EBM

CRITICAL APPRAISAL

Disusun oleh :
Nidya Annisa Putri (1102013211)
Tetty Prasetya Ayu Lestari (112013283)

Dosen Pembimbing :
dr. Aditarahma Imaningdyah

FAKULTAS KEDOKTERAN
UNIVERSITAS YARSI
2015/2016

Skenario
Seorang perempuan usia 40 tahun datang ke rumah sakit untuk kontrol. Pasien
adalah penderita Sistemic Lupus Ertimatous (SLE) selama 2 tahun. Pada pemeriksan
fisik di dapatkan suhu 37,5oC, konjungtiva pucat, terdapat sariawan di mulut dan pada
wajah terdapat malar rash.
Hasil pemeriksaan laboratorium didapatkan kadar D3 10ng/ml. Pasien
menanyakan apakah ada hubungan antara mengkonsumsi kortikosteroid dengan kadar
vitamin D3 yang rendah?
Foreground Question
Apa hubungan antara penyakit SLE dengan defisiensi vitamin D 3 pada pasien
tersebut?
PICO
P: Perempuan penderita SLE
I : Kadar D3 menurun
C: Kadar D3 meningkat
O: Penurunan kadar vitamin D3 pada SLE
PencarianBuktiIlmiah
Keyword
: SLE And Vitamin 25(OH)D AND WOMAN AND
DEFICIENCY
Source/database
: ncbi.nlm.nih.gov
Limitation
: 2011 2016
Result
: 14
1. Vitamin D Antibodies in Systemic Sclerosis Patients: Findings and Clinical
Correlations.
2. Vitamin D prevents endothelial damage induced by increased neutrophil
extracellular traps formation in patients with systemic lupus erythematosus.
3. Vitamin D levels in Indian systemic lupus erythematosus patients: association
with disease activity index and interferon alpha.
4. 25-hydroxyvitamin D and cardiovascular disease in patients with systemic
lupus erythematosus: data from a large international inception cohort.
5. Vitamin D deficiency does not predict progression of coronary artery
calcium, carotid intima-media thickness or high-sensitivity C-reactive protein
in systemic lupus erythematosus.
6. Vitamin D in systemic lupus erythematosus: modest association with disease
activity and the urine protein-to-creatinine ratio.
7. Restoration of regulatory and effector T cell balance and B cell homeostasis in
systemic lupus erythematosus patients through vitamin D supplementation.
8. 25-Hydroxyivitamin D3 levels in patients with systemic lupus erythematosus
and its association with clinical parameters and laboratory tests.

9. Premature atherosclerosis is associated with hypovitaminosis D and

angiotensin-converting enzyme inhibitor non-use in lupus patients.
10. Reduced serum concentrations of 25-hydroxy vitamin D in Egyptian patients
with systemic lupus erythematosus: relation to disease activity.
11. 25-Hydroxyvitamin D deficiency is associated with increased aortic stiffness
in patients with systemic lupus erythematosus.
12. Disease activity, proteinuria, and vitamin D status in children with systemic
lupus erythematosus and juvenile dermatomyositis.
13. Vitamin D levels in Chinese patients with systemic lupus erythematosus:
relationship with disease activity, vascular risk factors and atherosclerosis.
14. Vitamin D deficiency is associated with an increased autoimmune response in
healthy individuals and in patients with systemic lupus erythematosus.

Selected article
25-Hydroxyivitamin D3 levels in patients with systemic lupus erythematosus and its
association with clinical parameters and laboratory tests.

REVIEW JURNAL
Background:
Some studies have linked vitamin D insufficiency/deficiency with several
autoimmune diseases, such as insulin dependent diabetes mellitus, multiple sclerosis,
inflammatory bowel disease and SLE. Thus, vitamin D insuffi ciency/deficiency is
suggested to be an extrinsic factor capable of modifying the prevalence of
autoimmune diseases, such as SLE, and interfering with their severity.
Metode:
Cross-sectional, prospective study performed at the SLE Clinic, Department of
Rheumatology, Hospital das Clinicas, Universidade Federal de Pernambuco with
convenience sampling, including 78 patients with SLE and 64 volunteers (comparison
group), matched by gender and age
Result:
Insufficiency/deficiency of 25(OH)D was found in 45 (57.7%) patients with SLE and
25 (39%) individuals in the comparison group. The mean serum levels of 25(OH)D
were 29.3 ng/mL (6.155.2 ng/mL) in patients with SLE and 33.12 ng/mL (15.963.8
ng/mL) in the comparison group, and this difference was statistically signifi cant (P =
0.041). No statistically signifi cant difference was observed between the mean ages of
both groups. No statistically signifi cant association was observed between 25(OH)D

insuffi ciency/deficiency and the following: time to diagnosis; disease activity

(SLEDAI 6); fatigue; use of corticosteroids and antimalarials; and anti-DNA.
Discussion:
High prevalence of 25(OH)D insuffi ciency/defi ciency was found in patients with
SLE (57.7%), with statistically signifi cant difference as compared with the
comparison group. No association of vitamin D insufficiency/deficiency was observed
with the clinical variables and laboratory tests studied. The authors emphasize the
importance of determining 25(OH)D serum levels in all patients with SLE, regardless
of where they live and time to disease diagnosis.
1. APAKAH HASIL PENELITIAN TERSEBUT VALID?
1. Apakah terdapat sampel yang representative dan didefinisikan secara jelas pada
kondisi yang sama / similar point dalam perjalanan penyakit / course of the disease?
Ya, karena mengambil 78 pasien

2. Apakah follow-up lengkap dan cukup lama/ sufficiently long and complete?
Tidak ada
3. Apakah digunakan kriteria outcome yang obyektif dan tidak berbias?

4. Bila ditemukan subgroup dengan prognosis yang beda, apakah dilakukan

adjustment untuk faktor faktor prognostic yang penting?

II. APAKAH HASIL PENELITIAN INI PENTING?

1. Bagaimana gambaran outcome menurut waktu?
Tidak ada
2. Seberapa tepat perkiraan prognosis ?

III. APAKAH HASIL PENELITIAN INI DAPAT DIAPLIKASIKAN?

1. Apakah pasien dalam penelitian tersebut serupa dengan pasien saya?

2. Apakah hasil penelitian membantu dalam keputusan pemilihan terapi?

3. Apakah penelitian berguna untuk konseling pada penderita dan keluarganya?