
Pasien #en)an LES a5(i/ 'e',un<ai li'/osi(o,enia T= 5hususn<a
*a)ian CD4A <an) 'en)a5(iGasi CD+A @Tsu,ressorB un(u5 'ene5an
hi,era5(i/ sel B6 Ter#a,a( ,eru*ahan @shi/(B /eno(i, si(o5in #ari sel Th0 5e
sel Th!6 A5i*a(n<a si(o5in 2en#erun) un(u5 'e'*an(u a5(iGasi sel B
'elalui IL>10= IL>4= IL>& #an IL>-6
Au(oan(i*o#i <an) (er#a,a( ,a#a LES #i(u;u5an ,a#a an(i)en <an)
(er5onsen(rasi ,a#a ,er'u5aan sel a,o,(osis6 Oleh 5arena i(u a*nor'ali(as
#ala' ,en)a(uran a,o,(osis 'e',un<ai ,eranan ,en(in) #ala'
,a(o)enesis LES6 Pa#a LES (er;a#i ,enin)5a(an a,o,(osis #ari li'/osi(6
Selain i(u= (er;a#i ,ula ,ersis(ensi sel a,o,(osis a5i*a( #e/e5 ,e'*ersihan
@2learan2eB6 Ka#ar C1T <an) ren#ah 'en2e)ah a'*ilan sel a,o,(osis oleh
'a5ro/a)6 Penin)5a(an e5s,resi B2l>! ,a#a sel T #an ,ro(ein "as ,a#a
CD+A 'en)a5i*a(5an ,enin)5a(an a,o,(osis #an li'/osi(o,enia6
es5i,un hor'on s(eroi# @seC hor'oneB (i#a5 'en<e*a*5an LES=
na'un 'e',un<ai ,eranan ,en(in) #ala' ,re#is,osisi #an #era;a(
5e,arahan ,en<a5i(6 Pen<a5i( LES (eru(a'a (er;a#i ,a#a ,ere',uan an(ara
'enars #an 'eno,ause= #ii5u(i ana5>ana5 #an se(elah 'eno,ause6 Na'un=
s(u#i oleh Coo,er #55 'en<a(a5an *ah4a 'enars <an) (erla'*a( #an
'eno,ause #ini ;u)a #a,a( 'en#a,a( LES= <an) 'enan#a5an *ah4a
,a;anan es(ro)en <an) le*ih la'a *u5an risi5o (er*esar un(u5 'en#a,a(
LES6
A#an<a #e/isiensi rela(i/ hor'on an#ro)en #an ,enin)5a(an hor'on
es(ro)en 'eru,a5an 5ara5(eris(i5 ,a#a LES6 Ana5>ana5 #en)an LES ;u)a
'e',un<ai 5a#ar hor'on "S$ @"olli2le>s(i'ula(in) hor'oneB= L$
@Lu(eini%in) hor'oneB #an ,rola5(in <an) 'enin)5a(6 Pa#a ,ere',uan
#en)an LES= ;u)a (er#a,a( ,enin)5a(an 5a#ar 1- al/a hi#ro5sies(ron #an
es(riol6 "re5uensi LES ;u)a 'enin)5a( saa( 5eha'ilan (ri'es(er 5e(i)a #an
,os(,ar(u'6 Pa#a he4an ,er2o*aan hor'on an#ro)en a5an 'en)ha'*a(
,er5e'*an)an ,en<a5i( lu,us ,a#a he4an *e(ina= se#an)5an 5as(rasi
,ra,u*er(as a5an 'e',er(in))i an)5a 5e'a(ian ,en#eri(a ;an(an6
"a5(a *ah4a se*a)ian 5asus *ersi/a( s,ora#is (an,a #i5e(ahui /a5(or
,re#is,osisi )ene(i5n<a *elu' #a,a( #iun)5a,5an se2ara ;elas=
'enun;u55an /a5(or lin)5un)an ;u)a *er,en)aruh6 In/e5si #a,a(
'en)in#u5si res,on i'un s,esi/i5 *eru,a 'ole2ular 'i'i2r< <an)
'en)a2au re)ulasi sis(e' i'un6 "a5(or lin)5un)an <an) 'en2e(us5an
LES= *isa #iliha( ,a#a (a*el *eri5u( :

/aktor Lingk'ngan 0ang m'ngkin erperan dalam patogenesis L'p's Eritemato's Sistemik 1dik'tip dari 2'dd03 Kelle0&s .e4took of
2he'matolog0- 5th ed *66)
7efinite
Ul(raGiole( B li)h(
Proale
$or'on seC
rasio ,en#eri(a 4ani(a : ,ria H 1:1F rasio ,en#eri(a 'enar2he : 'eno,ause H ?:1
Possile
"a5(or #ie(
Al/al/a s,rou(s #an s,rou(in) /oo#s <an) 'en)an#un) L>2anaGanineF Pris(ane a(au *ahan <an) sa'aF Die( (in))i sa(ura(e# /a(s
"a5(or In/e5si
DNA *a5(eriF $u'an re(roGirusesF En#o(o5sin= li,o,olisa5ari#a *a5(eri
"a5(or ,a,aran #en)an o*a( (er(en(u :
F In(er/eron>$i#rala%inF Pro5aina'i#F Isonia%i#F $i#an(oinF Klor,ro'a%inF e(h<l#o,aF D>Peni2illa'ineF ino5si5linF
An(i*o#i an(i>TN"

KLASI/IKASI
Kriteria klasifikasi l'p's eritematos's sistemik
Kri(eria ACR 11+! Kri(eria ACR 1117
Rua' 'alar @*u((er/l<B
Rua' lu,us #is5oi#
"o(osensi(iGi(as
Ulserasi 'u5o5u(aneus oral a(au nasal
Ar(ri(is nonerosi/
Ne/ri(is
Pro(einuria O 0=& )r9hari
Sel silin#er
Ense/alo,a(i
Rua' 'alar @*u((er/l<B
Rua' lu,us #is5oi#
"o(osensi(iGi(as
Ulserasi 'u5o5u(aneus oral a(au nasal
Ar(ri(is nonerosi/
Ne/ri(is
Pro(einuria O 0=& )r9hari
Sel silin#er
Ense/alo,a(i
Sei%ure
Psi5osis
Pleuri(is a(au ,eri5ar#i(is
Si(o,enia
I'unoserolo)i ,osi(i/
An(i*o#i (erha#a, #sDNA
An(i*o#i (erha#a, nu5lear an(i)en S'
Se#iaan sel LE ,osi(i/
U;i *iolo)is ,osi(i/ ,alsu un(u5 si/ilis






U;i an(i*o#i an(inu5lear ,osi(i/
Sei%ure
Psi5osis
Pleuri(is a(au ,eri5ar#i(is
Si(o,enia
I'unoserolo)i ,osi(i/
An(i*o#i (erha#a, #sDNA
An(i*o#i (erha#a, nu5lear an(i)en S'
An(i*o#i an(i/os/oli,i# ,osi(i/=
*er#asar :
16 an(i*o#i an(i5ar#ioli,in I):
a(au I)
!6 an(i5oa)ulan lu,us
?6 u;i serolo)i ,osi(i/ ,alsu un(u5
si/ilis sela'a - *ulan=
#i5on/ir'asi #en)an u;i
i'o*ilisasi Tre,one'a ,alli#u'
a(au u;i a*sor,si an(i*o#i
(re,one'al /luores2en(
U;i an(i*o#i an(inul5ear ,osi(i/
@Di5u(i, #en)an 'o#i/i5asi #ari Pe((< #an LaCer= !00&B
PA.OGENESIS LAINN8A
Pa#a ,asien SLE (er;a#i )an))uan res,on i'un <an) 'en<e*a*5an
a5(iGasi sel B= ,enin)5a(an ;u'lah sel <an) 'en)hasil5an an(i*o#i=
hi,er)a'a)lo*uline'ia= ,ro#u5si au(oan(i*o#i= #an ,e'*en(u5an
5o',le5s i'un @o5 #an Lau= !00?B6 A5(iGasi sel T #an sel B #ise*a*5an
5arena a#an<a s(i'ulasi an(i)en s,esi/i5 *ai5 <an) *erasal #ari luar se,er(i
*ahan>*ahan 5i'ia= DNA *a5(eri= an(i)en Girus= /os/oli,i# #in#in) sel a(au
<an) *erasal #ari #ala' <ai(u ,ro(ein DNA #an RNA6 An(i)en ini #i*a4a
oleh an(i)en ,resen(in) 2ells @APCsB a(au *eri5a(an #en)an an(i*o#i ,a#a
,er'u5aan sel B6 Ke'u#ian #i,roses oleh sel B #an APCs 'en;a#i
,e,(i#a #an #i*a4a 5e sel T 'elalui 'ole5ul $LA <an) a#a #i ,er'u5aan6
Sel T a5an (era5(iGasi #an 'en)eluar5an si(o5in <an) #a,a( 'eran)san)
sel B un(u5 'e'*en(u5 au(oan(i*o#i <an) ,a(o)en6 In(era5si an(ara sel B
#an sel T ser(a APCs #an sel T (er;a#i #en)an *an(uan si(o5in= 'ole5ul CD
40= CTLA>4
Ber#asar5an ,ro/il si(o5in sel T #i*a)i 'en;a#i ! <ai(u Th1 #an Th!6 sel
Th1 *er/un)si 'en#u5un) 2ell>'e#ia(e# i''uni(<= se#an)5an Th!
