POLIARTIKULARNI ARTRITIS - PREVENCIJA HRONIČNIH OŠTEĆENJA ZGLOBOVA
DOI:
https://doi.org/10.46793/PP170204005LKljučne reči:
juvenilni idiopatski artritis, poliartikularni artritis, terapijaApstrakt
Poliartikularni oblik juvenilnog idiopatskog artritisa (JIA) klinički definiše prisustvo artritisa u pet i više zglobova tokom prvih šest meseci bolesti. U zavisnosti od prisustva reumatoidnog faktora u serumu (RF), razlikujemo dve podgrupe: RF pozitivni i RF negativni poliarikularni JIA. Iako je klinička slika slična, medjusobno se razlikuju po toku bolesti i u prognostičkom smislu. RF negativni poliartrikularni JIA ima nešto sporije progresivan tok, za razliku od RF pozitivnog poliartrikularnog JIA koji već na početku bolesti može dovesti do oštećenja i destrukcije zglobova, zbog čega je kod ovog podtipa neophodan agresivniji terapijski pristup. Poslednjih godina nova saznanja o etiopatogenezi JIA i napredak genetskog inženjeringa su omogućili razvoj i primenu najnovijih terapijskih sredstava što je svakako promenilo tok i ishod bolesti kod ovih pacijenata. Savremeni koncept lečenja ima za cilj da obezbedi dobar kvalitet života ovim pacijentima, da se aktivnost bolesti dovede pod kontrolu, da umanji subjektivne tegobe, omogući normalan rast i razvoj dece, očuva funkcionalnost zglobova i prevenira pojavu deformiteta, nastanak invalidnosti i radne nesposobnosti. Terapijski pristup u poliartikularnom JIA jeste strogo individualno prilagođen svakom bolesniku i zavisi od podtipa poliartikularnog JIA i prisustva loših prognostičih faktora, te predstavlja kombinaciju primene antiinflamatornih i imunomodulatornih lekova uz neophodnost sprovodjenja fizikalne terapije. Kako pacijenti sa poliartrikularnim JIA imaju lošu prognozu bolesti treba ih lečiti što ranije i što agresivnije uključujući ranu primenu metotreksata i bioloških lekova, posebno ukoliko ne postignu adekvatan terapijski odgovor ili imaju gastričnu nepodnošljivost na metotreksat. Uvodjenje biološke terapije i naša dosadašnja decenijska pozitivna iskustva ukazali su na visok stepen terapijske efikasnosti i bezbednosti kod najmlađih bolesnika, što je u skladu sa rezultatima drugih evropskih zemalja.
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