<\/span><\/strong><\/h4>\n<\/span><\/strong><\/h4>\nProf. Dr. Bojinc\u0103 Mihai<\/span><\/strong>
\nUniversitatea de Medicin\u0103 \u0219i Farmacie \u201dCarol Davila\u201d, Bucure\u0219ti, Rom\u0203nia<\/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=”4.9.7″ hover_enabled=”0″ sticky_enabled=”0″]<\/p>\n
Sclerodermia dincolo de piele
Autori: F. Vreju1, R. Ionescu2, M. Bojinc\u01032<\/span>
1Universitatea de Medicin\u0103 \u0219i Farmacie Craiova
2Universitatea de Medicin\u0103 \u0219i Farmacie \u201dCarol Davila\u201d Bucure\u0219ti<\/p>\nDincolo de manifest\u0103rile cutanate bine cunoscute, sclerodermia sistemic\u0103 (scleroza sistemic\u0103 progresiv\u0103) este o boal\u0103 complex\u0103, multiorgan, care influen\u021beaz\u0103 at\u00e2t calitatea vie\u021bii c\u00e2t \u0219i supravie\u021buirea. De aceea, complexitatea suferin\u021bei trebuie cunoscut\u0103 de to\u021bi speciali\u0219tii care trateaz\u0103 pacien\u021bi cu sclerodermie. Cateodat\u0103, demersul diagnostic are nevoie de explor\u0103ri paraclinice speciale; elementele clinice, utile pentru conturarea nosologic\u0103 a suferin\u021bei pacientului, pot include manifest\u0103ri complexe digestive, renale, pulmonare, cardiace; \u00een fine, din p\u0103cate, scelrodermia este o suferin\u021b\u0103 \u00een care tratamentele cu viz\u0103 patogenic\u0103, sunt pu\u021bine, \u00eens\u0103 \u00een dezvoltare continu\u0103. \u00cen aceast\u0103 mas\u0103 rotund\u0103 ne propunem s\u0103 trecem \u00een revist\u0103 o parte din aceste elemente; de aceea, prezent\u0103m date actuale privind explor\u0103ri paraclinice utile, principalele manifest\u0103ri clinice extracutanate \u0219i modalit\u0103\u021bi moderne de tratament.<\/p>\n
Terapii actuale \u00een sclerodermia sistemic\u0103
Autor: M. Bojinc\u0103<\/span><\/p>\nTratamentul sclerodermiei sistemice (sclerozei sistemice progresive) trebuie f\u0103cut de o echip\u0103 multidisciplinar\u0103 \u0219i este o provocare pentru fiecare specialist \u0219i pentru orice echip\u0103. \u00cen 2016 EULAR (European League Against Rheumatism – organiza\u021bia reumatologilor europeni) \u0219i EUSTAR (EULAR Scleroderma Trials and Research group – grupul european de studiu al sclerodermiei) au elaborat un set de recomand\u0103ri de tratament pentru scleroza sistemic\u0103. Modul \u00een care sunt structurate aceste recomand\u0103ri, pe grupe de manifest\u0103ri ale bolii, arat\u0103 \u0219i progresele terapeutice dar \u0219i limitele \u00een\u021belegerii patogeniei cu inexisten\u021ba unei terapii globale. Recomand\u0103rile se refer\u0103 ini\u021bial la fenomenul Raynaud din scleroza sistemic\u0103 pentru care prima linie de tratament continu\u0103 s\u0103 fie blocan\u021bii canalelor de calciu de tip dihidropiridinic respectiv nifedipina \u0219i medica\u021biile derivate. Aceast\u0103 medica\u021bie reduce frecven\u021ba \u0219i severitatea atacurilor Raynaud. Principalele reac\u021bii adverse au fost hipotensiunea, ame\u021belile \u0219i edemele. O alt\u0103 clas\u0103 de medicamente cu eficien\u021b\u0103 dovedit\u0103 \u00een reducerea frecven\u021bei, duratei \u0219i severit\u0103\u021bii fenomenului Raynaud este clasa inhibitorilor de fosfodiesteraza – 5 (PDE-5) din care au fost studiate sildenafil, tadalafil \u0219i vardenafil. Aceste medicamente se recomand\u0103 s\u0103 fie utilizate la pacien\u021bii cu r\u0103spuns insuficient la blocan\u021bii de calciu. Ca reac\u021bii adverse au fost raportate reac\u021bii vasomotorii, reac\u021bii alergice, dureri toracice, mialgii, tulbur\u0103ri vizuale. Iloprost poate fi utilizat \u00een formele severe de fenomen Raynaud dup\u0103 e\u0219ecul terapiei oral\u0103. Eficien\u021ba terapiei cu Iloprost este dovedit\u0103 \u00een administrare intravenoas\u0103 cu ritmul de 0,5-3 ng\/kg\/min 3-5 zile succesiv. Fluoxetina medicament antidepresiv prin efectul de inhibare a recapt\u0103rii serotoninei s-a dovedit eficient \u00een fenomenul Raynaud \u00een doze de 20 mg\/zi. Evaluarea a fost f\u0103cut\u0103 \u00een c\u00e2teva studii mici, \u00een unele dintre aceste studii efectele fluoxetinei fiind mai semnificative dec\u00e2t ale nifedipinei dar \u0219i reac\u021biile adverse care au dus la ie\u0219irea din studiu.
