<\/span><\/strong><\/h4>\n<\/span><\/strong><\/h4>\nProf. Dr. Ancu\u021ba Codrina<\/span><\/strong>
\nUniversitatea de Medicin\u0103 \u0219i Farmacie \u201cGrigore T. Popa\u201d Ia\u0219i<\/span><\/strong><\/h4>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”3.25″][et_pb_column type=”4_4″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.4.8″]<\/p>\n
Provoc\u0103ri \u00een managementul artritei psoriazice. Noile recomand\u0103ri EULAR 2019<\/span>
Autor: Codrina Ancu\u0163a<\/span><\/p>\nObiective. Definit\u0103 ca o afec\u0163iune reumatic\u0103 cu determinism imun ce se developeaz\u0103 \u00een contextul psoriazisului, artropatia psoriazic\u0103 (APs) r\u0103m\u00e2ne o boal\u0103 multifa\u0163etat\u0103, complex\u0103, caracterizat\u0103 prin inflama\u0163ie cronic\u0103 \u015fi polimorfism clinic, cu impact major asupra calit\u0103\u0163ii vie\u0163ii.
Metode. Progresele f\u0103cute \u00een \u00een\u0163elegerea patobiologiei au permis dezvoltarea unui arsenal terapeutic multivalent, ce r\u0103spunde unei strategii bine definite, focusat\u0103 pe gestionare dual\u0103 a bolii, reumatologic\u0103 \u015fi dermatologic\u0103.
Rezultate. Menite s\u0103 jaloneze g\u00e2ndirea terapeutic\u0103, recomand\u0103rile EULAR 2019 men\u0163ioneaz\u0103 dezideratele (remisiunea sau boala cu activitate minim\u0103) \u015fi instrumentele de control \u00een strategia treat-to-target, anun\u0163\u0103 clasele terapeutice \u015fi stabilesc schemele de tratament \u00een func\u0163ie de fenotipul clinic articular, existen\u0163a manifest\u0103rilor sistemice, r\u0103spunsul\/ non-r\u0103spunsul la medica\u0163ie.
Astfel, AINS \u015fi glucocorticoizii local reprezint\u0103 medica\u0163ia de prim\u0103 inten\u0163ie, indiferent de pattern-ul musculocheletal; remisivele sintetice (cu prioritizarea metotrexatului) sunt apanajul afect\u0103rii articulare periferice, \u00een timp ce biologicele (inhibitorii TNF, IL-17A, IL-12\/23) se recomand\u0103 \u00een APs cu r\u0103spuns suboptimal la csDMARDs. Remisivele \u0163intite \u00ee\u015fi g\u0103sesc aplicabilitatea \u00een situa\u0163ii clar definite – inhibitorii JAK \u00een APs insuficient controlat\u0103 de biologice, iar inhibitorii PDE4 \u00een formele u\u015foare, ce nu se preteaz\u0103 la administrarea bioterapiei. Spre deosebire de artritele periferice, bDMARDs reprezint\u0103 prima linie de medica\u0163ie patogenic\u0103 \u00een formele axiale.
Mai mult, este anticipat atat momentul e\u015fecului terapeutic ce impune switching, dar \u015fi remisiunea persistent\u0103 ce permite adaptarea gradual\u0103 a schemei terapeutice (tapering).
Concluzie. Noile recomand\u0103ri EULAR 2019 constituie un punct de reper \u00een abordarea terapeutic\u0103 standardizat\u0103 a APs, promov\u00e2nd o strategie individualizat\u0103, progresiv\u0103, raportat\u0103 la fenotipul clinic \u015fi severitatea bolii.<\/p>\n
Challenges in the management of psoriasic arthritis. EULAR recommendations – 2019 update<\/span>
Author: Codrina Ancu\u0163a<\/span><\/p>\nObjectives. Defined as an immune-mediated rheumatic disorder developed in patients who have manifest or latent psoriasis, psoriatic arthritis (PsA) is considered a complex multifaceted condition characterized by chronic local and systemic inflammation and a broad spectrum of musculoskeletal as well as mon-musculoskeletal manifestations with significant burden.
Methods. Understanding the complex PsA pathobiology allowed the development of a multivalent therapeutic arsenal and a well-defined strategy focused on dual, rheumatologic and dermatologic management.