'ene5an sel (erse*u( #an 'e'*an(u sel B un(u5 'e',ro#u5si an(i*o#i6
Pa#a ,asien SLE #i(e'u5an a#an<a IL>10 <ai(u si(o5in <an) #i,ro#u5si
oleh sel Th! <an) *er/un)si 'ene5an sel Th1 sehin))a 'en))an))u
2ell>'e#ia(e# i''uni(<6
Sel T ,a#a SLE ;u)a 'en)ala'i )an))uan *eru,a *er5uran)n<a ,ro#u5si
IL>! #an hilan)n<a res,on (erha#a, ran)san)an ,e'*en(u5an IL>! <an)
#a,a( 'e'*an(u 'enin)5a(5an e5s,resi sel T
A*nor'ali(as #an #isre)ulasi sis(e' i'un ,a#a (in)5a( seluler #a,a(
*eru,a )an))uan /un)si li'/osi( T #an B= NKC= #an APCs6 $i,era5(iGi(as
sel B (er;a#i seirin) #en)an li'/osi(o,enia sel T 5arena an(i*o#i
an(ili'/osi( T6 Penin)5a(an sel B <an) (era5(iGasi 'en<e*a*5an (er;a#in<a
hi,er)a'a)lo*uline'ia <an) *erhu*un)an #en)an rea5(iGi(as sel/>an(i)en6
Pa#a sel B= rese,(or si(o5in= IL>!= 'en)ala'i ,enin)5a(an se#an)5an CR1
'enurun @SilGia an# Isen*er)= !001B6 $al ini ;u)a 'enin)5a(5an hea(
sho25 ,ro(ein 10 @hs, 10B ,a#a sel B #an CD4A6 Kele*ihan hs, 10 a5an
(erlo5alisasi ,a#a ,er'u5aan sel li'/osi( #an a5an 'en<e*a*5an
(er;a#in<a res,on i'un6 Sel T 'e',un<ai ! su*se( <ai(u CD+A
@su,resor9si(o(o5si5B #an CD4A @in#u2er9hel,erB6 SLE #i(an#ai #en)an
,enin)5a(an sel B (eru(a'a *erhu*un)an #en)an su*se( CD4A #an
CD4&RA6 CD4A 'e'*an(u 'en)in#u5si (er;a#in<a su,resi #en)an
'en<e#ia5an si)nal *a)i CD+A @Isen*er) an# $ors/all= 111+B6 Ber5uran)
;u'lah (o(al sel T ;u)a 'en<e*a*5an *er5uran)n<a su*se( (erse*u(
sehin))a si)nal <an) sa',ai 5e CD+A ;u)a *er5uran) #an 'en<e*a*5an
5e)a)alan sel T #ala' 'ene5an sel B <an) hi,era5(i/6 Ber5uran)n<a
5e#ua su*se( sel T ini <an) u'u' #ise*u( #ou*le ne)a(iGe @CD4>CD+>B
'en)a5(i/5an sin(esis #an se5resi au(oan(i*o#i @o5 an# Lau= !00?B6 Ciri
5has au(oan(i*o#i ini a#alah *ah4a 'ere5a (i#a5 s,esi/i5 ,a#a sa(u
;arin)an (er(en(u #an 'eru,a5an 5o',onen in(e)ral #ari se'ua ;enis sel
sehin))a 'en<e*a*5an in/la'asi #an 5erusa5an or)an se2ara luas @Al*ar=
!00?B 'elalui ? 'e5anis'e <ai(u ,er(a'a 5o',le5s i'un @'isaln<a
DNA>an(i DNAB (er;e*a5 #ala' 'e'*ran ;arin)an #an 'en)a5(i/5an
5o',le'en <an) 'en<e*a*5an 5erusa5an ;arin)an6 Ke#ua= au(oan(i*o#i
(erse*u( 'en)i5a( 5o',onen ;arin)an a(au an(i)en <an) (er;e*a5 #i #ala'
;arin)an= 5o',le'en a5an (era5(iGasi #an (er;a#i 5erusa5an ;arin)an6
e5anis'e <an) (era5hir a#alah au(oan(i*o#i 'ene',el ,a#a 'e'*ran
#an 'en<e*a*5an a5(iGasi 5o',le'en <an) *er,eran #alan 5e'a(ian sel
a(au au(oan(i*o#i 'asu5 5e #ala' sel #an *eri5a(an #en)an in(i sel #an
'en<e*a*5an 'enurunn<a /un)si sel (e(a,i *elu' #i5e(ahui
'e5anis'en<a (erha#a, 5erusa5an ;arin)an @E,s(ein= 111+B6
:an))uan sis(e' i'un ,a#a SLE #a,a( *eru,a )an))uan 5lirens 5o',le5s
i'un= )an))uan ,e'rosesan 5o',le5s i'un #ala' ha(i= #an ,enurunan
u,>(a5e 5o',le5s i'un ,a#a li',a @Al*ar= !00?B6 :an))uan 5lirens
5o',le5s i'un #a,a( #ise*a*5an *er5uran)n<a CR1 #an ;u)a /a)osi(osis
<an) ina#e5ua( ,a#a I):! #an I):? 5arena le'ahn<a i5a(an rese,(or
"2URIIA #an "2URIIIA6 $al ini ;u)a *erhu*un)an #en)an #e/isiensi
5o',onen 5o',le'en C1= C!= C46 A#an<a )an))uan (erse*u(
'en<e*a*5an 'enin)5a(n<a ,a,aran an(i)en (erha#a, sis(e' i'un #an
(er;a#in<a #e,osisi 5o',le5s i'un @,a#a *er*a)ai 'a2a' or)an sehin))a
(er;a#i /i5sasi 5o',le'en ,a#a or)an (erse*u(6 Peris(i4a ini 'en<e*a*5an
a5(iGasi 5o',le'en <an) 'en)hasil5an 'e#ia(or>'e#ia(or in/la'asi
<an) 'eni'*ul5an rea5si ra#an)6 Rea5si ra#an) inilah <an) 'en<e*a*5an
(i'*uln<a 5eluhan9)e;ala ,a#a or)an a(au (e',a( <an) *ersan)5u(an
se,er(i )in;al= sen#i= ,leura= ,le5sus 5oroi#eus= 5uli(= #an se*a)ain<a
9. 2A(9:. 2ON.OK 1ALOPECIA;
2am't 2ontok 1Alope"ia; akiat pen0akit l'p's
Per(u'*uhan ra'*u( se2ara nor'al (er;a#i #en)an si5lus : /ase ,an;an)
#ari Per(u'*uhan= "ase (ransisi a,o,(osis= #an /ase ,en#e5 #ari is(iraha(6 Pa#a
a5hir /ase is(iraha(= ra'*u( a5an ron(o5 #an ra'*u( *aru a5an (u'*uh #ari /oli5el
#an 'e'ulai si5lus 5e'*ali6 :an))uan ,a#a si5lus ini #a,a( 'en<e*a*5an
alo,e2ia6 Alo,e2ia *isa (er;a#i ;i5a (er;a#i ,en)rusa5an /oli5el ra'*u( <an) a5an
#i)an(i #en)an ;arin)an ,aru(6
.enis alo,e2ia area(a 'eru,a5an ;enis alo,e2ia <an) #i5arena5an rea5si
au(oi'un6 Au(oan(i*o#i 'en<eran) /oli5el ra'*u( #an 'en))an))u ,e'*en(u5an
ra'*u( se2ara nor'al6 Alo,e2ia area(a *iasan<a *erhu*un)an #en)an ,en<a5i(
au(oi'un se,er(i SLE= rheu'a(oi# ar(hri(is= ,en<a5i( (<roi#= #an lain>lain6
Etiologi
Pen<e*a* u'u' #ari alo,e2ia :
An#ro)ene(i2 alo,e2ia
An#ro)ene(i2 alo,e2ia 'eru,a5an 5elainan 'enurun <an) *er)an(un) ,a#a
an#ro)en #en)an ,eran u(a'a #ih<#ro(es(os(erone6
Pen0ea Lainn0a 3
O*a(>o*a(anF (er'asu5 o*a( 5e'o(era,i
In/e5si
Pen<a5i( sis(e'i5 <an) u'u'n<a 'eru,a5an SLE= 5elainan en#o5rin= #an
#e/isiensi nu(risi6
Kelainan *a(an) ra'*u(
Pen<a5i( au(oi'un
Kera2unan 'e(al *era(
Kelinan #er'a(olo)is
Ter#a,a( *an<a5 alasan 'en)a,a lu,us 'en)a5i*a(5an 5eron(o5an ra'*u(6
16 ,en<a5i( a5(i/ #i5ai(5an #en)an ,en<u'*a(an 5an(un) ra'*u(= <an)
'en)a5i*a(5an ra'*u( 'u#ah ron(o5 se(elah #isisir a(au 5era'as @#ise*u(
Kra'*u( lu,usLB6 Para ,asien #is2oi# lu,us #a,a( 'en)ala'i ra'*u(
ron(o5= *o(a5 ,a#a *a)ian (er(en(u @alope"ia areataB= a(au )un#ul6
!6 S(eroi# #a,a( 'en<e*a*5an ra'*u( ron(o5 ,a#a lela5i <an) *er*a5a( *o(a5
#i ,eli,is #an 5e,ala *a)ian a(as6 In/e5si= 5e'o(era,i= (e5anan e'osional=
?6 5e(i#a5sei'*an)an hor'on ;u)a 'en<e*a*5an ram't rontok6 Bisa
#i5a(a5an6 se5i(ar ?0 ,ersen ,asien SLE #an DLE 'en)eluh5an ra'*u(
ron(o56
46 Ter5ai( #en)an a#an<a ,enin)5a(an $LA <an) *erlo5asi #i len)an ,en#e5
5ro'oso' - 'e'*en(u5 $C6 Alo,esia area(a *erhu*un)an #en)an $LA
5elas II @ $LA>DR4=>DR& su*(i,e DR4 #an DR11= >D3? su*(i,e D37 #an
D3+B6
Pengoatan alope"ia *er)an(un) ,a#a ,en<e*a*n<a6 isaln<a= lu5a>lu5a #is2oi#
*erea5si (erha#a, sun(i5an lo5al ,a#a 5uli( 5e,ala #en)an 'en))una5an s(eroi#6
.i5a #i *a)ian ini (er*en(u5 *e5as lu5a= ra'*u( (i#a5 a5an (u'*uh 5e'*ali6
Pen)hen(ian ,e'a5aian s(eroi# 'en)hilan)5an K5e*o(a5anL6 O*a(>o*a(an
an(i'alarial #an 2or(i2os(eroi# 'enin)5a(5an ,er(u'*uhan ra'*u(6 Solusi
inoCi#il @Ro)aineB a#alah ,e'a5aian o*a(>o*a( (e5anan #arah un(u5
'eran)san) ,er(u'*uhan ra'*u( ,a#a oran) *o(a56 O*a(>o*a(an ini 'eran)san)
,er(u'*uhan ra'*u( *a)i ,ara ,asien l'p's la5i>la5i 'au,un ,ere',uan (e(a,i
(i#a5 'en)uran)i 5eron(o5an ra'*u(
C. PE.ECHIAE
Pe(e2hiae 'eru,a5an *in(i5>*in(i5 'erah <an) #a(ar #an *er*en(u5 *ula(
#i *a4ah ,er'u5aan 5uli( a5i*a( ,er#arahan in(ra#er'al @,er#arahan #i *a4ah
5uli(B6 Pe(e2hiae *er4arna 'erah 5arena 'en)an#un) #arah 'erah <an) *o2or
#ari 5a,iler 5e #ala' 5uli(6 Pe(e2hiae 2u5u, 5e2il @#ia'e(ern<a 5uran) #ari ?