Apari\u021bia ulcera\u021biilor digitale este frecvent\u0103 \u0219i asociat\u0103 cu complica\u021bii locale \u0219i generale. \u00cen afara tratamentului local, ghidul EULAR recomand\u0103 prostaglandine intravenos, \u00een special iloprost \u00een administrare intravenoas\u0103 \u00een doze de 0,5-2 ng\/kg\/min 3-5 zile succesiv. De\u0219i s-a \u00eencercat \u0219i utilizarea prostanoizilor orali totu\u0219i eficacitatea este mai semnificativ\u0103 \u00een administrare intravenoas\u0103. Alte variante de tratament sunt reprezentate de inhibitorii de PDE-5 dintre care Tadalafil 20 mg\/2 zile are rezultatele cele mai bune. Bosentan, un inhibitor dual al receptorilor de endotelin\u0103 (ERA) s-a dovedit eficient nu \u00een tratamentul ulcera\u021biilor digitale din sclerodermie ci \u00een prevenirea apari\u021biei de noi ulcera\u021bii \u00een doze ini\u021biale de 62,5 mg x 2\/zi \u0219i apoi 125 mg x 2 \/zi.
\u00cen hipertensiunea arterial\u0103 pulmonar\u0103 (HTP) din sclerodermie se recomand\u0103 de asemenea utilizarea antagoni\u0219tilor receptorilor de endotelin\u0103 (ERA) ca Bosentan, Ambrisentan, Macitentan care au demonstrat \u00eembun\u0103t\u0103\u021birea capacit\u0103\u021bii de efort \u0219i \u00eencetinirea agrav\u0103rii clinice. Au fost raportate mai multe reac\u021bii adverse la aceste medicamente cum ar fi: cre\u0219terea transaminazelor, edeme, palpita\u021bii, cefalee, anemie \u0219i altele.
Inhibitorii PDE-5, Sildenafil \u0219i Tadalafil au demonstrat o bun\u0103 eficacitate \u00een ameliorarea capacit\u0103\u021bii de efort \u0219i \u00eencetinirea agrav\u0103rilor. Riociguat este un membru al unei noi clase de medicamente utilizate \u00een HTP din boli conjunctivo-vasculare respectiv stimulatorii de guanilat ciclaz\u0103. Riociguat a demonstrat o ameliorare a capacit\u0103\u021bii de efort, o \u00eencetinire a agrav\u0103rii clinice dar \u0219i o ameliorare a parametrilor hemodinamici. \u00cen general, aceste medica\u021bii se utilizeaz\u0103 \u00een monoterapie dar \u00een cazul unei evolu\u021bii severe, progresive a HTP se poate utiliza o combina\u021bie de dou\u0103 tipuri de medica\u021bii cum ar fi ERA + inhibitor PDE-5.
Prostanoizii administra\u021bi intravenos ca Epoprostenol, Iloprost sunt utiliza\u021bi \u00een special \u00een formele severe, avansate de HTP (stadiile III – IV). \u00cen doz\u0103 de 2 ng\/kg\/min, perfuzie continu\u0103, Epoprostenol a demonstrat ameliorarea capacit\u0103\u021bii de efort \u0219i parametrilor hemodinamici \u0219i \u00eencetinirea agrav\u0103rii clinice.