Results. Raising the standard of care for patients with PsA, recent European League Against Rheumatism (EULAR) recommendations not only focus on treat-to-target strategy (remission or, alternatively, low disease activity) and a gradual approach using different drug categories, but also provide a standardized algorithm covering the broad spectrum of disease phenotypes, indicating that a comprehensive therapeutic decision should also consider non-musculoskeletal manifestations, comorbidities and safety. Thus, non-steroidal anti-inflammatory drugs and local injections of glucocorticoids may be considered as first-line medication, irrespective of the musculoskeletal pattern. In patients with peripheral arthritis, a conventional synthetic disease-modifying antirheumatic drug (csDMARD) should be early initiated, with methotrexate preferred if relevant skin involvement, while biological drugs (bDMARD) (TNF, IL-17A or IL-12\/23 inhibitors) are recommended in active PsA with inadequate response to at least one csDMARD. Conversely, a TNF or IL-17A inhibitor represents the treatment of choice if axial PsA. JAK inhibitors are classically indicated after bDMARD failure, while phosphodiesterase-4 inhibitors in the context of mild disease.
The challenges of switching in patients with drug failure as well as tapering in those targeting sustained remission are also addressed.
Conclusion. 2019 updated EULAR recommendations remain a benchmark in the standardized therapeutic approach of PsA, providing a personalized, gradual process based on clinical phenotype and severity.<\/p>\n
Scurt CV<\/span><\/p>\nProfesor universitar, Disciplina Reumatologie, Recuperare, Medicina Fizica si Balneologie, Universitatea de Medicina si Farmacie \u201cGrigore T. Popa\u201d Iasi.
Medic primar reumatologie si reabilitare, sef clinica Reumatologie 2, Spitalul Clinic Recuperare Iasi
Coordonator Centru EUSTAR 162, afiliat retelei EUSTAR (European Scleroderma Trials and Research Group),
Coordonator Centru Capilaroscopie \u2013 Network of imaging training center 2016-2021 (EULAR)
Training in capilaroscopie (Paris, Franta 2004), ecografie musculoscheletala (Paris, Franta, 2004; Barcelona, Spania, 2008); osteodensitometrie DXA (Bucuresti, Romania, 2006).
Membru in societati stiintifice internationale:<\/strong> EUSTAR, IASP (International Association for the Study of Pain) si Special Interest Group Musculoskeletal Pain, SLEuro (European Lupus Society)
Domenii de interes:<\/strong> terapia biologica in patologia reumatismala imun mediata, orphan disease (Sclerodermia sistemica, miopatii inflamatorii idiopatice), sarcina si patologia reumatismala imun mediata<\/p>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.22″ background_color=”rgba(117,194,33,0.23)” background_image=”https:\/\/pdi.ro\/2020\/wp-content\/uploads\/2020\/02\/back_justflowers_overlay1.png” background_blend=”luminosity” custom_padding=”54px|0px|0|0px|false|false” top_divider_style=”waves2″ top_divider_color=”#ffffff” top_divider_height=”155px” top_divider_height_tablet=”” top_divider_height_phone=”97px” top_divider_height_last_edited=”on|desktop” bottom_divider_style=”waves2″ bottom_divider_color=”#75c221″ bottom_divider_flip=”vertical” bottom_divider_height_tablet=”” bottom_divider_height_phone=”59px” bottom_divider_height_last_edited=”on|desktop”][et_pb_row column_structure=”3_5,2_5″ _builder_version=”3.25″ custom_padding=”61px|0px|69px|0px|false|false”][et_pb_column type=”3_5″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.0.11″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” text_line_height=”1.2em” header_font=”||||||||” background_layout=”dark” text_font_size_tablet=”” text_font_size_phone=”” text_font_size_last_edited=”on|desktop”]<\/p>\n
Contacteaz\u0103 operatorul PDI 2020<\/p>\n
