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

Optimizing rheumatoid arthritis treatment with rituximab - individualized patient approach

Praćenje aktivnosti bolesti osnova je u usmjeravanju liječenja reumatoidnog artritisa rituksimabom (RTX). Uz praćenje kliničkih znakova i biomarkeri (RF i anti-CCP) mogu rano usmjeriti liječenje i ukazati na vjerojatan terapijski odgovor. Seropozitivnost (RF i/ili anti-CCP) povezani su dobrim odgovorom na liječenje s RTX u bolesnika koji nisu imali odgovarajući odgovor na anti-TNF lijek i DMARD te u bolesnika koji nisu liječeni metotreksatom (MTX). U odabiru lijeka za bolesnike koji nisu imali odgovarajući odgovor na anti TNF lijekove treba uzeti u obzir rezultate recentnih publikacija. One ukazuju da se u takvih bolesnika liječenih s RTX postiže značajno poboljšanje DAS8 u odnosu na liječenje novim anti-TNF lijekom. Recentne NICE smjernice preporučuju primjenu RTX u kombinaciji s MTX nakon izostanka odgovarajućeg odgovor na anti TNF lijek umjesto ponovne primjena novog antiTNF lijeka.Disease activity assessment is a cornerstone of monitoring rheumatoid arthritis (RA) development and guidance for rituximab treatment. Beside clinical signs and symptoms biomarkers (RF and anti-CCP) are important early predictors of response to therapy and they can predict disease development. Autoantibody (RF and anti-CCP) seropositivity has been associated with positive response to rituximab (RTX) in antiTNF-IR patients, DMARD-IR patients and MTX-naive patients. Selecting therapy for TNF-IR patients providing most likely response it should be taken in consideration results form recently published assessments demonstrating for RTX treated patients significant improvement in DAS28 from baseline versus alternative TNF inhibitor treatment. Recently published NICE treatment guideline is recommending upon antiTNF failure RTX treatment (in combination with MTX) instead antiTNF cycling

Clinical significance of antinuclear antibodies and other serological abnormalities in systemic lupus erythematosus (SLE)

Protutijela na dijelove jezgre su glavno serološko obilježje SLE. Neka od njih smatraju se patognomonična dok su druga epifenomen. Kliničko značenje nekih od protutijela važno je u postavljanaju dijagnoze, dok su druga bitna u monitoiranju bolesti. Pojedina protutijela povezuju se s određenim kliničkim obilježjima bolesti.Antinuclear antibodies are main serologic halmark of SLE. Some of them are patogenic. Others are epiphenomenon. Clinical significance of some atibodies are important in making dyagnosis of the disease, others are more importnat in monitoring the disease. Some antibodies are in correlation with particular clinical signs of the diseases