'ili'e(erB #an (i#a5 ,u2a( 5e(i5a #i(e5an6
A#a *an<a5 5on#isi #i 'ana ,e(e5ie #a,a( 'un2ul6
Pen<e*a* u'u'n<a (er'asu5 2e#era lo5al 9 (rau'a= rea5si aler)i=
au(oi''une #iseases= in/e5si Girus <an) 'erusa5 ,e'*e5uan #arah @,e'*e5uanB=
(ro'*osi(o,enia @(in)5a( (ro'*osi( <an) ren#ahB= ,en))unaan o*a( (er(en(u se,er(i
ra#iasi #an 5e'o(era,i= i#io,a(i5 (hro'*o2<(o,eni2 ,ur,ura @ITPB = leu5e'ia #an
5e)anasan su'su' (ulan) <an) #a,a( 'enurun5an ;u'lah (ro'*osi(= #an se,sis
@in/e5si aliran #arahB6
Pe(e2hiae ;u)a *isa #iin(er,re(asi5an se*a)ai Gas5uli(is= 'eru,a5an sua(u
,era#an)an ,a#a ,e'*uluh #arah <an) 'e'erlu5an ,en)o*a(an se)era un(u5
'en2e)ah 5erusa5an ,er'anen6
C. S.O(A.I.IS 7AN EPIS.AKSIS
7efinisi
eru,a5an Ra#an) sela,u( len#ir #ala' 'ulu(= <an) 'un)5in 'eli*a(5an
,i,i= )usi= li#ah= *i*ir= #an a(a, a(au lan(ai 'ulu(6 Ka(a Ws(o'a(i(isW se2ara hara/iah
*erar(i ,era#an)an 'ulu(6 Pera#an)an #a,a( #ise*a*5an oleh 5on#isi 'ulu( i(u
sen#iri= se,er(i 5e*ersihan 'ulu( <an) *uru5= )i)i ,alsu <an) #i,asan) *uru5= a(au
lu5a *a5ar #ari 'a5anan ,anas a(au 'inu'an= a(au #en)an 5on#isi <an)
'e',en)aruhi seluruh (u*uh= se,er(i o*a(= rea5si aler)i= a(au in/e5si 6
S(o'a(i(is *iasan<a *erhu*un)an #en)an 5e'erahan= ,e'*en)5a5an= #an
,en#arahan sese5ali #ari #aerah <an) (er5ena6Bau 'ulu( @hali(osisB ;u)a #a,a(
'en<er(ai 5on#isi ini6
Pen0ea dan ge!ala
Se;u'lah /a5(or #a,a( 'en<e*a*5an s(o'a(i(is= <an) 'eru,a5an 'asalah
<an) 2u5u, u'u'6 Ke5erin)an ,a#a 'ulu(= 'inu'an <an) (erlalu ,anas #a,a(
'e'*a5ar 'u5osa 'ulur #an 'en<e*a*5an iri(asi #an n<eri6 Pen<a5i(= se,er(i
in/e5si her,es= 2a',a5= leu5e'ia= AIDS= #an 5e5uran)an Gi(a'in C #a,a( ha#ir
#en)an s(o'a(i(is6 Pen<a5i( sis(e'i5 lain <an) (er5ai( #en)an s(o'a(i(is (er'asu5
,en<a5i( ra#an) usus @IBDB #an sin#ro' BehXe(= sua(u )an))uan 'ul(isis(e'
,era#an)an <an) ,en<e*a*n<a (i#a5 #i5e(ahui6
es5i,un ,en<e*a* saria4an (i#a5 #i5e(ahui= 5e5uran)an )i%i= 5hususn<a
Gi(a'in B1!= /ola(= a(au *esi #i2uri)ai se*a)ai /a5(or ,en<e*a*6 S(o'a(i(is ;u)a
#a,a(n #ise*a*5an oleh ,en))unaan al5ohol *erle*ihan= re',ah>re',ah=
'a5anan ,anas= a(au ,ro#u5 (e'*a5au6 Sensi(iGi(as (erha#a, o*a( 5u'ur= ,as(a
)i)i= #an li,s(i5 #a,a( 'en)iri(asi la,isan 'ulu(6 Pa,aran lo)a' *era(= se,er(i
'er5uri= (i'*al= a(au *is'u(h ;u)a #a,a( 'en<e*a*5an s(o'a(i(is6
EPIS.AKSIS
ANATOI 7ASKULAR
Su,lai #arah 2aGu' nasi *erasal #ari sis(e' 5aro(isF ar(eri 5aro(is e5s(erna #an
5aro(is in(erna6 Ar(eri 5aro(is e5s(erna 'e'*eri5an su,lai #arah (er*an<a5
,a#a 2aGu' nasi 'elalui :
1BAr(eri s,heno,ala(ina= 2a*an) (er'inal ar(eri 'a5silaris <an) *er;alan 'elalui
/ora'en s,heno,ala(ina <an) 'e'>,er#arahi se,(u' (i)a ,ere',a( ,os(erior #an
#in#in) la(eral hi#un)6
!BAr(eri ,ala(ina #esen#en 'e'*eri5an 2a*an) ar(eri ,ala>(ina 'a<or= <an)
*er;alan 'elalui 5analis in2isiGus ,a>la(u' #uru' #an 'en<u,lai *a)ian
in/eroan(erior se,(u' nasi6 Sis(e' 5aro(is in(erna 'elalui ar(eri o/(al'i5a
'e',er>2a*an)5an ar(eri e(h'oi# an(erior #an ,os(erior <an) 'en>#arahi se,(u'
#an #in#in) la(eral su,erior6Per#arahan $i#un) @Epistaksis= i'isanB a#alah
,ar#arahan <an) *erasal #ari hi#un)6
PEN0EBAB
Pen<e*a* e,is(a5sis:
16 In/e5si lo5al
> Vestibulitis
> Sinusitis
!6 Sela,u( len#ir <an) 5erin) ,a#a hi#un) <an) 'en)ala'i 2e#era
> Trau'a= 'isaln<a 'en)ore5 hi#un)= (er;a(uh= (er,u5ul= a#an<a *en#a
asin) #i hi#un)= (rau'a ,e'*e#ahan a(au iri(asi oleh )as <an) 'eran)san)
> Pa(ah (ulan) hi#un)
?6 Pen<a5i( kardiovaskuler
> Pen<e',i(an ar(eri @arteriosklerosisB
> Te5anan #arah (in))i
46 In/e5si sis(e'i5
> De'a' *er#arah
> In/luen%a
> or*ili
> De'a' (i/oi#
&6 Kelainan #arah
> Anemia aplastik
> eukemia
> !rombositopenia
> "emofiliaB
> !elangiektasi hemoragik herediter
-6 Tu'or ,a#a hi#un)= sinus a(au naso/arin)= *ai5 ;ina5 'au,un )anas
76 :an))uan en#o5rin= se,er(i ,a#a 5eha'ilan= 'enars #an 'eno,ause
+6 Pen)aruh lin)5un)an= 'isaln<a ,eru*ahan (e5anan a('os/ir 'en#a#a5
@se,er(i ,a#a ,ener*an) #an ,en<ela'9,en<a5i( #aissonB a(au lin)5un)an
<an) u#aran<a san)a( #in)in
16 Ben#a asin) #an rinoli(= #a,a( 'en<e*a*5an 'i'isan rin)an #iser(ai in)us
*er*au *usu5
106 Idiopatik= *iasan<a 'eru,a5an 'i'isan <an) rin)an #an *erulan) ,a#a
ana5 #an re'a;a6
Etiologi
Se2ara U'u' ,en<e*a* e,is(a5sis #i*a)i #ua <ai(u Lo5al #an Sis(e'i5
Lo5al
Pen<e*a* lo5al (eru(a'a (rau'a= serin) 5arena 5e2ela5aan lalulin(as= olah ra)a=
@se,er(i 5arena ,u5ulan ,a#a hi#un)B <an) #iser(ai ,a(ah (ulan) hi#un) @se,er(i
,a#a )a'*ar #i hala'an iniB= 'en)ore5 hi#un) <an) (erlalu 5eras sehin))a lu5a
,a#a 'u5osa hi#un)= a#an<a (u'or #i hi#un)= a#a *en#a asin) @sesua(u <an)
'asu5 5e hi#un)B *iasan<a ,a#a ana5>ana5= a(au lin(ah <an) 'asu5 5e hi#un)=
#an in/e5si a(au ,era#an)an hi#un) #an sinus @rini(is #an sinusi(isB
Sis(e'i5
Pen<e*a* sis(e'i5 ar(in<a ,en<a5i( <an) (i#a5 han<a (er*a(as ,a#a hi#un)= <an)
serin) 'e<e*a*5an 'i'isan a#alah hi,er(ensi= in/e5si sis(e'i5 se,er(i ,en<a5i(
#e'a' *er#arah #en)ue a(au 2i5un)u<a= 5elainan #arah se,er(i he'o/ili=
au(oi'un (ro'*osi(i,eni2 ,ur,ura6
Selain i(u a#a ;u)a ,en<e*a* lainn<a= #ian(aran<a:
!rauma, Per#arahan hi#un) #a,a( (er;a#i se(elah (rau'a rin)an= 'isaln<a
'en)eluar5an in)us se2ara (i*a>(i*a #an 5ua(= 'en)ore5 hi#un)= #an (rau'a <an)
he*a( se,er(i (er,u5ul= ;a(uh a(au 5e2ela5aan6 Selain i(u ;u)a #a,a( #ise*a*5an
oleh iri(asi )as <an) 'eran)san)= *en#a asin) #i hi#un) #an (rau'a ,a#a
,e'*e#ahan6
Infeksi, In/e5si hi#un) #an sinus ,aranasal se,er(i rhini(is a(au sinusi(is ;u)a #a,a(
'en<e*a*5an ,er#arahan hi#un)6
$eoplasma, $e'an)io'a #an 5arsino'a a#alah <an) ,alin) serin) 'eni'*ul5an
)e;ala e,i(a5sis6
%ongenital, Pen<a5i( (urunan <an) #a,a( 'en<e*a*5an e,i(a5sis a#alah
(elen)ia5(asis he'ora)i5 here#i(er6
&enyakit kardiovaskular, $i,er(ensi #an 5elainan ,a#a ,e'*uluh #arah #i hi#un)
se,er(i ar(erios5lerosis= sirosis= si/ilis #an ,en<a5i( )ula #a,a( 'en<e*a*5an
(er;a#in<a e,i(a5sis 5arena ,e2ahn<a ,e'*uluh #arah6
%elainan 'arah
!rombositopenia, hemophilia, dan leukemia
Infeksi sistemik
'emam berdarah, 'emam tifoid, influen(a dan sakit morbili
&erubahan tekanan atmosfer
#aisson disease (pada penyelam)
Patofisiologi
Se'ua ,en#arahan hi#un) #ise*a*5an le,asn<a la,isan 'u5osa hi#un) <an)
'en)an#un) *an<a5 ,e'*uluh #arah 5e2il6 Le,asn<a 'u5osa a5an #iser(ai lu5a
,a#a ,e'*uluh #arah <an) 'en)a5i*a(5an ,en#arahan6
(anifestasi Klinis
Per#arahan #ari hi#un)= )e;ala <an) lain sesuai #en)an e(iolo)i <an)
*ersan)5u(an6
E,i(a5sis *era(= 4alau,un ;aran) 'eru,a5an 5e)a4a(#arura(an <an) #a,a(
'en)an2a' 5esela'a(an ;i4a ,asien= *ah5an #a,a( *era5i*a( /a(al ;i5a (i#a5 2e,a(