Pentru afectarea pulmonar\u0103 \u0219i cutanat\u0103 se pot utiliza mai multe tipuri de medicamente. Metotrexat \u00een doz\u0103 de 10-15 mg\/s\u0103pt\u0103m\u00e2n\u0103 intramuscular este eficient \u00een formele cutanate difuze de sclerodermie. Ciclofosfamida, Azatioprina, Micoenolatul mofetil sunt de asemenea eficiente \u00een formele cutanate difuze. Ciclofosfamida poate fi utilizat\u0103 \u00een afectarea pulmonar\u0103 intersti\u021bial\u0103 din sclerodermie, unde deterin\u0103 ameliorarea clinic\u0103, ameliorarea testelor ventilatorii \u0219i calit\u0103\u021bii vie\u021bii chiar dac\u0103 nu a fost demonstrat\u0103 ameliorarea capacit\u0103\u021bii de transfer gazos. Ciclofosfamida a fost utilizat\u0103 \u00een studii at\u00e2t oral c\u00e2t \u0219i intravenos. Transplantul de celule stem hematopoetice este eficient at\u00e2t \u00een manifest\u0103rile cutanate c\u00e2t \u0219i \u00een cele pulmonare din sclerodermie. \u021ain\u00e2nd seama de reac\u021bii adverse \u0219i de riscuri transplantul de celule stem hematopoetice este recomandat pacien\u021bilor cu forme severe progresive de sclerodermie cu risc major de insuficien\u021b\u0103 de organ.
Criza renal\u0103 sclerodermic\u0103 este o cauz\u0103 important\u0103 de mortalitate \u00een sclerodermie. Se recomand\u0103 ini\u021bierea terapiei cu inhibitori de enzim\u0103 de conversie a angiotensinogenului (IEC) c\u00e2t mai repede cu putin\u021b\u0103 dup\u0103 diagnosticul de criz\u0103 renal\u0103 sclerodermic\u0103. IEC nu au dovedit un efect preventiv \u00een raport cu apari\u021bia crizei renale sclerodermice. Deoarece criza renal\u0103 sclerodermic\u0103 este asociat\u0103 cu utilizarea glucocorticoizilor (GC) se recomand\u0103 utilizarea cu pruden\u021b\u0103 a GC la pacien\u021bii cu sclerodermia \u0219i monitorizarea atent\u0103 a acestora.
Pentru afectarea digestiv\u0103 din sclerodermie se recomand\u0103 utilizarea inhibitorilor de pomp\u0103 protonic\u0103 (IPP) \u00een special la pacien\u021bii cu simptome digestive superioare de tip boal\u0103 de reflux gastroesofagian. La pacien\u021bii f\u0103r\u0103 simptome digestive utilizarea IPP trebuie f\u0103cut\u0103 cu pruden\u021ba. Utilizarea pe termen lung a IPP poate genera malabsorb\u021bie, deficite nutri\u021bionale \u0219i risc crescut de infec\u021bii. Tulbur\u0103rile de motilitate digestiv\u0103 din sclerodermie pot fi tratate cu prokinetice (metoclopramid, domperidon\u0103, cisaprid \u00een func\u021bie de medica\u021biile aprobate \u00een diferite \u021b\u0103ri) de\u0219i nu exist\u0103 studii controlate semnificative. \u00cen cazul apari\u021biei sindroamelor de proliferare bacterian\u0103 se pot utiliza cure periodice de antibiotice cu spectru larg cum ar fi chinolone, amoxicilin\u0103 + acid clavulanic, metronidazol etc. O serie de complica\u021bii specifice cum ar fi microstomia sau incontinen\u021ba anal\u0103 pot fi ameliorate prin kinetoterapie \u0219i alimenta\u021bie adecvat\u0103. \u00cen anumite situa\u021bii cum ar fi stricturile, hemoragiile digestive, necesitatea alimenta\u021biei pe sond\u0103 se poate apela la interve\u021bii endoscopice sau chirurgicale.
