CURRICULUM VITAE

Nama : dr. AGUS JOKO SUSANTO, SpPD, K-AI, FINASIM

Tempat/tanggal lahir : Wonogiri, 6 Desember 1973
Agama : Islam
Istri : dr. Dyah Rohmania Agustiana
Alamat kantor : Divisi Alergi Imunologi Klinik-KSM Ilmu Penyakit Dalam
RSUD dr. Moewardi/FK UNS Surakarta
Alamat rumah : Jl. Garuda 43 RT 1/RW 2 Triyagan, Mojolaban, Sukoharjo
Email : agusjoko.susanto4@gmail.com

RIWAYAT PENDIDIKAN

1. Dokter umum Tahun 1999 FK UNS Surakarta

2. Dokter Spesialis Penyakit Dalam Tahun 2010 FK UNS Surakarta
3. Dokter Spesialis Konsultan Tahun 2017 FK UI Jakarta
Alergi Imunologi Klinik

RIWAYAT PEKERJAAN

Tahun Nama Instansi Jabatan

Riwayat Pekerjaan
Tahun Nama Instansi Jabatan

Tahun 1999-2000 RS Keluarga Ibu, Tangerang Dokter Umum

Tahun 2000-2003 Puskesmas Pagerbarang, Tegal Kepala Puskesmas
Tahun 2003-2005 RSI Muhammadiyah Dokter Umum
Jatibarang, Brebes
Tahun 2003-2005 Bapel JPKM Kabupaten Tegal Kepala Bapel JPKM
Tahun 2010-2012 Bagian IPD RSUP dr. Sardjito/ Staf Bagian IPD
FK UGM Yogyakarta
Tahun 2013-Sekarang SMF IPD RSUD dr. Moewardi/ Ketua Divisi Alergi
FK UNS Surakarta Imunologi Klinik
Tahun 2013-Sekarang Tim Pelaksana Uji Coba Kurikulum Anggota
Pendidikan Klinis FK UNS
Tahun 2014-2015 Program Studi Profesi Dokter FK UNS Sekretaris Prodi
Tahun 2014-2017 Tim Perawatan Paliatif RS Moewardi Anggota
Tahun 2017-2018 Tim Verifikator Internal RS Moewardi Anggota
Tahun 2018-sekarang Tim Akreditasi RS Moewardi Ketua Pokja ARK
Tahun 2018-sekarang RS Dr Moewardi Gedung Flamboyan Kepala Instalasi

Keanggotaan Mulai Tahun

Ketua Dewan Pembina Yayasan Autoimun BARLINGMASCAKEBES 2018-sekarang

Dewan Pembina Yayasan Sjogren’s Sindrom Indonesia 2018-sekarang
EAACI Alergi Imunologi Eropa 2017-sekarang
PERALMUNI Indonesia 2015-sekarang
PERALMUNI Cabang Surakarta 2015-sekarang
FINASIM 2014-sekarang
PAPDI Cabang Surakarta 2010-sekarang
IDI Cabang Sukoharjo 2008-sekarang
 Vitamin D and Autoimmune Diseases

AGUS JOKO SUSANTO

Allergy and Clinical Immunology Division

Internal Department-Moewardi Hospital/Sebelas Maret University

AGUS JOKO S, 2019 JEMBER

 IMMUNE SYSTEM

AGUS JOKO S, 2019 JEMBER

AGUS JOKO S, 2019 JEMBER
 Schematic representation of
the human immune system IMMUNE
Ann Nutr Metab 2007;51:301-323 SYSTEM

INNATE ADAPTIVE
IMMUNITY IMMUNITY

Cell
Other non- Complement Humoral
Phagocytosis mediated
specific factors system immunity
immunity

Epithelial barrier
Neutrophilic T lymphocytes
and digestive
granulocyte
functions
Antigen-
NK cells, acute Eosinophilic presenting
phase proteins granulocyte

Monocyte/
Enzymes,
Macrophage,
transferrin, etc
AGUS JOKO S, 2019 JEMBER Dendritic cells
AGUS JOKO S, 2019 JEMBER
 AUTOIMMUNE DISEASE

AGUS JOKO S, 2019 JEMBER

 Autoimmune diseases
• Normally, the immune system does not attack the self.
• This is ensured by elimination of auto-reactive lymphocytes
during their development (negative selection).
• However, there is a large group of diseases in which the
immune system does attack self-cells: autoimmune diseases.
• The attack can be either humoral (by auto-antibodies) or
cellular (by auto-reactive T cells).
• The attack can be directed either against a very specific
tissue, or to a large number of tissues (systemic autoimmune
disease), depending on the self-antigen which is attacked.

AGUS JOKO S, 2019 JEMBER

 Autoimmune Diseases

When the immune system attacks

the body's own cells, it produces
an autoimmune disease.