#i(olon)6 Su'*er ,er#arahan #a,a( *erasal #ari #e,an hi#un) 'au,un *ela5an)
hi#un)6 E,i(a5sis an(erior @#e,anB #a,a( *erasal #ari ,le5sus 5iessel*a2h a(au #ari
a6 e('oi# an(erior6 Ple5sus 5iesel*a2h ini serin) 'en;a#i su'*er e,i(a5sis
(eru(a'a ,a#a ana5>ana5 #an *iasan<a #a,a( se'*uh sen#iri6
E,i(a5sis ,os(erior @*ela5an)B #a,a( *erasal #ari a6 s/eno,ala(ina #an a6 e('oi#
,os(erior6 Per#arahan *iasan<a he*a( #an ;aran) *erhen(i sen#iri6 Serin)
#i(e'u5an ,a#a ,asien #en)an hi,er(ensi= ar(erios5lerosis a(au ,asien #en)an
,en<a5i( ;an(un)6 Pe'eri5saan <an) #i,erlu5an a#alah #arah Len)5a, #an /un)si
he'os(asis6
Epidemiologi
E,is(a5sis ;aran) #i(e'u5an ,a#a *a<i= serin) ,a#a ana5= a)a5 ;aran) ,a#a oran)
#e4asa 'u#a= #an le*ih *an<a5 la)i ,a#a oran) #e4asa 'u#a6 E,is(a5sis a(au
,er#arahan hi#un) #ila,or5an (i'*ul ,a#a -0E ,o,ulasi u'u'6 Pun2a5 5e;a#ian
#ari e,is(a5sis #i#a,a(5an *eru,a #ua ,un2a5 @*i'o#alB <ai(u ,a#a usia P10 (ahun
#an O&0 (ahun6
Komplikasi
en2e)ah 5o',li5asi= se*a)ai a5i*a( #ari ,er#arahan <an) *erle*ihan= #a,a(
(er;a#i s<o5 a(au ane'ia= (urunn<a (e5anan #arah <an) 'en#a#a5 #a,a(
'eni'*ul5an in/ar5 sere*ri= insu/isiensi 5oroner= a(au in/ar5 'io5ar#= sehin))a
#a,a( 'en<e*a*5an 5e'a(ian6 Dala' hal ini harus se)era #i*eri ,e'asan)an in/us
un(u5 'e'*an(u 2airan 'asu5 le*ih 2e,a(6 Pe'*erian an(i*io(i5a ;u)a #a,a(
'e'*an(u 'en2e)ah (i'*uln<a sinusi(is= o(i(is 'e#ia a5i*a( ,e'asan)an (a',on6
Ke'a(ian a5i*a( ,en#arahan hi#un) a#alah sesua(u <an) ;aran)6 Na'un= ;i5a
#ise*a*5an 5erusa5an ,a#a ar(eri 'a5sillaris #a,a( 'en)a5i*a(5an ,en#arahan
he*a( 'elalui hi#un) #an suli( un(u5 #ise'*uh5an6 Tin#a5an ,e'*erian (e5anan=
Gaso5ons(ri5(or 5uran) e/e5(i/6 Di'un)5in5an ,en<e'*uhan s(ru5(ur ar(eri
'a5sillaris @<an) #a,a( 'erusa5 sara/ 4a;ahB a#alah solusi sa(u>sa(un<a6
Ko',li5asi <an) #a,a( (i'*ul:
Sinusi(is
Se,(al he'a(o' @*e5uan #arah ,a#a se5a( hi#un)B
De/or'i(as @5elainan *en(u5B hi#un)
As,irasi @'asu5n<a 2airan 5e saluran na,as *a4ahB
Kerusa5an ;arin)an hi#un) in/e5si
DIA:NOSA
Dia)nosis #i(e)a55an *er#asar5an )e;ala #an hasil ,e'eri5saan /isi56
Pe'eri5saan lainn<a <an) #ila5u5an un(u5 'e',er5ua( #ia)nosis e,is(a5sis:
> Pe'eri5saan #arah (e,i len)5a,
> "un)si he'os(a(is
> Tes /un)si ha(i #an )in;al
> Pe'eri5saan /o(o hi#un)= sinus ,aranasal #an naso/arin)
PEN:OBATAN
Epistaksis anterior
Pen#eri(a se*ai5n<a #u#u5 (e)a5 a)ar (e5anan Gas5ular *er5uran) #an 'u#ah
'e'*a(u55an #arah #ari (en))oro5an
E,is(a5sis an(erior <an) rin)an *iasan<a *isa #ihen(i5an #en)an 2ara 'ene5an
2u,in) hi#un) sela'a &>10 'eni(
.i5a (in#a5an #ia(as (i#a5 'a',u 'en)hen(i5an ,er#arahan= 'a5a #i,asan)
(a',on an(erior <an) (elah #i*asahi #en)an a#renalin #an li#o2ain a(au ,an(o2ain
un(u5 'en)hen(i5an ,er#arahan #an 'en)uran)i rasa n<eri
Se(elah ,er#arahan *erhen(i= #ila5u5an ,en<u'*a(an su'*er ,er#arahan
#en)an 'en<e',ro(5an laru(an ,era5 ni(ra( !0>?0E @a(au asa' (ri2hlora2e(a(
10EB a(au #en)an elektrokauter
Bila #en)an 2ara (erse*u( ,er#arahan 'asih (erus *erlan)sun)= 'a5a
#i,erlu5an ,e'asan)an (a',on an(erior <an) (elah #i*eri Gaselin a(au sale,
an(i*io(i5a a)ar (i#a5 'ele5a( sehin))a (i#a5 (er;a#i ,er#arahan ulan) ,a#a saa(
(a',on #ile,as5an6 Ta',on an(erior #i'asu55an 'elalui lu*an) hi#un) #e,an=
#i,asan) se2ara *erla,is 'ulai #ari #asar sa',ai ,un2a5 ron))a hi#un) #an harus
'ene5an su'*er ,er#arahan6 Ta',on #i,asan) sela'a 1>! hari6
.i5a (i#a5 a#a ,en<a5i( <an) 'en#asarin<a= ,en#eri(a (i#a5 ,erlu #ira4a( #an
#i'in(a le*ih *an<a5 #u#u5 ser(a 'en)an)5a( 5e,alan<a se#i5i( ,a#a 'ala' hari6
Pen#eri(a lan;u( usia harus #ira4a(6
Epistaksis posterior
Pa#a e,is(a5sis ,os(erior= se*a)ian *esar #arah 'asu5 5e #ala' 'ulu( sehin))a
,e'asan)an (a',on an(erior (i#a5 #a,a( 'en)hen(i5an ,er#arahan6
Per#arahan ,os(erior le*ih su5ar #ia(asi 5arena ,er#arahan *iasan<a he*a( #an
suli( 'eliha( *a)ian *ela5an) #ari ron))a hi#un)6
Dila5u5an ,e'asan)an (a',on ,os(erior @(a',on Belloc*B= <ai(u (a',on <an)
'e',un<ai (i)a helai *enan)= 1 helai #i se(ia, u;un)n<a #an 1helai #i (en)ah6
Ta',on #i,asan) sela'a !>? hari #iser(ai #en)an ,e'*erian an(i*io(i5 per+oral
un(u5 'en2e)ah in/e5si ,a#a sinus a(au,un (elin)a (en)ah6
Pa#a e,is(a5sis <an) *era( #an *erulan)= <an) (a5 #a,a( #ia(asi #en)an
,e'asan)an (a',on= ,erlu #ila5u5an ,en)i5a(an ar(eri e('oi#alis an(erior #an
,os(erior a(au ar(eri 'a5silaris in(erna6
E,is(a5sis a5i*a( ,a(ah (ulan) a(au se,(u' hi#un) *iasan<a *erlan)sun) sin)5a(
#an *erhen(i se2ara s,on(an= 5a#an)>5a#an) (i'*ul 5e'*ali *e*era,a ;a' a(au
*e*era,a hari 5e'u#ian se(elah ,e'*en)5a5an *er5uran)6
.i5a hal ini (er;a#i 'un)5in ,erlu #ila5u5an ,e'*e#ahan (erha#a, ,a(ah (ulan)
a(au ,en)i5a(an ar(eri6
Pa#a ,en#eri(a (elan)ie5(asi he'ora)i5 here#i(er @5elainan *en(u5 ,e'*uluh
#arahB= e,is(a5sis <an) he*a( *isa 'en<e*a*5an ane'ia *era( <an) (i#a5 'u#ah
#i5ore5si #en)an ,e'*erian %a( *esi (a'*ahan6
Un(u5 'en)a(asi ane'ia= #ila5u5an ,en2an)5o5an 5uli( 5e #ala' se,(u' hi#un)6
7. 9'tterfl0 rash
eru,a5an salah sa(u 2iri 5has #ari SLE6 Rash 9 rua' <an) 'un2ul
(erasa (i#a5 n<eri= (i#a5 )a(al= (e(a,i #a,a( 'eni'*ul5an ,erasaan (i#a5
n<a'an <an) *isa 'e'*uru5 #en)an ,a,aran 'a(ahari6 Rash <an) 'un2ul
*er4arna 'erah= #a(ar #an 'elin(asi hi#un) sehin))a *er*en(u5 se,er(i 5u,u>
5u,u6
Pa#a SLE= (er*en(u5 5o',le5s i'un <an) a5an 'e'i2u
,e'*en)5a5an ,a#a ,ro(ein 5ola)en #i ;arin)an i5a( <an) a5an 'eni'*ul5an
'ani/es(asi rash ,a#a 5uli(6 alar rash 9 *u((er/l< rash 'un2ul ,a#a 4&>-&E
,asien SLE6
A5an (e(a,i= 'alar rash ;u)a #a,a( (i'*ul ,a#a ,asien #en)an
#er'a(o'<osi(is= se*orrhei2 #er'a(i(is= rosa2ea= er<si,elas6
E. 7E(A(
Ti,e De'a'
De'a' Se,(i56
Suhu *a#an nai5 5e (in)5a( (in))i se5ali ,a#a 'ala' hari= lalu suhu (urun @'asihB
#i a(as nor'al ,a#a ,a)i hari ,a#a ,a)i hari6 Serin) (er#a,a( 'en))i)il=
*er5erin)a(
De'a' $e5(i56
Suhu *a#an nai5 5e (in)5a( (in))i se5ali ,a#a 'ala' hari= lalu suhu (urun sa',ai
nor'al ,a#a ,a)i hari ,a#a ,a)i hari6
De'a' Re'i(en6
Suhu *a#an #a,a( (urun se(ia, hari na'un (i#a5 ,ernah sa',ai suhu *a#an
nor'al= na'un selisih (a5 ,ernah sa',ai O! YC= (i#a5 se*esar ,enurunan ,a#a
#e'a' se,(i56
De'a' In(er'i(en6
Suhu *a#an #a,a( (urun *e*era,a ;a' #ala' 1 hari6 Bila #e'a' (er;a#i (ia, #ua
hari se5ali #ise*u( (ersiana #an *ila (er;a#i #ua hari *e*as #ian(ara #ua seran)an
#e'a' #ise*u( 5uar(ana6
De'a' Kon(in<u6
7ariasi suhu *a#an <an) 'enin)5a( se,an;an) hari #an (i#a5 *er*e#a le*ih #ari 1
YC6 .i5a sa',ai ,a#a (in)5a( <an) le*ih (in))i #ise*u( hi,er,ire5si6
De'a' Si5li56 De'a' #i(an#ai #en)an 5enai5an suhu sela'a *e*era,a hari=