\u00cen ultimii ani, dupa publicarea ghidului EULAR au ap\u0103rut foarte multe date noi privind diferite forme de terapii utile \u00een sclerodermie. Micofenolatul mofetil (MFM) s-a dovedit eficient \u00een tratamentul afect\u0103rii pulmonare intersti\u021biale din sclerodermie, determin\u00e2nd ameliorarea dispneei, probelor func\u021bionale respiratorii, capacit\u0103\u021bii de difuziune \u0219i leziunilor pulmonare eviden\u021biate prin tomografie computerizat\u0103. Ca urmare tinde s\u0103 egaleze sau s\u0103 \u00eenlocuiasc\u0103 ciclofosfamid\u0103 \u00een tratamentul afect\u0103rii pulmonare din sclerodermie. Dintre tratamentele biologice evaluate \u00een tratamentul sclerodermiei Rituximabul a dovedit efecte favorabile \u00een afectarea pulmonar\u0103 \u0219i cutanat\u0103 cu ameliorarea scorului Rodnan \u0219i probelor func\u021bionale pulmonare. S-a propus evaluarea comparativ\u0103 cu Ciclofosfamida penru a stabili mai precis eficien\u021ba tratamentului cu Rituximab. Pentru tratamentul HTP din sclerodermie s-a propus utilizarea Selexipag, un agonist selectiv al receptorilor de prostaciclin\u0103. Primele date sunt \u00eencurajatoare: tratamentul cu Selexipag reduce progresia HTP \u0219i mortalitatea.
Nintedanib. \u00cen tratamentul HTP au ap\u0103rut multe date privind eficien\u021ba \u0219i siguran\u021ba combina\u021biilor de medicamente. \u00cen sclerodermie au fost recent studiate o serie de medicamente cu efect antifibrozant cum ar fi Dasatinib, un inhibitor de tirozin kinaz\u0103 care nu a demonstrat efecte favorabile cutanate sau pulmonare \u00een sclerodermie dar \u0219i Nintedanib, un alt inhibitor de tirozin kinaz\u0103 care a demonstrat efecte favorabile \u00een pneumopatia fibrozant\u0103 idiopatic\u0103 dar \u0219i \u00een afectarea pulmonar\u0103 intersti\u021bial\u0103 din sclerodermie. De remarcat c\u0103 efectul pulmonar al Nintedanib este semnificativ dar nu exist\u0103 efecte favorabile pe alte tipuri de manifest\u0103ri sclerodermice inclusiv pe manifestarea cutanat\u0103.
\u00cen concluzie, de\u0219i \u00eenc\u0103 nu exist\u0103 \u00eenc\u0103 un tratament eficient pentru toate manifest\u0103rile sclerodermiei sistemice, exist\u0103 numeroase op\u021biuni terapeutice validate \u00een studii pentru diferitele manifest\u0103ri ale bolii.<\/p>\n
Scurt CV<\/span><\/p>\nExperien\u021b\u0103 profesional\u0103:<\/strong>
2021 – Profesor universitar disciplina Reumatologie \u2013 Universitatea de Medicin\u0103 \u0219i Farmacie \u201cCarol Davila\u201d Bucure\u0219ti
2007-2021 – Conferen\u021biar universitar –
2004-2007 \u2013 \u0218ef de lucr\u0103ri \u2013
2000-2004 \u2013 Asistent universitar \u2013<\/p>\nEduca\u021bie \u0219i preg\u0103tire:<\/strong>
1990-1991, 1991-1994 – Medic stagiar, medic secundar Medicin\u0103 Intern\u0103
1995 – Medic specialist Medicin\u0103 Intern\u0103
1998 – Medic specialist Reumatologie
2000 – Medic primar Medicin\u0103 Intern\u0103
2004 – Medic primar Reumatologie
2004 – Doctor \u00een Medicin\u0103<\/p>\nActivitate \u0219tiin\u021bific\u0103:<\/strong>
Autor \u0219i co-autor a 3 c\u0103r\u021bi \u0219i 8 capitole \u00een monografii \u0219i tratate.
Autor \u0219i co\u2013autor a peste 45 articole publicate \u00een reviste indexate \u00een baze de date interna\u021bionale.