[\/et_pb_text][et_pb_contact_form email=”contact@primaderma.ro\/2019″ submit_button_text=”Trimite mesajul” _builder_version=”3.19.4″ title_font=”||||||||”][et_pb_contact_field field_id=”Name” field_title=”Nume” _builder_version=”3.18.9″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][et_pb_contact_field field_id=”Email” field_title=”Adresa de e-mail” field_type=”email” _builder_version=”3.19.4″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][et_pb_contact_field field_id=”Message” field_title=”Mesajul dvs.” field_type=”text” fullwidth_field=”on” _builder_version=”3.18.9″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][\/et_pb_contact_form][\/et_pb_column][et_pb_column type=”2_5″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.0.11″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” header_font=”||||||||” background_layout=”dark”]<\/p>\n
Operatorul PDI 2020<\/p>\n
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![\"\"](\"https:\/\/pdi.ro\/2020\/wp-content\/uploads\/2020\/02\/eventer_logo_150px.png\")
<\/span><\/p>\n<\/span><\/p>\n<\/span><\/p>\nAdresa: Str. A. Panu nr. 13, Iasi<\/span>
Tel.: 0332.40.88.00-05<\/span>
E-mail: inscrieri@primaderma.ro<\/a>
<\/span>Website:\u00a0<\/span>www.eventernet.ro<\/a><\/p>\n[\/et_pb_text][et_pb_text disabled_on=”off|off|off” _builder_version=”4.0.11″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” header_font=”||||||||” background_layout=”dark” locked=”off”]<\/p>\n
Parteneri Media<\/p>\n
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Prof. Dr. Ancu\u021ba Codrina Universitatea de Medicin\u0103 \u0219i Farmacie \u201cGrigore T. Popa\u201d Ia\u0219iProvoc\u0103ri \u00een managementul artritei psoriazice. Noile recomand\u0103ri EULAR 2019 Autor: Codrina Ancu\u0163a Obiective. Definit\u0103 ca o afec\u0163iune reumatic\u0103 cu determinism imun ce se developeaz\u0103 \u00een contextul psoriazisului, artropatia psoriazic\u0103 (APs) r\u0103m\u00e2ne o boal\u0103 multifa\u0163etat\u0103, complex\u0103, caracterizat\u0103 prin inflama\u0163ie cronic\u0103 \u015fi polimorfism clinic, cu […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-8407","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8407","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/comments?post=8407"}],"version-history":[{"count":6,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8407\/revisions"}],"predecessor-version":[{"id":8592,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8407\/revisions\/8592"}],"wp:attachment":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/media?parent=8407"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Prof. Dr. Ancu\u021ba Codrina<\/span><\/strong>
\nUniversitatea de Medicin\u0103 \u0219i Farmacie \u201cGrigore T. Popa\u201d Ia\u0219i<\/span><\/strong><\/h4>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”3.25″][et_pb_column type=”4_4″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.4.8″]<\/p>\n
Provoc\u0103ri \u00een managementul artritei psoriazice. Noile recomand\u0103ri EULAR 2019<\/span>
Autor: Codrina Ancu\u0163a<\/span><\/p>\nObiective. Definit\u0103 ca o afec\u0163iune reumatic\u0103 cu determinism imun ce se developeaz\u0103 \u00een contextul psoriazisului, artropatia psoriazic\u0103 (APs) r\u0103m\u00e2ne o boal\u0103 multifa\u0163etat\u0103, complex\u0103, caracterizat\u0103 prin inflama\u0163ie cronic\u0103 \u015fi polimorfism clinic, cu impact major asupra calit\u0103\u0163ii vie\u0163ii.
Metode. Progresele f\u0103cute \u00een \u00een\u0163elegerea patobiologiei au permis dezvoltarea unui arsenal terapeutic multivalent, ce r\u0103spunde unei strategii bine definite, focusat\u0103 pe gestionare dual\u0103 a bolii, reumatologic\u0103 \u015fi dermatologic\u0103.
Rezultate. Menite s\u0103 jaloneze g\u00e2ndirea terapeutic\u0103, recomand\u0103rile EULAR 2019 men\u0163ioneaz\u0103 dezideratele (remisiunea sau boala cu activitate minim\u0103) \u015fi instrumentele de control \u00een strategia treat-to-target, anun\u0163\u0103 clasele terapeutice \u015fi stabilesc schemele de tratament \u00een func\u0163ie de fenotipul clinic articular, existen\u0163a manifest\u0103rilor sistemice, r\u0103spunsul\/ non-r\u0103spunsul la medica\u0163ie.