5e'u#ian #ii5u(i ,erio#e *e*as #e'a' sela'a *e*era,a hari <an) 5e'u#ian
#ii5u(i oleh 5enai5an suhu se,er(i se'ula6
De'a' 5a#an) #ihu*un)5an ,a#a sua(u ,en<a5i(= 'isal a*ses= ,neu'onia=
in/e5si saluran 5en2in) a(au 'alariaF 5a#an) i#o,a(i56
Bila #e'a' #iser(ai #en)an sa5i( o(o(= rasa le'as= (a5 na/su 'a5an= 'un)5in
,ile5= *a(u5 #an sa5i( (en))oro5 *iasan<a #i)olon)5an se*a)ai in/luen%a
@2o''on 2ol#B6 Kausa #e'a' selain in/e5si= ;u)a *isa a5i*a( (o5se'ia=
5e)anasan= o*a(= #an )an))uan ,usa( ,en)a(ur suhu sen(ral @hea( s(ro5e=
,er#arahan o(a5= 5o'aB
$al>hal 5husus <an) #i,erha(i5an ,a#a #e'a' se,er(i 2ara (i'*ul= la'a #e'a'=
si/a(= (in))i #e'a'= 5eluhan ser(a )e;ala lain #e'a'6 De'a' <an) (i*a>(i*a
(in))i= 'un)5in #ia5i*a(5an Girus6
De'a' Belu' Ter#ia)nosis 'eru,a5an 5ea#aan seseoran) <an) 'en)ala'i
#e'a' (erus>'enerus sela'a ? 'in))u #en)an suhu *a#an O?+6? YC #an (e(a,
*elu' #i(e'u5an ,en<e*a*n<a 4alau,un (elah #i(eli(i sela'a se'in))u se2ara
in(ensi/ #en)an 'en))una5an la*ora(oriu' #an ,enun;an) 'e#is lainn<a6
De'a' Di*ua(>Bua( @"a2(i(ius "eGerB 'eru,a5an #e'a' <an) #i*ua( seseoran)
#en)an sen)a;a #en)an *er*a)ai 2ara a)ar suhu *a#ann<a 'ele*ihi suhu *a#an
se*enarn<a6
/. N8E2I SEN7I
Pa#a ,en#eri(a SLE= sel ,las'a #ala' sinoGiu' @,a#a sen#iB 'e'*en(u5
an(i>I): @"R *eru,a I)B J 'eni'*ul5an 5o',le5s i'un #i sen#i6
Ko',le5s i'un ini a5an 'e'i2u a5(i/n<a 'e#ia(or in/la'asi @neu(ro/il= #55B
sehin))a a5an 'en<e*a*5an in/la'asi6 Selain i(u a5an (er;a#i ,ele,asan
ana/ila(o5sin @C?a=C&aB <an) a5an 'e'i2u sel 'as( un(u5 'en)eluar5an
his(a'in sehin))a (er;a#i n<eri ,a#a sen#i6
G. ANALGESIK
Anal)e(i5 a(au o*a( ,en)halan) n<eri a#alah %a(>%a( <an) 'en)uran)i a(au
'en)halau rasa n<eri (an,a 'e)halan)i 5esa#aran6 An(i,ire(i5 a#alah %a(>%a( <an)
#a,a( 'en)uran)i suhu (u*uh6 An(i>in/la'asi a#alah o*a( a(au %a(>%a( <an) #a,a(
'en)o*a(i ,era#an)an a(au ,e'*en)5a5an6
O*a( anal)esi2 an(i,ire(i5 ser(a O*a( An(i In/la'asi non S(eroi# @OAINSB
'eru,a5an sua(u 5elo',o5 o*a( <an) he(ero)en= *ah5an *e*era,a o*a( san)a(
*er*e#a se2ara 5i'ia68alau,un #e'i5ian= o*a(>o*a( ini (ern<a(a 'e'ili5i *an<a5
,ersa'aan #ala' e/e5 (era,i 'au,un e/e5 sa',in)6 Pro(o(i,e o*a( )olon)an ini
a#alah as,irin6 Karena i(u= *an<a5 )olon)an #ala' o*a( ini serin) #ise*u( o*a(
'iri, as,irin @As,irin>li5e #ru)sB
Klasi/i5asi 5i'ia4i OAINS se*enarn<a (i#a5 *an<a5 'an/aa( 5i'ian<a 5arena
a#a OAINS #ari su*)olon)an <an) sa'a 'e'ili5i si/a( <an) *er*e#a6 Se*ali5n<a
a#a OAINS <an) *er*e#a su*)olon)an (a,i 'e'ili5i si/a( <an) seru,a
Ke'a;uan ,eneli(ian #ala' #asa4arsa (era5hir ini 'e'*eri ,en;elasan
'en)a,a 5elo',o5 he(ero)en (erse*u( 'e'ili5i 5esa'aan e/e5 (era,i #an e/e5
sa',in)6 Tern<a(a se*a)ian *esar e/e5 (era,i #an e/e5 sa',in)n<a *er#asar5an
a(as ,en)ha'*a(an *iosin(esis ,ros(a)lan#in @P:B6
e5anis'e 5er;a #an <an) *erhu*un)an #en)an s<s(e' *iosin(esis
Pros(a)lan#in ini 'ulai #i,erliha(5an se2ara inGi(ro *ah4a #osis ren#ah as,irin
#an in#o'e(asin 'en)ha'*a( ,ro#u5si en%i'a(i5 Pros(a)lan#in6 Peneli(ian
lan;u(an 'e'*u5(i5an *ah4a Pros(a)lan#in a5an #ile,as5an *ila'ana sel
'en)ala'i 5erusa5an6 8alau,un se2ara inGi(ro OAINS #i5e(ahui 'en)ha'*a(
o*a( *er*a)ai rea5si *io5i'ia4i= hu*un)an #en)an e/e5 anal)esi2= an(i,ire(i5 #an
an(i in/la'asin<a *elu' ;elas6 Selain i(u= OAINS se2ara u'u' (i#a5 'en)ha'*a(
*iosin(esis leu5o(rien <an) #i5e(ahui i5u( *er,eran #ala' in/la'asi6
:olon)an o*a( ini 'en)ha'*a( en%i' si5loo5si)enase sehin))a 5onGersi
asa' ara5hi#ona( 'en;a#i P::! (er)an))u6Se(ia, o*a('en)ha'*a(
si5loo5si)enase #en)an 2ara <an) *er*e#a6Khusus ,arase(a'ol= ha'*a(an
*iosin(esis ,ros(a)lan#in han<a (er;a#i *ila lin)5un)ann<a ren#ah 5a#ar ,ero5si#
se,er(i #i hi,o(ala'us6Lo5asi in/la'asi *iasan<a 'en)an#un) *an<a5 ,ero5si#
<an) #ihasil5an oleh leu5osi(6Ini 'en;elas5an 'en)a,a an(i>in/la'asi ,arase(a'ol
,ra5(is (i#a5 a#a as,irin sen#iri 'en)ha'*a( #en)an 'en)ase(iliasi )u)us
a5(i/serin #an en%i' ini6Tro'*osi( san)a( ren(an (erha#a, ,en)ha'*a(an ini
5arena selain (i#a5 'a',u 'en)a#a5an re)enerasi en%i' sehin))a #osis (un))al
as,irin 40 ') sehari (elah 2u5u, un(u5 'en)ha'*a( si5loo5si)enase (ro'*osi(
'anusia sela'a 'asa hi#u, (ro'*osi( <ai(u +>11 hari6
N<eri a#alah ,erasaan sensoris #an le'ah e'osional <an) (i#a5 ena5 #an
*er5ai(an #en)an an2a'an @5erusa5anB ;arin)an6Kea#aan ,si5is s4an)a(
'e',en)aruhi n<eri= 'isaln<a e'osi #a,a( 'eni'*ul5an sa5i( 5e,ala a(au
'e',erhe*a(n<a= (e(a,i #a,a( ,ula 'en)hin#ar5an sensasi ran)san)an n<eri6
N<eri 'eru,a5an sua(u ,erasaan ,ri*a#i #an a'*an) (oleransi n<eri *er*e#a>*e#a
*a)i se(ia, oran)6Ba(as n<eri un(u5 suhu a#alah 5ons(an= <a5ni 44>4&0C6
e#ia(or n<eri an(ara lain 'en)a5i*a(5an rea5si ra#an) #an 5e;an)>5e;an)
<an) 'en)a5(iGasi rese,(or n<eri #i u;un)>u;un) sara/ *e*as #i 5uli(= 'u5osa= #an
;ari)an lainn<a6 No2i2e,(or ini (er#a,a( #iseluruh ;arin)an #an or)an (u*uh=
5e2uali #i s<s(e' sara/ ,usa(6 Dari sini ran)san)an #isalur5an 5e o(a5 'elalui
;arin)an <an) he*a( #ari (a;u5>(a;u5 neuron #en)an sina,s <an) a'a( *an<a5
'elalui su'>su' (ulan) *ela5an)= su'>su' (ulan) lan;u(an #an o(a5 (en)ah6 Dari
(hala'us i',uls #i(erus5an 5e ,usa( n<eri #i o(a5 *esar= #i'ana i',uls #irasa5an
se*a)ai n<eri6
A#a,un 'e#ia(or n<eri <an) #ise*u( ;u)a se*a)ai au(a5oi# an(ara lain
sero(onin= his(a'ine= *ra#i5inin= leu5o(rien #an ,ros()lan#in!6Bra#i5inin
'eru,a5an ,oli,e,(i#a @ran)5aian asa' a'inoB <an) #i*eri5an #ari ,ro(ein
,las'a6
A(as 5er;a /ar'a5olo)isn<a= anal)esi2 #i*a)i #ala' #ua 5elo',o5 *esar=
<ai(u:
Anal)e(i5 Peri/er @non nar5o(i5B
Ter#iri #ari o*a(>o*a( <an) (i#a5 *ersi/a( nar5o(i5 #an (i#a5 *e5er;a
sen(ral6
Anal)e(i5 Nar5o(i5
Khusus #i)una5an un(u5 'en)halau rasa n<eri he*a(= se,er(i /ra5(ur #an
5an5er6
N<eri ,a#a 5an5er u'u'n<a #io*a(i 'enuru( sua(u s5e'a *er(in)5a(
e',a(= <ai(u:
o O*a( ,eri/er @non O,ioi#B ,eroral a(au re2(alF ,arase(a'ol= ase(osal6
o O*a( ,eri/er *ersa'a 5o#ein a(au (ra'a#ol6
o O*a( sen(ral @O,ioi#B ,eroral a(au re2(al6
o O*a( O,ioi# ,aren(eral
:una 'e',er5ua( anal)e(i5 #a,a( #i5o'*inasi5an #en)an 2o>
anal)e(i5u'= se,er(i ,si5o/ar'a5a @a'i(ri,(ilin= leGo,ro'a%in a(au ,re#nisoneB6
O*a(>o*a( )olon)an anal)e(i5 #i*a)i #ala' *e*era,a 5elo',o5= <ai(u:
,arase(a'ol= salisila(= @ase(asol= salisila'i#a= #an *enorila(B= ,en)ha'*a(
Pros(a)lan#in @NSAIDBF i*u,ro/en= #eriGa(e>#eriGa( an(ranila( @ 'e/ena'ila(=
asa' ni/lu'a( )la/enin= /lo5(a/enin= #eriGa(e>#eriGa( ,ira%olinon @a'ino/ena%on=
iso,ro/il,ena%on= iso,ro/ila'ino/ena%onB= lainn<a *en%i#a'in6O*a( )olon)an
anal)esi2 nar5o(i5 *eru,a= ase(a'ino/en #an /enase(in6O*a( )olon)an an(i>
