IMUNOMODULATORNA REUMATOLOŠKA TERAPIJA I NESTEROIDNI ANTIREUMATICI PRIJE ZAČEĆA, U TRUDNOĆI I DOJENJU – PREGLED SMJERNICA

The course and outcome of pregnancy can be affected by the activity of the inflammatory rheumatic disease itself and by the drugs we use. Evidence on the safe use of drugs during pregnancy is largely lacking due to the observational nature of the studies conducted and the difficulty of conducting clinical trials in pregnancy. The current guidelines of the professional and scientific societies of rheumatology — the European Alliance of Associations for Rheumatology (EULAR), the American College of Rheumatology (ACR) and the British Society for Rheumatology (BSR) are analysed and consolidated in this review paper. Drugs like methotrexate, leflunomide, mycophenolate mofetil, cyclophosphamide and Janus kinase inhibitors (JAK inhibitors) are contraindicated in pregnancy and should be avoided during pregnancy planning and replaced by drugs that are compatible with pregnancy. Immunomodulators that are considered compatible with pregnancy are prednisone, hydroxychloroquine, sulfasalazine, azathioprine, cyclosporine, tacrolimus, colchicine, dapsone and most biologic drugs. When it comes to biologics, tumour necrosis factor inhibitors (TNF-inhibitors) are the most studied drugs and all of them are safe to use in the first and second trimesters of pregnancy. Certolizumab is considered to be the safest due to almost no placental transfer. There is still insufficient evidence for other biologic drugs, and it is recommended to discontinue them before pregnancy/when pregnancy is confirmed. The use of all biologic drugs can be continued throughout the pregnancy if they are necessary to establish control over the activity of the mother’s severe/life-threatening disease. Effective drug treatment of an active inflammatory rheumatic disease is possible with reasonable safety for the mother and the foetus/child during pregnancy and lactation nowadays.Upalne reumatske bolesti na različite načine mogu utjecati na tijek i ishod trudnoće, kako zbog aktivnosti same bolesti, tako i zbog lijekova koje primjenjujemo. Dokazi o sigurnoj upotrebi lijekova tijekom trudnoće uglavnom su manjkavi zbog opservacijske prirode studija i poteškoća u provođenju kliničkih ispitivanja u trudnoći. U ovom preglednom radu analizirane su i objedinjene aktualne smjernice reumatoloških stručnih društava – European Alliance of Associations for Rheumatology (EULAR), American College of Rheumatology (ACR) i British Society for Rheumatology (BSR). Metotreksat, leflunomid, mofetilmikofenolat, ciklofosfamid i inhibitori janus kinaze (JAK-inhibitori) kontraindicirani su u trudnoći te ih treba kod planiranja trudnoće isključiti i zamijeniti kompatibilnim lijekom. Imunomodulatorni lijekovi koji se smatraju kompatibilnima s trudnoćom jesu prednizon, hidroksiklorokin, sulfasalazin, azatioprin, ciklosporin, takrolimus, kolhicin, dapson te većina bioloških lijekova. Inhibitori faktora tumorske nekroze (TNF inhibitori) najbolje su proučeni i svi se smatraju sigurnima u prvom i drugom tromjesečju trudnoće, a certolizumab se smatra najsigurnijim i gotovo bez placentalnog prijenosa kroz sva tri tromjesečja. Za ostale biološke lijekove još uvijek nema dovoljno dokaza i preporučuje ih se prekinuti prije/kod potvrđene trudnoće. Svi biološki lijekovi mogu se nastaviti uzimati kroz čitavu trudnoću ako su potrebni za kontrolu aktivnosti teške/životno ugrožavajuće bolesti majke. Aktivnu upalnu reumatsku bolest danas je uglavnom moguće učinkovito liječiti uz razumnu sigurnost za majku i za plod/dijete tijekom trudnoće i dojenja

Difference in anaemia expression in men and women with renal failure treated with peritonial dyalisis

Anemija je poznata i česta komplikacija kroničnoga zatajenja bubrega (KZB) sa značajnim utjecajem na morbiditet i mortalitet, smanjenje kvalitete života i troškove zdravstvene zaštite. Smjernice za liječenje anemije KZB ne određuju spolno specifične ciljne vrijednosti hemoglobina (Hb). Iako među spolovima postoje sličnosti u temeljnoj fiziologiji anemije KZB, sve je više dokaza dokaza o različitom odgovoru na anemiju. Izvršili smo retrospektivnu analizu anemije bolesnika tijekom prvih šest mjeseci liječenja peritonejskom dijalizom (PD). Spolne razlike razine Hb koje postoje kod zdrave populacije održane su i kod terminalne faze KZB na početku liječenja PD-om, kao i nakon šest mjeseci liječenja. Veći udio žena (15-30%) zahtijeva uvođenje lijekova za stimulaciju eritropoeze (LSE), za razliku od muškaraca. Prosječna mjesečna doza eritropoetina bila je 70% veća kod žena. Unatoč nižim apsolutnim razinama Hb, žene pokazuju više razine Hb u odnosu na referentne vrijednosti specifične za spol, nego muškarci.Anemia is recognized as a common complication of chronic kidney disease (CKD) with a significant impact on morbidity and mortality and a decline in quality of life and health care costs. Guidelines for the treatment of CKD anemia do not specify sex-specific Hb targets. There are similarities among genders in the basic physiology of anemic CKD, but there is growing evidence with respect to differential responses to anemia between genders. We performed a retrospective analysis of patients during the first six months of peritoneal dialysis (PD) treatment. Gender differences in Hb level seen in the healthy populations are maintained in subjects with end stage renal disease at PD inception and after six months of treatment. A greater proportion (15-30%) of females require erythropoiesis stimulating agents (ESA) than males. The average monthly EPO dose was 70% higher in females. Despite lower absolute levels of Hb, women manifest higher Hb levels relative to gender-specific normative values than men