Astfel, AINS \u015fi glucocorticoizii local reprezint\u0103 medica\u0163ia de prim\u0103 inten\u0163ie, indiferent de pattern-ul musculocheletal; remisivele sintetice (cu prioritizarea metotrexatului) sunt apanajul afect\u0103rii articulare periferice, \u00een timp ce biologicele (inhibitorii TNF, IL-17A, IL-12\/23) se recomand\u0103 \u00een APs cu r\u0103spuns suboptimal la csDMARDs. Remisivele \u0163intite \u00ee\u015fi g\u0103sesc aplicabilitatea \u00een situa\u0163ii clar definite – inhibitorii JAK \u00een APs insuficient controlat\u0103 de biologice, iar inhibitorii PDE4 \u00een formele u\u015foare, ce nu se preteaz\u0103 la administrarea bioterapiei. Spre deosebire de artritele periferice, bDMARDs reprezint\u0103 prima linie de medica\u0163ie patogenic\u0103 \u00een formele axiale.
Mai mult, este anticipat atat momentul e\u015fecului terapeutic ce impune switching, dar \u015fi remisiunea persistent\u0103 ce permite adaptarea gradual\u0103 a schemei terapeutice (tapering).
Concluzie. Noile recomand\u0103ri EULAR 2019 constituie un punct de reper \u00een abordarea terapeutic\u0103 standardizat\u0103 a APs, promov\u00e2nd o strategie individualizat\u0103, progresiv\u0103, raportat\u0103 la fenotipul clinic \u015fi severitatea bolii.<\/p>\n
Challenges in the management of psoriasic arthritis. EULAR recommendations – 2019 update<\/span>
Author: Codrina Ancu\u0163a<\/span><\/p>\nObjectives. Defined as an immune-mediated rheumatic disorder developed in patients who have manifest or latent psoriasis, psoriatic arthritis (PsA) is considered a complex multifaceted condition characterized by chronic local and systemic inflammation and a broad spectrum of musculoskeletal as well as mon-musculoskeletal manifestations with significant burden.
Methods. Understanding the complex PsA pathobiology allowed the development of a multivalent therapeutic arsenal and a well-defined strategy focused on dual, rheumatologic and dermatologic management.
Results. Raising the standard of care for patients with PsA, recent European League Against Rheumatism (EULAR) recommendations not only focus on treat-to-target strategy (remission or, alternatively, low disease activity) and a gradual approach using different drug categories, but also provide a standardized algorithm covering the broad spectrum of disease phenotypes, indicating that a comprehensive therapeutic decision should also consider non-musculoskeletal manifestations, comorbidities and safety. Thus, non-steroidal anti-inflammatory drugs and local injections of glucocorticoids may be considered as first-line medication, irrespective of the musculoskeletal pattern. In patients with peripheral arthritis, a conventional synthetic disease-modifying antirheumatic drug (csDMARD) should be early initiated, with methotrexate preferred if relevant skin involvement, while biological drugs (bDMARD) (TNF, IL-17A or IL-12\/23 inhibitors) are recommended in active PsA with inadequate response to at least one csDMARD. Conversely, a TNF or IL-17A inhibitor represents the treatment of choice if axial PsA. JAK inhibitors are classically indicated after bDMARD failure, while phosphodiesterase-4 inhibitors in the context of mild disease.
The challenges of switching in patients with drug failure as well as tapering in those targeting sustained remission are also addressed.
Conclusion. 2019 updated EULAR recommendations remain a benchmark in the standardized therapeutic approach of PsA, providing a personalized, gradual process based on clinical phenotype and severity.<\/p>\n
Scurt CV<\/span><\/p>\nProfesor universitar, Disciplina Reumatologie, Recuperare, Medicina Fizica si Balneologie, Universitatea de Medicina si Farmacie \u201cGrigore T. Popa\u201d Iasi.
Medic primar reumatologie si reabilitare, sef clinica Reumatologie 2, Spitalul Clinic Recuperare Iasi
Coordonator Centru EUSTAR 162, afiliat retelei EUSTAR (European Scleroderma Trials and Research Group),
Coordonator Centru Capilaroscopie \u2013 Network of imaging training center 2016-2021 (EULAR)
Training in capilaroscopie (Paris, Franta 2004), ecografie musculoscheletala (Paris, Franta, 2004; Barcelona, Spania, 2008); osteodensitometrie DXA (Bucuresti, Romania, 2006).
