RELAPSNI POLIHONDRITIS: OD ETIOPATOGENEZE DO TERAPIJE
Sažetak
Relapsni polihondritis (RP) jeste retka autoimuna sistemska bolest, nedovoljno poznate etiopatogeneze, uglavnom relapsno-remitentnog toka, a zahvata elastičnu, hijalinu i fibroznu hrskavicu i tkiva bogata proteoglikanima. Može dovesti do anatomskog i funkcionalnog oštećenja, a uprkos lečenju, i do fatalnog ishoda. Najčešće se manifestuje u vidu aurikularnog i nazalnog hondritisa i poliartritisa. Zahvatanje laringotraheobronhijalnog stabla, kao i srčanih zalistaka i aorte, uz pojavu sekundarne infekcije ‒ pre svega donjih delova respiratornog trakta ‒ najčešći su uzroci letalnog ishoda. U mogući klinički spektar RP-a spadaju: zahvatanje oka episkleritisom, skleritisom i dr., unutrašnjeg uha vestibularnim poremećajima i pojava senzoneuronalnih simptoma,kao i zahvatanje centralnog i perifernog nervnog sistema. Uglavnom se značajno kasni sa postavljanjem dijagnoze, za koju je najbitnija klinička prezentacija, dok su laboratorijski nalazi od suportivnog značaja; imaging metode (CT, PET-CT, MR) važne su pak za procenu aktivnosti bolesti. Blaže oblike RP-a treba lečiti primenom nesteroidnih antiinflamatornih lekova i malim dozama kortikosteroida, dok se teži oblici leče primenom većih i, ukoliko je to potrebno, pulsnih doza kortikosteroida, kao i konvencionalnim i biološkim lekovima za modifikaciju bolesti. Uznapredovali oblici bolesti aorte i srčanih zalistaka zahtevaju hirurško lečenje.
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