in/la'asi nons(eroi# *eru,a as,irin #an salisila( lain= #eriGa(e asa' ,ro,iona(e=
asa' in#olase(a(= #eriGa(e o5si5a'= /ena'a(= /enil*u(a%on6
e5anis'e 5er;a ,en)ha'*a(an rasa n<eri a#a (i)a <ai(u:
o erin(an)i ,e'*en(u55an ran)san)an #ala' rese,(or rasa n<eri=
se,er(i ,a#a anas(esi lo2al6
o erin(an)i ,en<aluran ran)san)an n<eri #ala' sara/ sensoris=
se,er(i ,a#a anas(esi lo2al6
o Blo5a#e rasa n<eri ,a#a s<s(e' sara/ ,usa( se,er(i ,a#a anal)e(i5
sen(ral @nar5o(i5aB #an anas(esi u'u'6
A#a,un ;enis n<eri *eser(a (era,in<a= <ai(u:
o N<eri rin)an= Con(ohn<a: sa5i( )i)i= sa5i( 5e,ala= sa5i( o(o( 5arena in/e5si
Girus= n<eri hai#= 5eseleo6Pa#a n<eri #a,a( #i)una5an anal)e(i5 ,eri/er
se,er(i ,arase(a'ol= ase(osal #an )la/enin6
o Rasa n<eri 'enahun= Con(ohn<a: rheu'a(i2 #an ar(hri(is6
Pa#a n<eri ini #a,a( #i)una5an anal)e(i5 an(i>in/la'asi= se,er(i: ase(osal=
i*u,ro/en #an in#o'e(asin6
o N<eri he*a(= Con(oh: n<eri or)an #ala'= la'*un)= usus= *a(u )in;al= *a(u
e',e#u6
Pa#a n<eri ini #a,a( #i)una5an anal)e(i5 sen(ral *eru,a a(ro,ine=
*u(ils5o,ola'in @*us(o,anB= 2a'<lo/en @ as2aGanB6
o N<eri he*a( 'enahun= Con(oh: 5an5er= rheu'a(i2= neural)ia *era(6
Pa#a n<eri ini #i)una5an anal)e(i5 nar5o(i5= se,er(i /en(anil=
#e5s(ro'ora'i#a= *e%i(ra'i#a6
o O*a( anal)e(i5 nar5o(i5
:a'*ar 1: e5anis'e N<eri #an .alurn<a
Pemerantasan rasa n0eri
erin(an)i ,e'*en(u5an ran)san)an #ala' rese,(or n<eri ,eri/er= oleh
anal)e(i5a ,eri/er a(au anes(e(i5a lo5al6
Z erin(an)i ,en<aluran ran)san)an n<eri #ala' s<ara/>s<ara/ sensoris oleh
anes(e(i5a lo5al6
Z Blo5a#e ,usa( n<eri ,a#a SSP #en)an anal)e(i5a sen(ral @ nar5o(i5a B a(au
anes(e(i5a u'u'6
PENGGOLONGAN ANALGE.IK
Ber#asar5an a5sin<a= o*a(>a*a( anal)e(i5 #i*a)i 'en;a#i ! )olon)an :
Z 16 Anal)esi5 nono,ioi#= #an
Z !6 Anal)esi5 o,ioi#6
Ke#ua ;enis anal)e(i5 ini *er*e#a #ala' hal 'e5anis'e #an (ar)e( a5sin<a6
). Analgesik Nonopioid<Perifer 1NON-OPIOID ANALGESICS;
O*a(>o*a(an #ala' 5elo',o5 ini 'e'ili5i (ar)e( a5si ,a#a en%i'= <ai(u en%i'
si5loo5si)enase @CONB6 CON *er,eran #ala' sin(esis 'e#ia(or n<eri= salah
sa(un<a a#alah ,ros(a)lan#in6 e5anis'e u'u' #ari anal)e(i5 ;enis ini a#alah
'en)e*lo5 ,e'*en(u5an ,ros(a)lan#in #en)an ;alan 'en)inhi*isi en%i' CON
,a#a #aerah <an) (erlu5a #en)an #e'i5ian 'en)uran)i ,e'*en(u5an 'e#ia(or
n<eri 6 e5anis'en<a (i#a5 *er*e#a #en)an NSAID #an CON>! inhi*i(ors6
E/e5 sa',in) <an) ,alin) u'u' #ari )olon)an o*a( ini a#alah )an))uan
la'*un) usus= 5erusa5an #arah= 5erusa5an ha(i #an )in;al ser(a rea5si aler)i #i
5uli(6 E/e5 sa',in) *iasan<a #ise*a*5an oleh ,en))unaan #ala' ;an)5a 4a5(u
la'a #an #osis *esar6
:a'*ar !61 : Ori)in an# e//e2(s o/ ,ros(a)lan#ins
:a'*ar !6! : Pen)ha'*a(an oleh o*a(>o*a( Analgesik Nonopioid
*. Analgetik opioid
Anal)e(i5 o,ia# 'eru,a5an )olon)an o*a( <an) 'e'ili5i si/a( se,er(i
o,iu'9'or/in6 Si/a( #ari anal)esi5 o,ia# <ai(u 'eni'*ul5an a#i5si: ha*i(uasi #an
5e(er)an(un)an /isi56 Oleh 5arena i(u= #i,erlu5an usaha un(u5 'en#a,a(5an
anal)esi5 i#eal:
16 Po(ensi anal)esi5 <) sa'a 5ua( #en)an 'or/in
!6 Tan,a *aha<a a#i5si
> O*a( <an) *erasal #ari o,iu'>'or/in
> Sen<a4a se'isin(e(i5 'or/in
> Sen<a4a sin(e(i5 <an) *ere/e5 se,er(i 'or/in
Anal)e(i5 o,ia# 'e',un<ai #a<a ,en)halan) n<eri <an) san)a( 5ua( #en)an (i(i5
5er;a <an) (erle(a5 #i susunan s<ara/ ,usa( @SSPB6 U'u'n<a #a,a( 'en)uran)i
5esa#aran #an 'eni'*ul5an ,erasaan n<a'an @eu/oriaB66 Anal)e(i5 o,ioi# ini
'eru,a5an ,ere#a n<eri <an) ,alin) 5ua( #an san)a( e/e5(i/ un(u5 'en)a(asi n<eri
<an) he*a(6
Tu*uh se*enarn<a 'e'ili5i sis(e' ,en)ha'*a( n<eri (u*uh sen#iri @en#o)enB=
(eru(a'a #ala' *a(an) o(a5 #an su'su' (ulan) *ela5an) <an) 'e',ersuli(
,enerusan i',uls n<eri6 Den)an sis(e' ini #a,a( #i'en)er(i 'en)a,a n<eri #ala'
si(uasi (er(e5an= 'isaln<a lu5a ,a#a 5e2ela5aan lalu lin(as 'ula>'ula (i#a5 (erasa
#an *aru #isa#ari *e*era,a saa( 5e'u#ian6 Sen<a4a>sen<a4a <an) #i5eluar5an
oleh sis(e' en#o)en ini #ise*u( o,ioi# en#o)en6 Be*era,a sen<a4a <an)
(er'asu5 #ala' ,en)ha'*a( n<eri en#o)en an(ara lain: en5e/alin= en#or/in= #an
#inor/in6
O,ioi# en#o)en ini *erhu*un)an #en)an *e*era,a /un)si ,en(in) (u*uh se,er(i
/lu5(uasi hor'onal= ,ro#u5si anal)esia= (er'ore)ulasi= 'e#iasi s(ress #an
5e)elisahan= #an ,en)e'*an)an (oleransi #an 5e(er)an(un)an o,ioi#6 O,ioi#
en#o)en 'en)a(ur ho'eos(a(is= 'en)a,li/i5asi sin<al #ari ,er'u5aan (u*u5 5e
o(a5= #an *er(in#a5 ;u)a se*a)ai neuro'o#ula(or #ari res,on (u*uh (erha#a,
ran)san) e5s(ernal6
Bai5 o,ioi# en#o)en #an anal)esi5 o,ioi# *e5er;a ,a#a rese,(or o,ioi#= *er*e#a
#en)an anal)esi5 nono,ioi# <an) (ar)e( a5sin<a ,a#a en%i'6
A#a *e*era,a ;enis Rese,(or o,ioi# <an) (elah #i5e(ahui #an #i(eli(i= <ai(u
rese,(or o,ioi# [= \= ]= ^= _6 @#an <an) (er*aru #i(e'u5an a#alah N9O"3 re2e,(or=
ini(iall< 2alle# (he o,ioi#>re2e,(or>li5e 1 @ORL>1B re2e,(or or Kor,hanL o,ioi#
re2e,(or #an e>re2e,(or= na'u' *elu' ;elas /un)sin<aB6
Rese,(or [ 'e'e#iasi e/e5 anal)esi5 #an eu/oria #ari o,ioi#= #an 5e(er)an(un)an
/isi5 #ari o,ioi#6 Se#an)5an rese,(or [ ! 'e'e#iasi e/e5 #e,resan ,erna/asan6
Rese,(or ^ <an) se5uran)n<a 'e'ili5i ! su*(i,e *er,eran #ala' 'e'e#iasi e/e5
anal)esi5 #an *erhu*un)an #en)an (oleransi (erha#a, [ o,ioi#6 rese,(or \ (elah
#i5e(ahui #an *er,eran #ala' e/e5 anal)esi5= 'iosis= se#a(i/= #an #iuresis6
Rese,(or o,ioi# ini (erse*ar #ala' o(a5 #an su'su' (ulan) *ela5an)6 Rese,(or ^
#an rese,(or \ 'enun;u5an sele5(i/i(as un(u5 e5e5/alin #an #inor/in= se#an)5an
rese,(or [ sele5(i/ un(u5 o,ioi# anal)esi26
e5anis'e u'u'n<a :
Teri5a(n<a o,ioi# ,a#a rese,(or 'en)hasil5an ,en)uran)an 'asu5n<a ion Ca
!A
5e
#ala' sel= selain i(u 'en)a5i*a(5an ,ula hi,er,olarisasi #en)an 'enin)5a(5an
'asu5n<a ion K
A
5e #ala' sel6 $asil #ari *er5uran)n<a 5a#ar ion 5alsiu' #ala'
sel a#alah (er;a#in<a ,en)uran)an (erle,asn<a #o,a'in= sero(onin= #an ,e,(i#a
,en)han(ar n<eri= se,er(i 2on(ohn<a su*s(ansi P= #an 'en)a5i*a(5an (rans'isi
G. 2E.IK:LOSI.OSIS
Re(i5ulosi( a#alah eri(rosi( 'u#a <an) si(o,las'an<a 'asih
'en)an#un) se;u'lah *esar sisa>sisa ri*oso'e #an RNA <an) *erasal #ari sisa
in(i #ari *en(u5 ,enuh ,en#ahulun<a6 Ri*oso'e 'e',un<ai 5e'a',uan un(u5
*erea5si #en)an ,e4arna (er(en(u se,er(i brilliant cresyl blue a(au new methylene
blue un(u5 'e'*en(u5 en#a,an )ranula a(au /ila'en <an) *er4arna *iru6 Rea5si
ini han<a (er;a#i ,a#a ,e4arnaan (erha#a, sel <an) 'asih hi#u, #an (i#a5
#i/i5sasi6 Oleh 5arena i(u #ise*u( ,e4arnaan supravital6 Re(i5ulosi( ,alin) 'u#a
@i'a(urB a#alah <an) 'en)an#un) ri*oso'e (er*an<a5= se*ali5n<a re(i5ulosi(
(er(ua han<a 'e',un<ai *e*era,a (i(i5 ri*oso'e6