Membru in societati stiintifice internationale:<\/strong> EUSTAR, IASP (International Association for the Study of Pain) si Special Interest Group Musculoskeletal Pain, SLEuro (European Lupus Society)
Domenii de interes:<\/strong> terapia biologica in patologia reumatismala imun mediata, orphan disease (Sclerodermia sistemica, miopatii inflamatorii idiopatice), sarcina si patologia reumatismala imun mediata<\/p>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.22″ background_color=”rgba(117,194,33,0.23)” background_image=”https:\/\/pdi.ro\/2020\/wp-content\/uploads\/2020\/02\/back_justflowers_overlay1.png” background_blend=”luminosity” custom_padding=”54px|0px|0|0px|false|false” top_divider_style=”waves2″ top_divider_color=”#ffffff” top_divider_height=”155px” top_divider_height_tablet=”” top_divider_height_phone=”97px” top_divider_height_last_edited=”on|desktop” bottom_divider_style=”waves2″ bottom_divider_color=”#75c221″ bottom_divider_flip=”vertical” bottom_divider_height_tablet=”” bottom_divider_height_phone=”59px” bottom_divider_height_last_edited=”on|desktop”][et_pb_row column_structure=”3_5,2_5″ _builder_version=”3.25″ custom_padding=”61px|0px|69px|0px|false|false”][et_pb_column type=”3_5″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.0.11″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” text_line_height=”1.2em” header_font=”||||||||” background_layout=”dark” text_font_size_tablet=”” text_font_size_phone=”” text_font_size_last_edited=”on|desktop”]<\/p>\n
Contacteaz\u0103 operatorul PDI 2020<\/p>\n
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Operatorul PDI 2020<\/p>\n
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<\/span><\/p>\n<\/span><\/p>\n<\/span><\/p>\nAdresa: Str. A. Panu nr. 13, Iasi<\/span>
Tel.: 0332.40.88.00-05<\/span>
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Prof. Dr. Ancu\u021ba Codrina Universitatea de Medicin\u0103 \u0219i Farmacie \u201cGrigore T. Popa\u201d Ia\u0219iProvoc\u0103ri \u00een managementul artritei psoriazice. Noile recomand\u0103ri EULAR 2019 Autor: Codrina Ancu\u0163a Obiective. Definit\u0103 ca o afec\u0163iune reumatic\u0103 cu determinism imun ce se developeaz\u0103 \u00een contextul psoriazisului, artropatia psoriazic\u0103 (APs) r\u0103m\u00e2ne o boal\u0103 multifa\u0163etat\u0103, complex\u0103, caracterizat\u0103 prin inflama\u0163ie cronic\u0103 \u015fi polimorfism clinic, cu […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-8407","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8407","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/comments?post=8407"}],"version-history":[{"count":6,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8407\/revisions"}],"predecessor-version":[{"id":8592,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8407\/revisions\/8592"}],"wp:attachment":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/media?parent=8407"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Autor: Codrina Ancu\u0163a<\/span><\/p>\n
Obiective. Definit\u0103 ca o afec\u0163iune reumatic\u0103 cu determinism imun ce se developeaz\u0103 \u00een contextul psoriazisului, artropatia psoriazic\u0103 (APs) r\u0103m\u00e2ne o boal\u0103 multifa\u0163etat\u0103, complex\u0103, caracterizat\u0103 prin inflama\u0163ie cronic\u0103 \u015fi polimorfism clinic, cu impact major asupra calit\u0103\u0163ii vie\u0163ii.
Metode. Progresele f\u0103cute \u00een \u00een\u0163elegerea patobiologiei au permis dezvoltarea unui arsenal terapeutic multivalent, ce r\u0103spunde unei strategii bine definite, focusat\u0103 pe gestionare dual\u0103 a bolii, reumatologic\u0103 \u015fi dermatologic\u0103.
Rezultate. Menite s\u0103 jaloneze g\u00e2ndirea terapeutic\u0103, recomand\u0103rile EULAR 2019 men\u0163ioneaz\u0103 dezideratele (remisiunea sau boala cu activitate minim\u0103) \u015fi instrumentele de control \u00een strategia treat-to-target, anun\u0163\u0103 clasele terapeutice \u015fi stabilesc schemele de tratament \u00een func\u0163ie de fenotipul clinic articular, existen\u0163a manifest\u0103rilor sistemice, r\u0103spunsul\/ non-r\u0103spunsul la medica\u0163ie.
