Lege Artis Medicinae

[PSORIATIC ARTHRITIS AND ITS PHARMACOLOGICAL TREATMENT MODALITIES]

KOÓ Éva1

SEPTEMBER 19, 2008

Lege Artis Medicinae - 2008;18(08-09)

[Psoriatic arthritis is a destructive form of inflammatory arthritis that occurs in 10-30% of patients with psoriasis. Its prevalence is about 10.000 to 20.000 in Hungary. The pathogenesis includes both genetic and immunological factors. Average disease progression based on functional status is, on average, 0.05 HAQ score/year. The traditional disease-modifying antirheumatic drugs (DMARDs) are not always successful in controlling the disease and preventing joint damage. Based on the pathogenesis of psoriatic arthritis, several new drugs (anti-tumour necrosis factor alfa, or anti-TNF-α) have been introduced in the therapy, which have been found to be effective both in psoriasis and psoriatic arthritis. The development of the Biological Response Modifying Drugs (BRMDs) makes treatment possible for patients with the most serious, high activity disease, who are refractory to other therapy. There is no significant difference in efficacy among the different biological agents (etanercept, infliximab, adalimumab). The review presents the traditional DMARDs, as well as the indications, effectiveness, side effects and the national prescription regulations of the anti- TNF-alfa agents. Both DMARDs and TNF-α inhibitors can be safely used in psoriatic arthritis under strict specialist control.]

AFFILIATIONS

  1. Budai Irgalmasrendi Kórház, II. Reumatológiai Osztály

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[The Discovery of Insulin]

KÖVES Péter

Lege Artis Medicinae

[“It is Important to Transmit the Message...” An Interview with Professor Gábor Pavlik by Elemér Nemesánszky]

NEMESÁNSZKY Elemér

Lege Artis Medicinae

[What Cannot be Learned from the Books]

BORCSICZKY Dóra

Lege Artis Medicinae

[The Self-Healing Art of Frida Kahlo]

OLÁH Szabina

Lege Artis Medicinae

[The History of Prosthetics from the Beginning until Today]

MAYER Ágnes

All articles in the issue

Related contents

Clinical Oncology

[Therapy of endometrial cancer - an update]

SIPOS Norbert

[Endometrial cancer is the most frequent gynecologic malignancy in developed countries. Recently, there is a signifi cant increase of incidence caused by epidemic obesity. While the etiology of endometrial cancer can be heterogeneous, the effective therapy should be rather personalized. The primary therapy of endometrial cancer is operative. The recommended surgery is total abdominal hysterectomy and bilateral salpingo-oophorectomy. Management of pelvic and paraaortic lymphadenectomy is supported by the latest international recommendations, except cases of low-risk tumors (stage I/A, grade 1 or 2, endometrioid type, diameter of tumor <2 cm). Method of adjuvant therapy, especially in developed stages, is still controversial. Efficacy of postoperative irradiation, chemotherapy and chemoirradiation is under investigation by several ongoing studies. Recurrent endometrial cancer has bad prognosis, the best solution in this case is chemotherapy. In recent years targeted therapy (especially antiangiogenetic drugs, mTORinhibitors and hormontherapy) gave us some promising results. Around 80% of endometrial cancers can be diagnosed at early stages and cured with efficacy. Unfortunately, there is a group of tumors with bad prognosis, low differentiation, or recurrency, which can be a real challenge for clinicians. In this review we discuss the latest and most promising studies and scientifi c results in connection with treatment of high-risk endometrial cancers.]

Clinical Oncology

[Obesity and cancer]

VALTINYI Dorottya

[The role of obesity in the development of cancer is well-known from ages. However, these days we witness the explosion-like increase of obesity, globally, but mainly in the economically advanced population, and, which is even more alarming, among youngsters. The prognosis of the obesity-related cancer is rather poor, therefore, the prevention, including the screening, have outstanding importance. Unfortunately, the participation of the obes persons, especially obes women, in these programs is very low. The diagnostics and therapies should consider the special features of obesity, which are related to the magnitude, distribution, composition of fatty tissue connected to the changes in pharmacokinetics. Moreover, the problems might be complicated with obesity-associated non-tumorous severe diseases (e.g. cardiovascular, diabetes type 2).This review covers different aspects of obesity-cancer relationships, with an emphasis on everyday oncology.]

Clinical Oncology

[Pregnancy and cancer]

NAGY Zsuzsanna, SZILLER István, VALTINYI Dorottya, HORVÁTH Orsolya

[The joint appearance of pregnancy and cancer is rare. It is highly recommended that the tumorous pregnant should be managed by a multidisciplinary team. The early diagnosis is very important, but it is not easy, because the symptoms of pregnancy and cancer are rather similar. Imaging diagnosis has to avoid ionizing radiation (e.g. PET/CT). The same is true for chemotherapy in the fi rst trimester, due to the increased risk of developmental abnormalities. Consequently, radiation therapy is not allowded throughout the pregnancy, and the chemotherapy in the fi rst trimester is a strong indication for the interruption of pregnancy. Surgery, with good practice, usually can be performed without complications. Chemotherapy, given in the second and third trimester generally follows the standard protocols with a low frequency of developmental errors. Early delivery should not be encouraged, except the delay has a hazardous effect on the mother and/or on the child. The pregnant should be informed about all steps to be an active part of the fi nal decision.]

Clinical Neuroscience

[Burning sensation in oral cavity - burning mouth syndrome in everyday medical practice]

GERLINGER Imre

[Burning mouth syndrome (BMS) refers to chronic orofacial pain, unaccompanied by mucosal lesions or other evident clinical signs. It is observed principally in middle-aged patients and postmenopausal women. BMS is characterized by an intense burning or stinging sensation, preferably on the tongue or in other areas of the oral mucosa. It can be accompanied by other sensory disorders such as dry mouth or taste alterations. Probably of multifactorial origin, and often idiopathic, with a still unknown etiopathogenesis in which local, systemic and psychological factors are implicated. Currently there is no consensus on the diagnosis and classification of BMS. This study reviews the literature on this syndrome, with special reference to the etiological factors that may be involved and the clinical aspects they present. The diagnostic criteria that should be followed and the therapeutic management are discussed with reference to the most recent studies.]

Lege Artis Medicinae

[Clinical aspects of ischaemic bowel disease]

DEMETER Pál

[Decreased blood flow through the intestines leads to mesenteric ischaemia, which is characterised by cellular damage due to the lack of oxygen and nutrients. Extensive collateralisation between splanchnic vessels serves as a protective mechanism against ischaemia. Intestinal ischaemia can be classified on the basis of its timing, location and the vessels involved. Acute mesenteric ischaemia can result from arterial embolisation, arterial or venous thrombosis, or vasoconstriction secondary to systemic circulation disorder associated with hypovolaemia. Chronic mesenteric ischaemia develops as a consequence of partial or complete occlusion of splanchnic vessels. Colonic ischaemia is mainly caused by a limited circulation disorder of the inferior mesenteric artery. Mortality rates for the various forms of acute mesenteric ischaemia are different. However, early diagnosis before bowel infarction might improve survival. This paper summarises the cilical aspects, diagnosis and therapeutic options of intestinal ischaemia.]