AGUS JOKO S, 2019 JEMBER

 Why do people get autoimmune disease?

AGUS JOKO S, 2019 JEMBER

Nature Immunology (9): 759-761 (2001)

 TRIGGER FACTOR
Genetic
Drugs and alcohol
Infection

Hormone

Habitual smoker

Ultraviolet radiation

AGUS JOKO S, 2019 Insomnia

 Autoimmune diseases
• Specific:
• Juvenile diabetes (attacks insulin-producing cells)
• Multiple sclerosis (attacks myelin coating of nerve axons)
• Myasthenia gravis (attacks nerve-muscle junction)
• Thyroiditis (attacks the thyroid)
• Etc..

• Systemic: Immune complexes accumulate in many tissues and

cause inflammation and damage.
• Systemic Lupus Erythematosus (anti-nuclear antibodies):
harms kidneys, heart, brain, lungs, skin…, etc..
• Rheumatoid Arthritis (anti-IgG antibodies):
joints, hearts, lungs, nervous system…, etc..
• Rheumatic fever: cross-reaction between antibodies to
AGUS JOKO S, 2019 JEMBER
streptococcus and auto-antibodies.
 SPESIFIC ORGAN
THYROIDITIS HASHIMOTO
MIXODEMA PRIMER
TIROTOKSIKOSIS
ANEMIA PERNISIOSA
GASTRITIS ATROFI AUTOIMUN
PENYAKIT ADDISON
MENOPAUSE PREMATUR
DIABETES JUVENILE
SINDROMA GOOD,S PASTEUR
MYASTHENIA GRAVIS
INFERTILITAS PADA LAKI2
PEMPHIGUS VULGARIS
PEMPHIGOID
OPHTHALMIA SIMPATETIK
UVEITIS FAKOGENIK
MULTIPEL SKLEROSIS
AIHA
ITP
LEUKOPENIA IDIOPATIK
SIROSIS BILIER PRIMER
HEPATITIS KRONIK AKTIF
KOLITIS ULCERATIVA
SINDROMA SJÖGREN
RA
DERMATOMIOSITIS
AGUS JOKO S, 2019 SKLERODERMA
DISKOID LE NON SPESIFIC ORGAN
SLE
 I. CLASSICAL SYSTEMATIC AUTOIMMUNE DISEASES
- Systemic Lupus Erythematosus - Mixed Connective Tissue Disease
- Antiphospholipid Syndrome - Relapsing Polychondrisis
- Rheumatoid Arthritis - Raynaud Phenomenon
- Macrophage Activation Syndrome in - Drug-Induced Autoimmunity
- Juvenile Idiopathic Arthritis - The Multiple Autoimmune Syndrome
- Adult Still Disease

- Systemic Sclerosis

- Sjogren Syndrome

AGUS JOKO S, 2019 JEMBER

 II. SYSTEMIC VASCULITIS
- Giant Cell Arteritis
- Polymyalgia Rheumatica
- Cogan Syndrome
- Henoch-Shoenlein Purpura
- Cryoglobulinemic Syndrome
- Hypersensitivity Angitis
- Takayasu Arteritis
- Polyarteritis Nodosa
- Microscopic Polyangitis
AGUS JOKO S, 2019 JEMBER
- Wagener Granulomatosis
- Churg-Strauss Syndrome
- Buerger Disease
- Behcet Disease
- Susac Syndrome
- Goodpasture Disease
- Kawasaki Disease
 III. IDIOPATHIC INFLAMMATORY MYOPATHIES

- Polymyositis

- Dermatomyositis

- Clinically Amyopathic Dermatomyositis

- Sporadic Inclusion Body Myositis

- Antisynthetase Syndrome

- Granulomatous Myositis

- Eosinophilic Myositis

- Eosinophilic Fasciitis

AGUS JOKO S, 2019 JEMBER

 IV. OTHER IMMUNE-MEDIATED SYSTEMIC DISEASES

- Sarcoidosis

- Spondyloarthropathies

- Periodic Fever Syndrome

- Fibromyalgia Syndrome

AGUS JOKO S, 2019 JEMBER

 V. ENDOCRINE AND REPRODUCTIVE AUTOIMMUNE DISEASE

- Hashimoto Thyroiditis - Autoimmune Parathyroid Disease

- Atrophic Thyroiditis - Autoimmune Polyendocrine Syndrome

- Subacute Thyroiditis - Endometriosis

- Graves Disease - Autoimune Ovarian Failure

- Postpartum Thyroiditis - Autoimmune Orchitis

- Autoimmune Diabetes Mellitus

- Autoimmune Addison Disease or

- Autoimmune Adrenalitis

- Autoimmune Hypophysis
AGUS JOKO S, 2019 JEMBER
 VI. HEPATOBILIARY AND PANCREATIC AUTOIMMUNE DISEASE