Autor \u0219i co-autor a peste 50 de articole \u00een reviste listate CNCSIS b+
Autor a peste 200 de prezent\u0103ri \u015fi postere la conferinte \u015fi congrese na\u0163ionale \u015fi interna\u0163ionale<\/p>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”4.9.6″ background_color=”rgba(117,194,33,0.23)” background_image=”https:\/\/pdi.ro\/2021\/wp-content\/uploads\/2021\/05\/PDI2021_header_1920x550px.jpg” background_blend=”multiply” 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” global_module=”9177″ saved_tabs=”all”][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=”4.9.4″ 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
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Prof. Dr. Bojinc\u0103 Mihai Universitatea de Medicin\u0103 \u0219i Farmacie \u201dCarol Davila\u201d, Bucure\u0219ti, Rom\u0203niaSclerodermia dincolo de pieleAutori: F. Vreju1, R. Ionescu2, M. Bojinc\u010321Universitatea de Medicin\u0103 \u0219i Farmacie Craiova2Universitatea de Medicin\u0103 \u0219i Farmacie \u201dCarol Davila\u201d Bucure\u0219ti Dincolo de manifest\u0103rile cutanate bine cunoscute, sclerodermia sistemic\u0103 (scleroza sistemic\u0103 progresiv\u0103) este o boal\u0103 complex\u0103, multiorgan, care influen\u021beaz\u0103 at\u00e2t calitatea vie\u021bii […]<\/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-10442","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/pages\/10442","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/comments?post=10442"}],"version-history":[{"count":3,"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/pages\/10442\/revisions"}],"predecessor-version":[{"id":10446,"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/pages\/10442\/revisions\/10446"}],"wp:attachment":[{"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/media?parent=10442"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Prof. Dr. Bojinc\u0103 Mihai<\/span><\/strong>
\nUniversitatea de Medicin\u0103 \u0219i Farmacie \u201dCarol Davila\u201d, Bucure\u0219ti, Rom\u0203nia<\/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=”4.9.7″ hover_enabled=”0″ sticky_enabled=”0″]<\/p>\n
Sclerodermia dincolo de piele
Autori: F. Vreju1, R. Ionescu2, M. Bojinc\u01032<\/span>
1Universitatea de Medicin\u0103 \u0219i Farmacie Craiova
2Universitatea de Medicin\u0103 \u0219i Farmacie \u201dCarol Davila\u201d Bucure\u0219ti<\/p>\nDincolo de manifest\u0103rile cutanate bine cunoscute, sclerodermia sistemic\u0103 (scleroza sistemic\u0103 progresiv\u0103) este o boal\u0103 complex\u0103, multiorgan, care influen\u021beaz\u0103 at\u00e2t calitatea vie\u021bii c\u00e2t \u0219i supravie\u021buirea. De aceea, complexitatea suferin\u021bei trebuie cunoscut\u0103 de to\u021bi speciali\u0219tii care trateaz\u0103 pacien\u021bi cu sclerodermie. Cateodat\u0103, demersul diagnostic are nevoie de explor\u0103ri paraclinice speciale; elementele clinice, utile pentru conturarea nosologic\u0103 a suferin\u021bei pacientului, pot include manifest\u0103ri complexe digestive, renale, pulmonare, cardiace; \u00een fine, din p\u0103cate, scelrodermia este o suferin\u021b\u0103 \u00een care tratamentele cu viz\u0103 patogenic\u0103, sunt pu\u021bine, \u00eens\u0103 \u00een dezvoltare continu\u0103. \u00cen aceast\u0103 mas\u0103 rotund\u0103 ne propunem s\u0103 trecem \u00een revist\u0103 o parte din aceste elemente; de aceea, prezent\u0103m date actuale privind explor\u0103ri paraclinice utile, principalele manifest\u0103ri clinice extracutanate \u0219i modalit\u0103\u021bi moderne de tratament.<\/p>\n
Terapii actuale \u00een sclerodermia sistemic\u0103