Astfel, AINS \u015fi glucocorticoizii local reprezint\u0103 medica\u0163ia de prim\u0103 inten\u0163ie, indiferent de pattern-ul musculocheletal; remisivele sintetice (cu prioritizarea metotrexatului) sunt apanajul afect\u0103rii articulare periferice, \u00een timp ce biologicele (inhibitorii TNF, IL-17A, IL-12\/23) se recomand\u0103 \u00een APs cu r\u0103spuns suboptimal la csDMARDs. Remisivele \u0163intite \u00ee\u015fi g\u0103sesc aplicabilitatea \u00een situa\u0163ii clar definite – inhibitorii JAK \u00een APs insuficient controlat\u0103 de biologice, iar inhibitorii PDE4 \u00een formele u\u015foare, ce nu se preteaz\u0103 la administrarea bioterapiei. Spre deosebire de artritele periferice, bDMARDs reprezint\u0103 prima linie de medica\u0163ie patogenic\u0103 \u00een formele axiale.
Mai mult, este anticipat atat momentul e\u015fecului terapeutic ce impune switching, dar \u015fi remisiunea persistent\u0103 ce permite adaptarea gradual\u0103 a schemei terapeutice (tapering).
Concluzie. Noile recomand\u0103ri EULAR 2019 constituie un punct de reper \u00een abordarea terapeutic\u0103 standardizat\u0103 a APs, promov\u00e2nd o strategie individualizat\u0103, progresiv\u0103, raportat\u0103 la fenotipul clinic \u015fi severitatea bolii.<\/p>\n
Challenges in the management of psoriasic arthritis. EULAR recommendations – 2019 update<\/span> Objectives. Defined as an immune-mediated rheumatic disorder developed in patients who have manifest or latent psoriasis, psoriatic arthritis (PsA) is considered a complex multifaceted condition characterized by chronic local and systemic inflammation and a broad spectrum of musculoskeletal as well as mon-musculoskeletal manifestations with significant burden. Scurt CV<\/span><\/p>\n Profesor universitar, Disciplina Reumatologie, Recuperare, Medicina Fizica si Balneologie, Universitatea de Medicina si Farmacie \u201cGrigore T. Popa\u201d Iasi. [\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.22″ background_color=”rgba(117,194,33,0.23)” background_image=”https:\/\/pdi.ro\/2020\/wp-content\/uploads\/2020\/02\/back_justflowers_overlay1.png” background_blend=”luminosity” custom_padding=”54px|0px|0|0px|false|false” top_divider_style=”waves2″ top_divider_color=”#ffffff” top_divider_height=”155px” top_divider_height_tablet=”” top_divider_height_phone=”97px” top_divider_height_last_edited=”on|desktop” bottom_divider_style=”waves2″ bottom_divider_color=”#75c221″ bottom_divider_flip=”vertical” bottom_divider_height_tablet=”” bottom_divider_height_phone=”59px” bottom_divider_height_last_edited=”on|desktop”][et_pb_row column_structure=”3_5,2_5″ _builder_version=”3.25″ custom_padding=”61px|0px|69px|0px|false|false”][et_pb_column type=”3_5″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.0.11″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” text_line_height=”1.2em” header_font=”||||||||” background_layout=”dark” text_font_size_tablet=”” text_font_size_phone=”” text_font_size_last_edited=”on|desktop”]<\/p>\n Contacteaz\u0103 operatorul PDI 2020<\/p>\n [\/et_pb_text][et_pb_contact_form email=”contact@primaderma.ro\/2019″ submit_button_text=”Trimite mesajul” _builder_version=”3.19.4″ title_font=”||||||||”][et_pb_contact_field field_id=”Name” field_title=”Nume” _builder_version=”3.18.9″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][et_pb_contact_field field_id=”Email” field_title=”Adresa de e-mail” field_type=”email” _builder_version=”3.19.4″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][et_pb_contact_field field_id=”Message” field_title=”Mesajul dvs.” field_type=”text” fullwidth_field=”on” _builder_version=”3.18.9″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][\/et_pb_contact_form][\/et_pb_column][et_pb_column type=”2_5″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.0.11″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” header_font=”||||||||” background_layout=”dark”]<\/p>\n Operatorul PDI 2020<\/p>\n [\/et_pb_text][et_pb_text _builder_version=”4.0.11″ text_font=”||||||||”]<\/p>\n <\/span><\/p>\n <\/span><\/p>\n Adresa: Str. A. Panu nr. 13, Iasi<\/span> [\/et_pb_text][et_pb_text disabled_on=”off|off|off” _builder_version=”4.0.11″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” header_font=”||||||||” background_layout=”dark” locked=”off”]<\/p>\n Parteneri Media<\/p>\n [\/et_pb_text][et_pb_gallery gallery_ids=”7203,7204,7232,7231″ fullwidth=”on” _builder_version=”4.0.11″ transform_scale=”86%|86%” max_width=”63%” auto=”on” auto_speed=”3500″ hover_transition_duration=”100ms” hover_transition_delay=”50ms” hover_transition_speed_curve=”ease-in-out” locked=”off”][\/et_pb_gallery][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":" Prof. Dr. Ancu\u021ba Codrina Universitatea de Medicin\u0103 \u0219i Farmacie \u201cGrigore T. Popa\u201d Ia\u0219iProvoc\u0103ri \u00een managementul artritei psoriazice. Noile recomand\u0103ri EULAR 2019 Autor: Codrina Ancu\u0163a Obiective. Definit\u0103 ca o afec\u0163iune reumatic\u0103 cu determinism imun ce se developeaz\u0103 \u00een contextul psoriazisului, artropatia psoriazic\u0103 (APs) r\u0103m\u00e2ne o boal\u0103 multifa\u0163etat\u0103, complex\u0103, caracterizat\u0103 prin inflama\u0163ie cronic\u0103 \u015fi polimorfism clinic, cu […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-8407","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8407","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/comments?post=8407"}],"version-history":[{"count":6,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8407\/revisions"}],"predecessor-version":[{"id":8592,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8407\/revisions\/8592"}],"wp:attachment":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/media?parent=8407"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Author: Codrina Ancu\u0163a<\/span><\/p>\n
Methods. Understanding the complex PsA pathobiology allowed the development of a multivalent therapeutic arsenal and a well-defined strategy focused on dual, rheumatologic and dermatologic management.
Results. Raising the standard of care for patients with PsA, recent European League Against Rheumatism (EULAR) recommendations not only focus on treat-to-target strategy (remission or, alternatively, low disease activity) and a gradual approach using different drug categories, but also provide a standardized algorithm covering the broad spectrum of disease phenotypes, indicating that a comprehensive therapeutic decision should also consider non-musculoskeletal manifestations, comorbidities and safety. Thus, non-steroidal anti-inflammatory drugs and local injections of glucocorticoids may be considered as first-line medication, irrespective of the musculoskeletal pattern. In patients with peripheral arthritis, a conventional synthetic disease-modifying antirheumatic drug (csDMARD) should be early initiated, with methotrexate preferred if relevant skin involvement, while biological drugs (bDMARD) (TNF, IL-17A or IL-12\/23 inhibitors) are recommended in active PsA with inadequate response to at least one csDMARD. Conversely, a TNF or IL-17A inhibitor represents the treatment of choice if axial PsA. JAK inhibitors are classically indicated after bDMARD failure, while phosphodiesterase-4 inhibitors in the context of mild disease.
The challenges of switching in patients with drug failure as well as tapering in those targeting sustained remission are also addressed.
Conclusion. 2019 updated EULAR recommendations remain a benchmark in the standardized therapeutic approach of PsA, providing a personalized, gradual process based on clinical phenotype and severity.<\/p>\n
Medic primar reumatologie si reabilitare, sef clinica Reumatologie 2, Spitalul Clinic Recuperare Iasi
Coordonator Centru EUSTAR 162, afiliat retelei EUSTAR (European Scleroderma Trials and Research Group),
Coordonator Centru Capilaroscopie \u2013 Network of imaging training center 2016-2021 (EULAR)
Training in capilaroscopie (Paris, Franta 2004), ecografie musculoscheletala (Paris, Franta, 2004; Barcelona, Spania, 2008); osteodensitometrie DXA (Bucuresti, Romania, 2006).
Membru in societati stiintifice internationale:<\/strong> EUSTAR, IASP (International Association for the Study of Pain) si Special Interest Group Musculoskeletal Pain, SLEuro (European Lupus Society)
Domenii de interes:<\/strong> terapia biologica in patologia reumatismala imun mediata, orphan disease (Sclerodermia sistemica, miopatii inflamatorii idiopatice), sarcina si patologia reumatismala imun mediata<\/p>\n<\/span><\/p>\n
Tel.: 0332.40.88.00-05<\/span>
E-mail: inscrieri@primaderma.ro<\/a>
<\/span>Website:\u00a0<\/span>www.eventernet.ro<\/a><\/p>\n