- Autoimmune Hepatitis

- Primary Biliary Cirrhosis

- Primary Sclerosing Chalangitis

- Extrahepatic Manifestations in Patient with Cirrhosis Hep C Virus Infx

- Autoimmune Pancreatitis

AGUS JOKO S, 2019 JEMBER

 VII. GASTROINSTESTINAL AUTOIMMUNE DISEASES

- Autoimmune Gastritis

- Ulcerative Colitis

- Inflammatory Bowel Disease

- Celiac Disease

AGUS JOKO S, 2019 JEMBER

 VIII. CUTANEOUS AUTOIMMUNE DISEASES

- Cutaneous Lupus Erythematosus

- Pemphigus and Bullous Pemphigoid

- Vitiligo

- Psoriatic Arthropathy

AGUS JOKO S, 2019 JEMBER

 IX. CARDIOVASCULAR AND PULMONARY AUTOIMMUNE DISEASES

- Autoimmune Dilated Cardiomyopathy

- Rheumatic Fever

- Accelerated Atherosclerosis in Autoimmune Diseases

- Idiopathic Interstitial Pneumonitis

- Pulmonary Arterial Hypertension

AGUS JOKO S, 2019 JEMBER

 X. NEUROLOGICAL AUTOIMMUNE DISEASES
- Multiple Sclerosis

- Myasthenia Gravis

- Lambert-Eaton Myasthenic Syndrome

- Amyotropic Lateral Sclerosis

- Paraneoplastic Neurological Syndrome

- Guillain-Barre and Other Immune-Mediated Neuropathies

- Neuromyelitis Optica (Devic Syndrome)

- Central Nervous System Vasculitis

- Autoimmune Epilepsy

-
AGUS JOKO S, 2019 JEMBER
Autoimmune Chorea and Autoimmune Sensorineural Hearing Loss
 XI. OCULAR AUTOIMMUNE DISEASES

- Autoimmune Retinopathies

- Autoimmune Uveitis

- Vogt-Koyanagi-Harada Disease

- Orbital Myositis

AGUS JOKO S, 2019 JEMBER

 XII. RENAL AUTOIMMUNE DISEASES

- IgA Nephropathy

- Membranous Nephropathy

- Minimal Change Nephropathy

- Focal and Segmental Glomerulosclerosis

- Membranoproliferative or Mesangiocapillary Glomerulonephritis

AGUS JOKO S, 2019 JEMBER

 XIII. HEMATOLOGIC AUTOIMMUNE DISEASES
- Autoimmune Hemolytic Anemia

- Pernicious Anemia

- Idiopathic Aplastic Anemia

- Acquired Adult Pure Red Cell Aplasia

- Myelodysplastic Syndrome

- Autoimmune Lymphopenia

- Autoimmune Neutropenia

- Autoimmune Thrombocytopenic Purpura

- Trombotic Thrombocytopenic Purpura

- Heparin-Induced Thrombocytopenia and Autoimmune Coagulopathies

AGUS JOKO S, 2019 JEMBER
 Diperlukan pendekatan
Tim Dokter multidisipliner untuk
menangani kasus penyakit
yang Menangani Autoimun

Penyakit Dalam
Divisi Alergi Imunologi, Hematologi
Bedah onkologi, Endokrinologi, Gastroent
Bedah digestif, erohepatologi, Nefrologi, Rematolo
onkologi, BTKV dll gi,Tropik Infeksi, psikosomatis dll

Jantung, Paru Kulit, Mata, Obgyn dll

Tim Paramedis Rehabilitasi Medik, Gizi

AGUS JOKO S, 2019 JEMBER
 VITAMIN D

AGUS JOKO S, 2019 JEMBER

 • Vitamin D3 (cholecalciferol) is made in the skin from 7-
dehydrocholesterol from ultraviolet-B (UVB) and a
thermal process.

• Solar UVB extends from 290-315 nm

UVA extends from 315-400 nm

• Vitamin D3 is converted in the liver to 25-

hydroxyvitamin D3 (calcidiol), the circulating form.

• Calcidiol is converted in the kidney and other organs to

1,25-dihydroxyvitamin D3 (calcitriol), the hormonal
version.

AGUS JOKO S, 2019 JEMBER

 Metabolism Of Vitamin D

AGUS JOKO S, 2019 JEMBER

 – Vitamin D receptors found in gut, bone, brain, breast, prostate,
lymphocytes, placenta, and other tissues

– Routine screening is appropriate

– Supplementation helpful in:

DM, Metabolic Syndrome, CAD, depression, autoimmune diseases, various
cancers, HTN, osteoporosis, osteoarthritis, pain, MS, epilepsy, elderly fall
prevention, PCOS, pregnancy & lactation, periodontal disease, URI and influenza,
and decreasing all-cause mortality.