Autor: M. Bojinc\u0103<\/span><\/p>\nTratamentul sclerodermiei sistemice (sclerozei sistemice progresive) trebuie f\u0103cut de o echip\u0103 multidisciplinar\u0103 \u0219i este o provocare pentru fiecare specialist \u0219i pentru orice echip\u0103. \u00cen 2016 EULAR (European League Against Rheumatism – organiza\u021bia reumatologilor europeni) \u0219i EUSTAR (EULAR Scleroderma Trials and Research group – grupul european de studiu al sclerodermiei) au elaborat un set de recomand\u0103ri de tratament pentru scleroza sistemic\u0103. Modul \u00een care sunt structurate aceste recomand\u0103ri, pe grupe de manifest\u0103ri ale bolii, arat\u0103 \u0219i progresele terapeutice dar \u0219i limitele \u00een\u021belegerii patogeniei cu inexisten\u021ba unei terapii globale. Recomand\u0103rile se refer\u0103 ini\u021bial la fenomenul Raynaud din scleroza sistemic\u0103 pentru care prima linie de tratament continu\u0103 s\u0103 fie blocan\u021bii canalelor de calciu de tip dihidropiridinic respectiv nifedipina \u0219i medica\u021biile derivate. Aceast\u0103 medica\u021bie reduce frecven\u021ba \u0219i severitatea atacurilor Raynaud. Principalele reac\u021bii adverse au fost hipotensiunea, ame\u021belile \u0219i edemele. O alt\u0103 clas\u0103 de medicamente cu eficien\u021b\u0103 dovedit\u0103 \u00een reducerea frecven\u021bei, duratei \u0219i severit\u0103\u021bii fenomenului Raynaud este clasa inhibitorilor de fosfodiesteraza – 5 (PDE-5) din care au fost studiate sildenafil, tadalafil \u0219i vardenafil. Aceste medicamente se recomand\u0103 s\u0103 fie utilizate la pacien\u021bii cu r\u0103spuns insuficient la blocan\u021bii de calciu. Ca reac\u021bii adverse au fost raportate reac\u021bii vasomotorii, reac\u021bii alergice, dureri toracice, mialgii, tulbur\u0103ri vizuale. Iloprost poate fi utilizat \u00een formele severe de fenomen Raynaud dup\u0103 e\u0219ecul terapiei oral\u0103. Eficien\u021ba terapiei cu Iloprost este dovedit\u0103 \u00een administrare intravenoas\u0103 cu ritmul de 0,5-3 ng\/kg\/min 3-5 zile succesiv. Fluoxetina medicament antidepresiv prin efectul de inhibare a recapt\u0103rii serotoninei s-a dovedit eficient \u00een fenomenul Raynaud \u00een doze de 20 mg\/zi. Evaluarea a fost f\u0103cut\u0103 \u00een c\u00e2teva studii mici, \u00een unele dintre aceste studii efectele fluoxetinei fiind mai semnificative dec\u00e2t ale nifedipinei dar \u0219i reac\u021biile adverse care au dus la ie\u0219irea din studiu.
Apari\u021bia ulcera\u021biilor digitale este frecvent\u0103 \u0219i asociat\u0103 cu complica\u021bii locale \u0219i generale. \u00cen afara tratamentului local, ghidul EULAR recomand\u0103 prostaglandine intravenos, \u00een special iloprost \u00een administrare intravenoas\u0103 \u00een doze de 0,5-2 ng\/kg\/min 3-5 zile succesiv. De\u0219i s-a \u00eencercat \u0219i utilizarea prostanoizilor orali totu\u0219i eficacitatea este mai semnificativ\u0103 \u00een administrare intravenoas\u0103. Alte variante de tratament sunt reprezentate de inhibitorii de PDE-5 dintre care Tadalafil 20 mg\/2 zile are rezultatele cele mai bune. Bosentan, un inhibitor dual al receptorilor de endotelin\u0103 (ERA) s-a dovedit eficient nu \u00een tratamentul ulcera\u021biilor digitale din sclerodermie ci \u00een prevenirea apari\u021biei de noi ulcera\u021bii \u00een doze ini\u021biale de 62,5 mg x 2\/zi \u0219i apoi 125 mg x 2 \/zi.
\u00cen hipertensiunea arterial\u0103 pulmonar\u0103 (HTP) din sclerodermie se recomand\u0103 de asemenea utilizarea antagoni\u0219tilor receptorilor de endotelin\u0103 (ERA) ca Bosentan, Ambrisentan, Macitentan care au demonstrat \u00eembun\u0103t\u0103\u021birea capacit\u0103\u021bii de efort \u0219i \u00eencetinirea agrav\u0103rii clinice. Au fost raportate mai multe reac\u021bii adverse la aceste medicamente cum ar fi: cre\u0219terea transaminazelor, edeme, palpita\u021bii, cefalee, anemie \u0219i altele.
