ABSTRAK
Pendahuluan: Artritis reumatoid (AR) merupakan penyakit autoimun yang sering didapatkan. Gangguan pendengaran sensorinerual dan konduktif telah dilaporkan pada AR, namun hasilnya berbeda-beda. Patogenesis gangguan pendengaran sensorineural berhubungan dengan Matrix Metalloproteinase-3 (MMP-3). Tujuan: Untuk mengevaluasi gangguan pendengaran pada pasien AR dan untuk menilai hubungan antara kadar MMP-3 plasma dengan gangguan pendengaran. Metode: Kelompok studi terdiri atas 21 pasien AR dengan gangguan pendengaran dan 21 pasien AR tanpa gangguan pendengaran diinklusikan sebagai kontrol. Semua pasien dievaluasi dengan audiometri nada murni dan timpanometri. Kadar MMP-3 plasma pasien diukur dengan Enzyme-Linked Immunosorbent Assay. Hasil: Penelitian ini mendapatkan gangguan pendengaran sensorineural (76,2%), konduktif (14,3%), dan campuran (9.5%). Proporsi derajat gangguan pendengaran yang terbanyak adalah derajat ringan (66,7%). Didapatkan perbedaan yang bermakna ambang dengar (p<0,001), rerata hantaran udara pada frekuensi 1000 Hz hingga 8000 Hz (p<0,05), dan rerata hantaran tulang pada semua frekuensi diantara kedua kelompok (p<0,05). Kami mendapatkan peningkatan insiden timpanogram tipe As pada kelompok kasus ( 28,6%), dan pada kelompok kontrol (47,6%). Didapatkan perbedaan bermakna (p<0,001) mean kadar MMP-3 diantara kedua kelompok. Kesimpulan: Gangguan pendengaran sering didapatkan pada AR. MMP-3 berkontribusi dalam mendegradasi sendi inkudomaleus dan inkudostapedius dan dapat merusak sel telinga dalam akibat proses oksidatif. Pemeriksaan audiometri dan timpanometri berkala direkomendasikan untuk memantau gangguan pendengaran tersebut.
Kata Kunci: gangguan pendengaran, audiometri, timpanometri, MMP-3, Enzyme-Linked Immunosorbent Assay, artritis rheumatoid.
ABSTRACT
Background: Rheumatoid Arthritis (RA) is a common autoimmune
disease. Sensorineural and conductive hearing loss have been reported in RA, but the results of most studies are not in agreement. The pathogenesis of the hearing loss is not clearly understood. The presence of sensorineural hearing loss was related to matrix metalloproteinase-3 (MMP-3). Objectives: to evaluate hearing loss in RA patients and to examine the correlation between plasma MMP-3 level and the hearing loss. Methods: Subjects consisted of 21 RA patients with hearing loss as study group and 21 RA patients without hearing loss as control group. All patients were evaluated by pure tone audiometry and tympanometry. The
amounts of plasma MMP-3 of the patients were determined using Enzyme-Linked Immunosorbent Assay. Results: This study found sensorineural (76.2%), conductive (14.3%), and mixed (9.5%) hearing loss. The most common degree of hearing loss was mild (66.7%). There were significant differences between the groups in mean hearing thresholds (p<0.001), mean air conduction thresholds in 1,000 Hz – 8,000 Hz (p<0.05), and mean bone conduction thresholds in every frequencies (p<0.05). We found an increased incidence of As type tympanogram in study group (28.6%) and control group (47.6%). The significant difference (p<0.05) of mean MMP-3 levels was also found between the groups.
Conclusion: Hearing loss is a common finding in RA. MMP-3 may
contribute to degrade incudomalleal and incudostapedial joint and to harm inner ear cells by an oxidative process. Frequent evaluation of audiometric and tympanometric tests is recommended for controlling the hearing loss.
Key words: hearing loss, MMP-3, Enzyme-Linked Immunosorbent Assay,
rheumatoid arthritis