AGUS JOKO S, 2019 JEMBER

 Hypothesis
Accelerated decrease in population serum 25 D caused by :
- Decreased cutaneous synthesis of vitamin D3
- Decreased ingestion of vitamin D-fortified foods
- Increased storage of vitamin D in fat stores
- Failure to mobilize stored vitamin D from fat

AGUS JOKO S, 2019 JEMBER

 How to measure

• 25 OH vitamin D
• Don’t measure 1,25 vitamin D
• Calcium or PTH
• Consider in severe deficiency

AGUS JOKO S, 2019 JEMBER

 Serum Calcidiol Levels
The consensus of scientific understanding appears to be:
– Vitamin D deficiency is serum calcidiol levels :
<20 ng/mL (50 nmol/L)
– Insufficiency in the range : 20-32 ng/mL
– Sufficiency in the range : 33-80 ng/mL
– Normal in sunny countries : 54-90 ng/mL
– Vitamin D excess : >100 ng/mL

Grant WB, Holick MF. Benefits and requirements of vitamin D for optimal health: a review. Altern Med
Rev. 2005;10:94-111.
AGUS JOKO S, 2019 JEMBER
 VITAMIN D AND
AUTOIMMUNE DISEASE
 AUTOIMMUNITY PATHOGENESIS

VITAMIN D
FACTORS

GENETIC IMMUNE
SUSCEPTIBILITY DEREGULATION

AUTOIMMUNITY

AGUS JOKO S, 2019 JEMBER

AGUS JOKO S, 2019 JEMBER
 Vitamin D and Autoimmune Disease

25(OH)D3 Vitamin
serum
levels D intake

UV VDR
exposure polymorphism

AGUS JOKO S, 2019 JEMBER Dankers W,et al. Front.Immunol.

2016;(7):697
 Low Vitamin D Status
Correlates with diseases

- Infection
- Cancer
- Autoimmunity and immune mediated diseases
- Cardiovascular
- Bone and skeletal disease
- Etc

Rosen CJ, NEJM 2011; 364; 248-254

AGUS JOKO S, 2019 JEMBER

 Autoimmune Disease

Vitamin D insufficiency in:

– 50% of patients w/ fibromyalgia + SLE
– Huisman et al. J Rheumatol. 2001;28(11):2535.
– 58% Japanese F’s with Graves Disease
– Yamashita et al. Endocr J. 2001;48(1):63.
– 73% Austrian patients w/ Ankylosing Spondilitis
– Falkenbach et al. Wien Klin Wochenschr. 2001;113(9):328
– Rhematoid Arthtritis
– Cantorna.Proc Soc Exp Biol Med. 2000;223(3):230

AGUS JOKO S, 2019 JEMBER

 Prevention and
treatment

AGUS JOKO S, 2019 JEMBER

 Prevention
• Sunlight
• Winter supplementation
• Supplement
– Pregnant mothers
– Breastfed infants
– Children
– Elderly
– Other high risk
AGUS JOKO S, 2019 JEMBER
 Treatment of deficiency
• High dose:
– Ergocalciferol (D2) 50,000 IU rx weekly x 8 weeks
– D2 not as well-absorbed as D3

• Maintenance:
– Cholecalciferol (D3) 800-2000 IU daily, higher in certain situations

• Sunlight
– 15-45 minutes nonburning midday sun (depending on skin pigment)
several times per week

• UV radiation AGUS JOKO S, 2019 JEMBER

 Toxicity
– Impossible to become toxic from the sun

– Doses > 10,000 IU daily can be toxic

– 25 OH levels of >150 ng/ml

– Symptoms include
– Renal calculi
– Hypercalcemia
– Renal insufficiency
AGUS JOKO S, 2019 JEMBER
– Fatigue and weakness
TAKE HOME
MESSAGE
 Diperlukan pendekatan
Tim Dokter multidisipliner untuk
menangani kasus penyakit
yang Menangani Autoimun

Penyakit Dalam
Divisi Alergi Imunologi, Hematologi
Bedah onkologi, Endokrinologi, Gastroent
Bedah digestif, erohepatologi, Nefrologi, Rematolo
onkologi, BTKV dll gi,Tropik Infeksi, psikosomatis dll

Jantung, Paru Kulit, Mata, Obgyn dll

Tim Paramedis Rehabilitasi Medik, Gizi

AGUS JOKO S, 2019 JEMBER
 Secangkir Kopi Hangat
• Live setiap hari Rabu pagi jam 9.00 – 10.00
(Bincang tentang penyakit autoimun)

• IG : - rsud.moewardi
- @alergi_imunologi_internis_solo

FB : - RSUD Dr. MOEWARDI

- alergi imunologi internis solo

You tube : RSUD Dr. Moewardi

THANK YOU