Pa#a ,e4arnaan 8ri)h( re(i5ulosi( (a',a5 se*a)ai eri(rosi( <an) *eru5uran le*ih
*esar #an *er4arna le*ih *iru #ari,a#a eri(rosi(6 Re(i5ulu' (erliha( se*a)ai *in(i5>
*in(i5 a*nor'al6 Poli5ro'a(o/ilia <an) 'enun;u55an 4arna 5e*iru>*iruan #an
*in(i5>*in(i5 *aso/il ,a#a eri(rosi(= se*enarn<a #ise*a*5an oleh *ahan ri*oso'e
(erse*u(6
$i(un) re(i5ulosi( 'eru,a5an in#i5a(or a5(iGi(as su'su' (ulan) #an #i)una5an
un(u5 'en#ia)nosis ane'ia6 Ban<a5n<a re(i5ulosi( #ala' #arah (e,i
'en))a'*ar5an eri(ro,oesis <an) ha',ir a5ura(6 Penin)5a(an ;u'lah re(i5ulosi(
#i #arah (e,i 'en))a'*ar5an a5selerasi ,ro#u5si eri(rosi( #ala' su'su' (ulan)6
Se*ali5n<a= hi(un) re(i5ulosi( <an) ren#ah (erus>'enerus #a,a( 'en)in#i5asi5an
5ea#an hi,o/un)si su'su' (ulan) a(au ane'ia a,las(i56
(etode
$i(un) re(i5ulosi( u'u'n<a 'en))una5an 'e(o#e ,e4arnaan su,raGi(al6 Sa',el
#arah #i2a',ur #en)an laru(an brilliant cresyl blue (B#B) a(au new methylene
blue 'a5a ri*oso'e a5an (erliha( se*a)ai /ila'en *er4arna *iru6 .u'lah
re(i5ulosi( #ihi(un) ,er 1000 eri(rosi( #an #in<a(a5an #ala' E= ;a#i hasiln<a
#i*a)i 106
Pe4arna <an) #i)una5an 'e'ili5i /or'ula se*a)ai *eri5u( :
Brillian( Cres<l Blue @BCBB : *rillian( 2res<l *lue 160 )rF NaCl 06+&E 1160
'l6 Sarin) laru(an se*elu' #i,er)una5an6
Ne4 'e(h<lene *lue : NaCl 06+ )rF 5aliu' o5sala( 164 )rF ne4 'e(h<lene
*lue N 06& )rF aTua#es( 100 'l6 Sarin) laru(an se*elu' #i,er)una5an6
Dian;ur5an 'en))unaan new methylene blue= 5esalahan 'e(o#e ini ,a#a nilai
nor'al !& E6
Sa',el #arah <an) #i)una5an un(u5 hi(un) re(i5ulosi( a#alah #arah 5a,iler a(au
Gena= #en)an an(i5oa)ulan @EDTAB a(au (an,a an(i5oa)ulan @se)arB6
Prosed'r
Ke #ala' (a*un) 'asu55an #arah #an ,e4arna #en)an ,er*an#in)an 1 : 1=
2a',ur *ai5>*ai5= *iar5an sela'a 1& 'eni( a)ar ,e4arnaann<a se',urna6
Bua(lah se#iaan a,us 2a',uran i(u= *iar5an 5erin) #i u#ara6
Peri5salah #i *a4ah 'i5ros5o, #en)an ,er*esaran 100C6 Eri(rosi( na',a5
*iru 'u#a #an re(i5ulosi( a5an (a',a( se*a)ai sel <an) 'en)a#un)
)ranula9/ila'en <an) *er4arna *iru6 Bila 5uran) ;elas 4a5(u
,e4arnaann<a #i,er,an;an) a(au #i2oun(ers(ain @#i2a( la)iB #en)an 2a(
8ri)h(6
$i(un)lah ;u'lah re(i5ulosi( #ala' 1000 sel eri(rosi(6 .i5a 5esuli(an
'en)hi(un)= la5u5an ,en)e2ilan 'e#an ,en)liha(an o5uler #en)an
'ele(a55an 5er(as *erlu*an) ,a#a lensa o5uler6 $i(un) re(i5ulosi(
#i(en(u5an #en)an ,erhi(un)an se*a)ai *eri5u( :
$i(un) re(i5ulosi( H @ ;u'lah re(i5ulosi( ,er 1000 eri(rosi( : 10 B E
Nilai 2'!'kan
De4asa : 06& > 16& E
Ba<i *aru lahir : !6& > -6& E
Ba<i : 06& > ?6& E
Ana5 : 06& > !60 E
(asalah Klinis
"a5(or>/a5(or <an) 'e',en)aruhi (e'uan hasil la*ora(oriu' :
Bila he'a(o5ri(n<a ren#ah 'a5a ,erlu #i(a'*ah5an #arah
Ca( <an) (i#a5 #isarin) 'en<e*a*5an ,en)en#a,an 2a( ,a#a sel>sel
eri(rosi( sehin))a (erliha( se,er(i re(i5ulosi(
en)hi(un) #i #aerah <an) (erlalu ,a#a(
Penin)5a(an 5a#ar )lu5ose a5an 'en)uran)i ,e4arnaan
Pen<e*a* Re(i5ulosi(o,enia :
R Ti#a5 a#an<a 9 #es(ru5si sel ,re2ursor he'a(o,oie(i2 @'isaln<a Ane'ia
A,las(i5B
R Ti#a5 a#an<a ,re2ursor eri(ro,oie(i5 @ 'isaln<a ,ure re# 2ell a,lasiaB
R Ane'ia #e/isiensi *esi
R Ane'ia ,ernisiosa a(au #e/isiensi asa' /ola(
R Transien( er<(hro*las(o,enia ,a#a neona(es6
R Tera,i ra#iasi
R Ke)a)alan su'su' (ulan) 5arena 5e)anasan a(au in/e5si
Pen<e*a* Re(i5ulosi(osis :
R Ane'ia he'oli(i5
R Per#arahan
R Res,on (erha#a, ,en)o*a(an @,e'*erian %a( *esi= asa' /ola(= eri(ro,oie(inB
R $e'ol<(i2 #isease o/ (he ne4*orn6
Ca(a(an :
R Re(i5ulosi( a5an 'enin)5a( #i (e',a( #en)an 5e(in))ian (er(en(u oleh 5arena
(u*uh 'ela5u5an a#a,(asi (erha#a, ren#ahn<a 5an#un)an o5si)en ,a#a
(e',a( (s*6
R Re(i5ulosi( a5an 'enin)5a( ,a#a i*u ha'il6 Ba<i *aru lahir 'e',un<ai
hi(un)
R Re(i5ulosi( <an) (in))i= na'un a5an 'enurun 5e nilai nor'al #ala' *e*era,a
'in))u6
H. .2O(9ISI.OPENIA
Thro'*o2<(o,enia a#alah ;u'lah ,la(ele(>,la(ele( <an) le*ih ren#ah #ari nor'al
#ala' #arah6Pla(ele(>,la(ele( a#alah salah sa(u #ari 5o',onen>5o',onen #arah
*ersa'a #en)an sel>sel #arah ,u(ih #an 'erah6 Pla(ele(>,la(ele( 'e'ain5an ,eran
<an) ,en(in) #ala' ,en))u',alan #an ,er#arahan6 Pla(ele(>,la(ele( (er*en(u5
#ala' su'su' (ulan) @*one 'arro4B seru,a ,a#a sel>sel lain #ala' #arah se,er(i=
sel>sel #arah ,u(ih #an sel>sel #arah 'erah6 Pla(ele(>,la(ele( *erasal #ari
'e)a5ar<o2<(es <an) a#alah sel>sel <an) *esar <an) #i(e'u5an #ala' su'su'
(ulan) *ela5an)6 "ra)'en>/ra)'en #ari 'e)a5ar<o2<(es ini a#alah ,la(ele(>
,la(ele( <an) #ile,as5an 5e#ala' aliran #arah6 Pla(ele(>,la(ele( <an) *ere#ar
'e'*en(u5 5ira>5ira #ua ,er(i)a #ari ,la(ele(>,la(ele( <an) #ile,as5an #ari
su'su' (ulan) *ela5an) @*one 'arro4B6 Se,er(i)a lainn<a se2ara 5has #isi',an
@#isi(aB #ala' li',a @s,leenB6Pla(ele(>,la(ele(= ,a#a u'u'n<a= 'e',un<ai
5ehi#u,an <an) sin)5a( 7 sa',ai 10 hari #ala' #arah= se(elah i(u 'ere5a
#i5eluar5an #ari sir5ulasi #arah6 .u'lah #ari ,la(ele(>,la(ele( #ala' #arah #iru;u5
se*a)ai ;u'lah ,la(ele( #an nor'aln<a a#alah an(ara 1&0=000 sa',ai 4&0=000 ,er
'i2ro li(er @se,erse;u(a #ari li(erB #arah6 Pla(ele( <an) *er;u'lah 5uran) #ari
1&0=000 #iis(ilah5an (hro'*o2<(o,enia6 Pla(ele( <an) *er;u'lah le*ih *esar #ari
4&0=000 #ise*u( (hro'*o2<(osis6"un)si #ari ,la(ele(>,la(ele( a#alah san)a( ,en(in)
#ala' sis(i' ,en))u',alan6 Pla(ele(>,la(ele( a#alah *a)ian #ari ,a(h4a< @;alan
5e2ilB <an) san)a( ru'i(6 ere5a *ersir5ulasi #ala' #arah #an 'en;a#i a5(i/ ;i5a
a#a ,er#arahan a(au lu5a a,a sa;a #ala' (u*uh6 Ki'ia>5i'ia (er(en(u #ile,as5an
#ari ,e'*uluh>,e'*uluh a(au s(ru5(ur>s(ru5(ur lain <an) lu5a <an) 'e'*eri
sin<al ,a#a ,la(ele(>,la(ele( un(u5 'en;a#i a5(i/ #an *er)a*un) #en)an
5o',onen>5o',onen lain #ari sis(i' un(u5 'en)hen(i5an ,er#arahan6 Ke(i5a
#ia5(i/5an= ,la(ele(>,la(ele( 'en;a#i len)5e( #an 'ele5a( sa(u sa'a lain #an ,a#a
#in#in) ,e'*uluh #arah ,a#a (e',a( lu5a un(u5 'e',erla'*a( #an
'en)hen(i5an ,er#arahan #en)an 'en<u'*a( ,e'*uluh #arah a(au ;arin)an <an)
rusa5 @he'os(asisB6A#alah ,en(i) un(u5 'en2a(a( *ah4a= 'es5i,un ;u'lah>
;u'lah ,la(ele( *er5uran) ,a#a (hro'*o2<(o,enia= /un)si 'ere5a *iasan<a (e(a,
u(uh se,enuhn<a6 Pen<a5i(>,en<a5i( lain ha#ir <an) #a,a( 'en<e*a*5an /un)si
,la(ele( <an) (er)an))u 'es5i,un ;u'lah ,la(ele( nor'al6.u'lah ,la(ele( <an)
ren#ah ,a#a 5asus>5asus <an) ,arah 'un)5in *era5i*a( ,er#arahan <an) s,on(an
a(au 'un)5in 'en<e*a*5an ,enun#aan #ala' ,roses ,en))u',alan <an) nor'al6
Pa#a (hro'*o2<(o,enia rin)an= 'un)5in (i#a5 a#a e/e5>e/e5 <an) 'eru)i5an
#ala' ;alan>;alan 5e2il ,en))u',alan a(au ,er#arahan6
Pen<e*a* Thro'*o2<(o,enia
.u'lah>;u'lah ,la(ele( <an) ren#ah= (hro'*o2<(o,enia= #a,a( #ise*a*5an oleh
