Dodatni uticaj visokih doza alfakalcidola na mišićnu funkciju prilikom lečenja bolesnika sa aktivnom formom reumatoidnog artritisa
Sažetak
Uvod/Cilj. Hormon D (vitamin D) igra važnu ulogu u imunoregulaciji i koštano-mišićnom metabolizmu. Cilj rada bio je ispitivanje uticaja alfakalcidola (1αD3) analoga hormona D, i prednizona, na mišićnu funkciju i aktivnost bolesti kod obolelih od aktivnog reumatoidnog artritisa (RA). Metode. U istraživanje je bilo uključeno 67 bolesnika sa RA koji su imali aktivnu bolest (indeks aktivnosti bolesti – DAS28 > 3,2), uprkos maksimalno podnošljivoj dozi metotreksata (MTX), tokom prethodna tri meseca. Prikupljeni su podaci o aktivnosti bolesti (DAS28), mišićnoj funkciji [(test ustajanja sa stolice (CRT), test ustani i kreni (TUG), šestominutni test hodanja (6MWT), tandem hod (TW)], kao i zapaljenski i bezbednosni laboratorijski nalazi. Bolesnici su nasumično raspoređeni na tromesečno lečenje: 1 μg (grupa A1) 2 μg (grupa A2) ili 3 μg (grupa A3) 1αD3 dnevno ili prednizon (grupa C) 20 mg dnevno, prvih mesec dana, potom 10 mg, uz MTX. Rezultati. Na kraju lečenja u svim terapijskim grupama nađena je visoko statistički značajno snižena aktivnost bolesti (p < 0,01). U grupi A2, lečenih 1αD3 u dozi 2 µg/dan značajno su poboljšani TUG i 6MWT, a kod lečenih 1αD3 3 µg (A3 grupa) došlo je do visoko statistički značajnog poboljšanja CRT (p < 0,01) i značajnog poboljšanja 6MWT (p < 0,05). U grupi C došlo je do visoko statistički značajnog sniženja nivoa vitamina D (25(OH)D3) u serumu (p < 0,01), nasuprot njegovom povećanju kod lečenih alfakalcidolom. Zaključak. Alfakalcidol u dozi 2 µg i 3 µg dnevno podjednako je efikasan kao prednizon (13,3 mg dnevno) u kontroli aktivnosti RA, a ima i dodatni povoljan efekat na mišićnu funkciju.
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