Inhibitorii PDE-5, Sildenafil \u0219i Tadalafil au demonstrat o bun\u0103 eficacitate \u00een ameliorarea capacit\u0103\u021bii de efort \u0219i \u00eencetinirea agrav\u0103rilor. Riociguat este un membru al unei noi clase de medicamente utilizate \u00een HTP din boli conjunctivo-vasculare respectiv stimulatorii de guanilat ciclaz\u0103. Riociguat a demonstrat o ameliorare a capacit\u0103\u021bii de efort, o \u00eencetinire a agrav\u0103rii clinice dar \u0219i o ameliorare a parametrilor hemodinamici. \u00cen general, aceste medica\u021bii se utilizeaz\u0103 \u00een monoterapie dar \u00een cazul unei evolu\u021bii severe, progresive a HTP se poate utiliza o combina\u021bie de dou\u0103 tipuri de medica\u021bii cum ar fi ERA + inhibitor PDE-5.
Prostanoizii administra\u021bi intravenos ca Epoprostenol, Iloprost sunt utiliza\u021bi \u00een special \u00een formele severe, avansate de HTP (stadiile III – IV). \u00cen doz\u0103 de 2 ng\/kg\/min, perfuzie continu\u0103, Epoprostenol a demonstrat ameliorarea capacit\u0103\u021bii de efort \u0219i parametrilor hemodinamici \u0219i \u00eencetinirea agrav\u0103rii clinice.
Pentru afectarea pulmonar\u0103 \u0219i cutanat\u0103 se pot utiliza mai multe tipuri de medicamente. Metotrexat \u00een doz\u0103 de 10-15 mg\/s\u0103pt\u0103m\u00e2n\u0103 intramuscular este eficient \u00een formele cutanate difuze de sclerodermie. Ciclofosfamida, Azatioprina, Micoenolatul mofetil sunt de asemenea eficiente \u00een formele cutanate difuze. Ciclofosfamida poate fi utilizat\u0103 \u00een afectarea pulmonar\u0103 intersti\u021bial\u0103 din sclerodermie, unde deterin\u0103 ameliorarea clinic\u0103, ameliorarea testelor ventilatorii \u0219i calit\u0103\u021bii vie\u021bii chiar dac\u0103 nu a fost demonstrat\u0103 ameliorarea capacit\u0103\u021bii de transfer gazos. Ciclofosfamida a fost utilizat\u0103 \u00een studii at\u00e2t oral c\u00e2t \u0219i intravenos. Transplantul de celule stem hematopoetice este eficient at\u00e2t \u00een manifest\u0103rile cutanate c\u00e2t \u0219i \u00een cele pulmonare din sclerodermie. \u021ain\u00e2nd seama de reac\u021bii adverse \u0219i de riscuri transplantul de celule stem hematopoetice este recomandat pacien\u021bilor cu forme severe progresive de sclerodermie cu risc major de insuficien\u021b\u0103 de organ.
Criza renal\u0103 sclerodermic\u0103 este o cauz\u0103 important\u0103 de mortalitate \u00een sclerodermie. Se recomand\u0103 ini\u021bierea terapiei cu inhibitori de enzim\u0103 de conversie a angiotensinogenului (IEC) c\u00e2t mai repede cu putin\u021b\u0103 dup\u0103 diagnosticul de criz\u0103 renal\u0103 sclerodermic\u0103. IEC nu au dovedit un efect preventiv \u00een raport cu apari\u021bia crizei renale sclerodermice. Deoarece criza renal\u0103 sclerodermic\u0103 este asociat\u0103 cu utilizarea glucocorticoizilor (GC) se recomand\u0103 utilizarea cu pruden\u021b\u0103 a GC la pacien\u021bii cu sclerodermia \u0219i monitorizarea atent\u0103 a acestora.