5e*era)a'an #ari se*a*>se*a*6 Pa#a u'u'n<a= 'ere5a #a,a( #i*a)i 5e#ala':
16 ,ro#u5si ,la(ele( <an) *er5uran)=
!6 ,en)han2uran a(au 5onsu'si ,la(ele( <an) 'enin)5a(= a(au
?6 ,en<i(aan <an) 'enin)5a( oleh li',a a(au in2rease# s,leni2 seTues(ra(ion
@,enan)5a,an #ari ,la(ele(>,la(ele( <an) *ersir5ulasi #ala' li',aB6Be*era,a
#ari ,en<e*a*>,en<a*a* <an) ,alin) u'u' #an ,en(in) a(au
(hro'*o2<(o,enia #iurai5an #i*a4ah6Pro#u5si ,la(ele( <an) *er5uran)
Pro#u5si ,la(ele( <an) *er5uran) *iasan<a #ihu*un)5an ,a#a ,ersoalan su'su'
(ulan) *ela5an) @a)ranulo2<(osisB6 Pa#a 5e*an<a5an #ari 5on#isi>5on#isi ini=
,ro#u5si>,ro#u5si sel #arah 'erah #an sel #arah ,u(ih 'un)5in ;u)a (er,en)aruh6
Pen)han2uran a(au 5onsu'si ,la(ele( <an) 'enin)5a(
Pen)han2uran a(au 5onsu'si ,la(ele( <an) 'enin)5a( #a,a( (erliha( ,a#a se;u'lah
5on#isi>5on#isi 'e#is6 ere5a #a,a( #i*a)i 5e#ala' ,en<e*a*>,en<e*a* <an)
*erhu*un)an #en)an i'un #an (i#a5 *erhu*un)an #en)an i'un6Ban<a5 o*a(>o*a(
#a,a( 'en<e*a*5an ;u'lah ,la(ele( <an) ren#ah #en)an 'en<e*a*5an rea5si
i''unolo)i2 (erha#a, ,la(ele(>,la(ele(= <an) #ise*u( #ru)>in#u2e#
(hro'*o2<(o,enia6
:e;ala>:e;ala #ari Thro'*o2<(o,enia
Pa#a *an<a5 5e;a#ian>5e;a#ian= (hro'*o2<(o,enia 'un)5in (i#a5 'e',un<ai
)e;ala>)e;ala= (eru(a'a ;i5a rin)an= #an ia #a,a( #i#e(e5si han<a se2ara 5e*e(ulan
,a#a ,e5er;aan #arah ru(in <an) #ila5u5an un(u5 se*a*>se*a* lain6.i5a
(hro'*o2<(o,enian<a ,arah= 2on(ohn<a 5uran) #ari !0 ,er 'i2ro li(er= ia #a,a(
*er'ani/es(asi se*a)ai ,er#arahan <an) 'enin)5a( 5e(i5a oran) i(u (er,o(on) a(au
(erlu5a a(au ,e#arahan <an) 'enin)5a( sela'a ,erio#e 'ens(ruasi6Per#arahan
se2ara s,on(an #a,a( ;u)a (er;a#i #en)an (hro'*o2<(o,enia <an) ,arah @5uran)
#ari 10=000 sa',ai !0=000 ,la(ele(>,la(ele(B6 Ti,e ,er#arahan ini *iasan<a (er;a#i
#i*a4ah 5uli( a(au sela,u( len#ir a(au 'u2us 'e'*rane @la,isan #ala' #ari
ron))a 'ulu(= saluran ,en2ernaan= a(au ron))a hi#un)B6Pe(e2hiae 'un)5in
(erliha( ,a#a ,asien>,asien #en)an ;u'lah>;u'lah ,la(ele( <an) san)a( ren#ah6
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(erliha( #i*a4ah 5uli( ,a#a *a)ian>*a)ian (u*uh <an) *er)an(un)an 5arena
(e5anan <an) 'enin)5a( <an) #ise*a*5an oleh )a<a *era(= 2on(ohn<a= ,a#a 5a5i>
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lain <an) (eliha( ,a#a (hro'*o2<(o,enia #ise*u( ,ur,ura= <an) a#alah s,o(>s,o(
<an) 5e2il #an un)u #i*a4ah 5uli( se*a)ai a5i*a( #ari he'orrha)e6 Ini se2ara 5has
le*ih *esar #ari ? 'ili'e(er #ala' #ia'e(ern<a #an 'un)5in 'e4a5ili ,er(e'uan
#ari ,e(e2hiae6
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#i(un;u5an #an #iseli#i5i olaeh #o5(er <an) 'e'erin(ah5an ,enari5an #arah6 Pa#a
oran)>oran) #en)an (hro'*o2<(o,enia <an) #i5e(ahui= ,era4a(an /ollo4>u,
#i,u(us5an *er#asar5an ,a#a #ia)nosis #an 5e,arahan6Oran)>oran) #en)an
(hro'*o2<(o,enia ,a#a u'u'n<a a4aln<a #ira4a( oleh ahli ,en<a5i( #ala'
@in(ernis(B a(au #o5(er 5elua)a6 A#a5alan<a= 5onsul(asi #en)an #o5(er <an)
s,esialisasi #ala' ,en<a5i(>,en<a5i( #arah @he'a(olo)is(B a#alah *er'an/aa(
un(u5 ,en<eli#i5an a(au ,era4a(an <an) le*ih 'en<eluruh6
DA"TAR PUSTAKA
$aln B$6 Pa(ho)enesis o/ sis(e'i2 lu,us er<he'a(osus6 In : Kelle< 8N= $arris ED= Ru##< S=
Sle#)e CB6 TeC(*oo5 o/ rheu'a(olo)<6!
n#
e#66 Phila#el,hia686*6 Sau#res
Co',an<=11+&F101&>!7
Cassi#< .T= Pe((< RE6 Sis(e'i2 lu,us er<(he'o(osus In: TeC(*oo5 o/ ,e#ia(ri2 rheu'a(olo)<6
!(h e#6 USA: Chur2hill LiGin)s(one61110F!-1>?14
Du*ois EL= 8alla2e D.6 E(uolo)< an# ,a(ho,h<siolo)<: In(ro#u2(ion an# his(ori2al reGie46 In:
Du*ois EL6 Du*oisLs Lu,us Er<(he'a(osus6 4
(h
e#6 Phila#el,hia: Lea an#
/e*in)er=11+7F??>?7
8alla2e D.= Du*ois EL6 Lu,us= ,re)nan2<= an# neona(al lu,us6 In: Du*oisQs Lu,us
Er<(he'a(osus64
(h
e#6 Phila#el,hia: Lea an# "e*in)er= 11+7F&-&>71
Bran2h D8= Por(er T"6 Au(oi''une #isease In: ;a'es #K= s(eer P.= 8einer CP6 $i)h ris5
,re)nan2<6 Phila#el,hia: 8B Sau#ers !000F+&?>-4
6 Nasu(ion AR=Kas;'ir 0I= 'asalah ,en<a5i( lu,us eri(e'a(osus sis(e'i5 @LESB si RSUPN
Ci,(o an)un5usu'o .a5ar(a6 Si',osiu' Nasional I Sis(e'i2 lu,us Er<he'a(osus6
.a5ar(a 111&
Kali' $= $an#ono K6 :a'*aran 5lini5 #an hara,an hi#u, ,en#eri(a lu,us Er<he'a(osus
sis(e'i5 @SLEB ,a#a oran) ;a4a #i RSUD Dr6 sai/ul an4ar alan)= 11+&>11146 Si',osiu'
Nasional I Sis(e'i2 Lu,us Er<(he'a(osus .a5ar(a=111&
Bara(a4i#;a<a K:6 As,e5 i'unolo)is #an ,eranan ,e'eri5saan au(oan(i*o#i ,a#a lu,us
eri(e'a(osus sis(e'i56 a; Ke#o5 In#ones 111-F 4-: ?+?>?+4
Bara(a4i#;a<a K:6 I'unolo)i #asar6 .a5ar(a: Balai Pener*i( "K UI: 111-:+4>7
h((,:99'e#i2a/ar'a6*lo)s,o(62o'9!00+9049anal)esi5>an(i,ire(i5>#an>
an(iin/la'asi6h('l
Lahi(a R:6 Clini2al ,resen(a(ion o/ sis(e'i2 lu,us er<(he'a(osus6 In: Kelle< 8N= harris ED=
Ru##< S=Sle#)e CB6 TeC(*oo5 o/ rheu'a(olo)<6 !
n#
e#6 Phila#el,hia6 86B6 Saun#ers
Co',an<= 11+&F 10!1>?1
Bel'on $6 Lu,us 2lini2al oGerGie46 Ne4 0or5 UniGersi(< e#i2al Cen(er= 111+
Cunnin)ha' ":= :an( N"= LeGeno K.= :ils(ra, III LC= $au(h .C= 8ens(ro' KD= 8illia'
o*s(e(ri2s6 !0s( e# 6 Ne4 0or5>Chi2a)o>San "ransis2o: 2 :ra4>$ill= 1117:1!?1>44
Is*a)io $= Kas;'ir 0I6 ani/es(asi 5linis ,en<a5i( lu,us eri(e'a(osus sis(e'i56 Si',osiu'
Nasional I Sis(e'i2 Lu,us er<(he'a(osus .a5ar(a=111&
6 Dau# R= 8i*o4o N= A5i* AA6 Lu,us eri(e'a(osus sis(e'i5 ,a#a 5eha'ilan6 a; Ke#o5
In#ones 111-F 4-F ?7&>?7-
Dau# R= 8i*o4o N= A5i* AA6 Sis(e'i2 lu,us er<he'a(osus ,a#a 5eha'ilan6 Si',osisu'
Nasonal I s<a(e'i2 Lu,us Er<(he'a(osus= .a5ar(a= 111&
$an#ono K= Kali' $= $i#a<a( A= Pro,rsi an(i*o#i an(i/os/olo,i# ,a#a ,en#eri(a a*or(us
*erulan) #i RSUD Dr6 sai/ul an4ar ='alan)6 Si',osiu' Nasional I sis(e'i2 Lu,us
er<(he'a(osus= .a5ar(a 111&
A'es RR.= $u)hes :R76 An(i,hos,holi,i# an(i*o#i s<n#ro'e : 2lini2al an# (hera,eu(i2
as,e2(s6 Rheu'a(olo)< $i)hli)h(s6 NIII(h Euro,ean Con)ress o/ Rheu'a(olo)<6 111&
Ri(on)a P= .a2oe* T`6 Lu,us eri(e'a(osus sis(e'i5 #ala' o*s(e(ri #an )ine5olo)i6 a; O*s(e(
:ine5ol In#ones 111-F 4F !41>!4!
$ahn B$= ana)e'en( o/ sis(e'i2 lu,us er<(he'a(osus6 In: Kelle< 8N= $arris ED= ru##< S=
Sle#)e CB6 TeC(*oo5 o/ rheu'a(olo)< !
n#
e#6 Phila#el,hia: 86B6 Saun#ers Co',an<=
11+&F1040>&-
Talal N6 The e(iolo)< o/ sis(e'i2 lu,us er<(e'a(osus= In: Du*ois EL6 Du*oisQs Lu,us
Er<(he'a(osus 4
(h
e#6 Phila#el,hia: Lea an# "e*in)er= 11+7F?1>4?
a25a< IR6 Au(oi''uni(< in rela(ion (o lu,us er<(he'a(osus6 In6 Du*ois EL= Du*oisQs lu,us
Er<(he'a(osus 4
(h
e#= Phila#el,hia: Lea an# "e*en)er= 11+7F44>&!
In: Du*ois EL6 Du*oisQs Lu,us Er<(e'a(osus 4
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e#6 Phila#el,hia: Lea an# /e*in)er=
11+7F1&>