Treatment of vasculitis

Liječenje vakulitisa ovisi o etiologiji i tipu vaskulitisa. U liječenju sistemskih vaskulitisa glukokortikodi su prvi lijekovi izbora. Dok je u vaskulitisima velikih krvnih žila često dovoljna primjena samo glukokortikoida u s ANCA povezanim vaskulitisima gotovo uvijek je potrebna inicijalna kombinacija glukokortikoida i imunosupresiva (u težim oblicima ciklofosfamid, a u lakšim metotreksat ili azatioprin). Terapija održavanja u s ANCA povezanim vaskulitisima obično je meotreksat ili azatioprin. Od bioloških lijekova dosta se očekuje od primjene tocilizumaba u giganatocelularnom arteritisu, dok je u s ANCA povezanim vaskulitisma nedavno od regualatornih tijela odobrena primjena rituksimaba koji se smatra jednakovrijedan ciklofosfamidu u indukciji remisije, a preferira se u relapsnim oblicima bolesti.Treatment of vasculitis depends on etiology and type of vasculitis. Gluccocorticoids are drug of choice in treatment of systemic vasculitis. While in vasculitis of large vessels treatment with gluccocorticoids is often sufficient, in ANCA associated vasculitis almost always intial combination of gluccocorticoids and immunosupresive drugs (cyclofosfamide in severe forms; azatioprin and metotrrexate in moderate disease) is needed. Maintance therapy of ANCA associated vasculitis is methotrexate or azatioprin. From biologic therapy, in gigantocellular vasculitis treatment with tocilizumb has a great expectation, while in ANCA associated vasculitis recently rituximab was approved by regulatory agencies, and it is nontinferior to cyclofosfamide in induction of remission and prefarable in relapsing disease

Treatment of vasculitis

Liječenje vakulitisa ovisi o etiologiji i tipu vaskulitisa. U liječenju sistemskih vaskulitisa glukokortikodi su prvi lijekovi izbora. Dok je u vaskulitisima velikih krvnih žila često dovoljna primjena samo glukokortikoida u s ANCA povezanim vaskulitisima gotovo uvijek je potrebna inicijalna kombinacija glukokortikoida i imunosupresiva (u težim oblicima ciklofosfamid, a u lakšim metotreksat ili azatioprin). Terapija održavanja u s ANCA povezanim vaskulitisima obično je meotreksat ili azatioprin. Od bioloških lijekova dosta se očekuje od primjene tocilizumaba u giganatocelularnom arteritisu, dok je u s ANCA povezanim vaskulitisma nedavno od regualatornih tijela odobrena primjena rituksimaba koji se smatra jednakovrijedan ciklofosfamidu u indukciji remisije, a preferira se u relapsnim oblicima bolesti.Treatment of vasculitis depends on etiology and type of vasculitis. Gluccocorticoids are drug of choice in treatment of systemic vasculitis. While in vasculitis of large vessels treatment with gluccocorticoids is often sufficient, in ANCA associated vasculitis almost always intial combination of gluccocorticoids and immunosupresive drugs (cyclofosfamide in severe forms; azatioprin and metotrrexate in moderate disease) is needed. Maintance therapy of ANCA associated vasculitis is methotrexate or azatioprin. From biologic therapy, in gigantocellular vasculitis treatment with tocilizumb has a great expectation, while in ANCA associated vasculitis recently rituximab was approved by regulatory agencies, and it is nontinferior to cyclofosfamide in induction of remission and prefarable in relapsing disease

The efficacy and safety of the combination of leflunomide (Arava®) and biological agents in treatment of rheumatoid arthritis

U radu je prikazana učinkovitost i sigurnost primjene kombinacije leflunomida (Arava®) i bioloških lijekova u liječenju reumatoidnog artritisa.The efficacy and safety of the combination of leflunomide (Arava®) with biological agents in treatment of rheumatoid arthritis is are presented

Antiresorptive agents in the treatment of osteoporosis

Cilj medikamentoznog liječenja osteoporoze jest uspostaviti ravnotežu između aktivnosti osteoblasta i osteoklasta te time povećati mineralnu gustoću kosti i posljedično smanjiti rizik prijeloma. Antiresorptivni lijekovi suprimiraju djelovanje osteoklasta te na taj način smanjuju razgradnju kosti. Tu pripadaju bisfosfonati, selektivni modulatori estrogenskih receptora (SERM) te denosumab, dok su hormonsko nadomjesno liječenje i kalcitonin danas uglavnom napušteni. Vežući se za kristale hidroksiapatita na površini kosti bisfosfonati inhibiraju resorpciju kosti te posljedično dovode do smanjenja rizika za vertebralne i nevertebralne prijelome. Denosumab je monoklonsko protutijelo koje sprečavanjem interakcije između RANKL-a i RANK-a inhibira osteoklastogenezu i tako smanjuje resorpciju kosti u kortikalnoj i trabekularnoj kosti te posljedično znatno smanjuje rizik za prijelome.The aim of drug treatment of osteoporosis is the balance between activity of osteoblasts and osteoclasts with augmentation of mineral bone density and decrease of fracture risk. Antiresorptive agents depress osteoclasts and diminish resorption of bone. They include bisphosphonates, selective estrogen receptor modulators (SERMs), denosumab, while hormone replacement therapy and calcitonin are mostly abandoned. By binding to hydroxyapatite crystals of bone surface bisphosphonates inhibit the resorption of bone and prevent vertebral and non-vertebral fractures. Denosumab is a monoclonal antibody which by hindering interaction between RANKL and RANK inhibits osteoclastogenesis and diminishes bone resorption in cortical and trabecular bones, thus significantly lessening fracture risk

Interstitial lung disease (ILD) in systemic sclerosis (SSc)

Intersticijska bolest pluća je česta komplikacija sistemske skleroze koja nerijetko ima lošu prognozu te je zajedno s plućnom arterijskom hipertenzijom najčešći uzrok smrti u ovoj bolesti. U otkrivanju i praćenju iste, najvažnije metode su CT visoke rezolucije te funkcionalni testovi plućne funkcije. Odluka o započinjanju liječenja često je vrlo teška. Kandidati za imunosupresivno liječenje su obično bolesnici u kojih sistemska bolest kratko traje i u kojih dolazi do naglog pada DCO. Kao lijek izbora najčšće se spominje cikolofosfamid primjenjen intavavenski u mjesečnim intervalima zajedno s malim dozama glukokortikoida iako se u liječenju primjenjuju i drugi imunosupresivi, najčešće azatioprin ili mikofenolat mofetil.Intersitial lung disease is a frequent complication of systemic sclerosis that often has a poor pognosis and together with pulmonary arterial hypertension are the most common cause of death in scleroderma patients. For detection and evaluation of interstitial lung disease, high-resolution CT and pulmorary functional tests are pivotal. The decision about whether to start treatment is often the most difficult challenge. Patients with short duration of systemic disease with recent deterioration in DCO are the candidates for immunosupressive therapy. Best current initial treatment is intravenous monthly cyclophosphamide together with low-dose oral glucocorticoids although azathioprine and mycophenolate mofetil are also widelly used