Farmakoterapijske mogućnosti liječenja reumatoidnog artritisa

master's thesis

• Title (english): Pharmacotherapeutic possibilities in the treatment of rheumatoid arthritis
• Author: Silvia Majsec
• Mentor: Petra Turčić (mentor)
• Committee member: Maja Ortner Hadžiabdić (predsjednik povjerenstva)
• Committee member: Petra Turčić (član povjerenstva)
• Committee member: Jasna Jablan (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Department of pharmacology); Zagreb
• Defense date and country: 2019-07-09, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Reumatoidni artritis je kronična, sistemska, upalna autoimuna bolest koja simetrično zahvaća velike i male zglobove,
a obično se javlja u dobi između tridesete i pedesete godine života te pogađa 0,5-2 % svjetske populacije, češće žene.
Glavna tkiva zahvaćena upalom su sinovijalna membrana zglobova i ovojnica tetiva. Uzrok bolesti nije u potpunosti
razjašnjen, ali je bolest karakterizirana kompleksnom patogenezom koja uključuje interakciju genetičkih, imunosnih
i okolišnih čimbenika. Bolest je također praćena brojnim komorbiditetima, kao što su noduli na području laktova i
zglobova prstiju, pulmonarne, kardiovaskularne i hematološke tegobe te sekundarni Sjögrenov sindrom. Rana
dijagnoza je važna kako bi se spriječila progresija bolesti i što ranije postigla remisija. Dijagnostika još uvijek nije
specifična i teško je u ranom stadiju bolesti precizirati radi li se točno o reumatoidnom artritisu obzirom na određene
podudarnosti s ostalim autoimunim bolestima ili drugim vrstama artritisa. U dijagnostiku ulazi broj upaljenih
zglobova, trajanje upale, radiografske snimke te laboratorijski nalazi (prisutnost RF i/ili ACPA u serumu, povećane
vrijednosti CRP-a i sedimentacije eritrocita). Liječenje se obično započinje lijekovima koji modificiraju tijek bolesti
(eng. DMARD), uglavnom metotreksatom, osim u slučaju postojeće kontraindikacije ili slabe podnošljivosti, uz
povremenu primjenu kortikosteroida i NSAIL. Ako nije postignut zadovoljavaljući terapijski odgovor u terapijski
režim se dodadje još jedan DMARD ili biološki lijek. Biološki agensi u uporabi za terapiju RA su inhibitori TNF-α,
antagonisti IL-1, inhibitori aktivacije T-stanica, antagonisti B-stanica i antagonisti IL-6, a njihove najčešće nuspojave
uključuju ozbiljne infekcije, reakcije na mjestu primjene, gastrointestinalne nuspojave te supresiju koštane srži. Ne
preporuča se međusobna kombinacija bioloških lijekova.

Abstract (english)

Rheumatoid arthritis is a chronic, systemic, inflammatory autoimmune disease that symmetrically affects large and small
joints and usually occurs between the ages of thirty and fifty, affecting 0.5-2% of the world's population, more often
women. The main tissues affected by inflammation are the synovial membrane of the joints and the tendon. The cause of
the disease is not fully clarified, but the disease is characterized by complex pathogenesis that involves the interaction of
genetic, immune and environmental factors. The disease is also accompanied by numerous comorbidities, such as nodules
in the area of the elbows and joints of the fingers, pulmonary, cardiovascular and hematological disorders, and secondary
Sjögren's syndrome. Early diagnosis is important to prevent progression of the disease and to accomplish earlier remission.
Diagnosis is still not distinctive and in the early stages of the disease it is very difficult to determine whether is it exactly
rheumatoid arthritis considering certain similarities with other autoimmune diseases or other types of arthritis. Diagnosis
involves the number of injured joints, duration of inflammation, radiographic images and laboratory findings (presence
of RF and / or ACPA in serum, increased CRP and erythrocyte sedimentation). Treatment is usually started with DMARDs
(disease-modifying anti-rheumatic drugs), mainly methotrexate, except in the case of existing contraindications or poor
tolerability, with occasional use of corticosteroids and NSAIDs. If no satisfactory therapeutic response is achieved another
DMARD or biological drug is added in the therapeutic regimen. Biologic agents for use in therapy of RA include TNF-α
inhibitors, IL-1 antagonists, T-cell activation inhibitors, B-cell antagonists and IL-6 antagonists. Their most common side
effects include severe infections, injection site reaction, gastrointestinal side effects and bone marrow suppression. Mutual
combination of biological drugs is not recommended.

• Keywords: reumatoidni artritis; biološki lijekovi; liječenje
• Keywords (english): rheumatoid arthritis; biological drugs; therapy
• Language: croatian
• URN:NBN: urn:nbn:hr:163:467492
• Study programme: Title: Pharmacy; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: magistar/magistra farmacije (magistar/magistra farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2020-02-21 16:17:37