Pentru afectarea digestiv\u0103 din sclerodermie se recomand\u0103 utilizarea inhibitorilor de pomp\u0103 protonic\u0103 (IPP) \u00een special la pacien\u021bii cu simptome digestive superioare de tip boal\u0103 de reflux gastroesofagian. La pacien\u021bii f\u0103r\u0103 simptome digestive utilizarea IPP trebuie f\u0103cut\u0103 cu pruden\u021ba. Utilizarea pe termen lung a IPP poate genera malabsorb\u021bie, deficite nutri\u021bionale \u0219i risc crescut de infec\u021bii. Tulbur\u0103rile de motilitate digestiv\u0103 din sclerodermie pot fi tratate cu prokinetice (metoclopramid, domperidon\u0103, cisaprid \u00een func\u021bie de medica\u021biile aprobate \u00een diferite \u021b\u0103ri) de\u0219i nu exist\u0103 studii controlate semnificative. \u00cen cazul apari\u021biei sindroamelor de proliferare bacterian\u0103 se pot utiliza cure periodice de antibiotice cu spectru larg cum ar fi chinolone, amoxicilin\u0103 + acid clavulanic, metronidazol etc. O serie de complica\u021bii specifice cum ar fi microstomia sau incontinen\u021ba anal\u0103 pot fi ameliorate prin kinetoterapie \u0219i alimenta\u021bie adecvat\u0103. \u00cen anumite situa\u021bii cum ar fi stricturile, hemoragiile digestive, necesitatea alimenta\u021biei pe sond\u0103 se poate apela la interve\u021bii endoscopice sau chirurgicale.
\u00cen ultimii ani, dupa publicarea ghidului EULAR au ap\u0103rut foarte multe date noi privind diferite forme de terapii utile \u00een sclerodermie. Micofenolatul mofetil (MFM) s-a dovedit eficient \u00een tratamentul afect\u0103rii pulmonare intersti\u021biale din sclerodermie, determin\u00e2nd ameliorarea dispneei, probelor func\u021bionale respiratorii, capacit\u0103\u021bii de difuziune \u0219i leziunilor pulmonare eviden\u021biate prin tomografie computerizat\u0103. Ca urmare tinde s\u0103 egaleze sau s\u0103 \u00eenlocuiasc\u0103 ciclofosfamid\u0103 \u00een tratamentul afect\u0103rii pulmonare din sclerodermie. Dintre tratamentele biologice evaluate \u00een tratamentul sclerodermiei Rituximabul a dovedit efecte favorabile \u00een afectarea pulmonar\u0103 \u0219i cutanat\u0103 cu ameliorarea scorului Rodnan \u0219i probelor func\u021bionale pulmonare. S-a propus evaluarea comparativ\u0103 cu Ciclofosfamida penru a stabili mai precis eficien\u021ba tratamentului cu Rituximab. Pentru tratamentul HTP din sclerodermie s-a propus utilizarea Selexipag, un agonist selectiv al receptorilor de prostaciclin\u0103. Primele date sunt \u00eencurajatoare: tratamentul cu Selexipag reduce progresia HTP \u0219i mortalitatea.
Nintedanib. \u00cen tratamentul HTP au ap\u0103rut multe date privind eficien\u021ba \u0219i siguran\u021ba combina\u021biilor de medicamente. \u00cen sclerodermie au fost recent studiate o serie de medicamente cu efect antifibrozant cum ar fi Dasatinib, un inhibitor de tirozin kinaz\u0103 care nu a demonstrat efecte favorabile cutanate sau pulmonare \u00een sclerodermie dar \u0219i Nintedanib, un alt inhibitor de tirozin kinaz\u0103 care a demonstrat efecte favorabile \u00een pneumopatia fibrozant\u0103 idiopatic\u0103 dar \u0219i \u00een afectarea pulmonar\u0103 intersti\u021bial\u0103 din sclerodermie. De remarcat c\u0103 efectul pulmonar al Nintedanib este semnificativ dar nu exist\u0103 efecte favorabile pe alte tipuri de manifest\u0103ri sclerodermice inclusiv pe manifestarea cutanat\u0103.
\u00cen concluzie, de\u0219i \u00eenc\u0103 nu exist\u0103 \u00eenc\u0103 un tratament eficient pentru toate manifest\u0103rile sclerodermiei sistemice, exist\u0103 numeroase op\u021biuni terapeutice validate \u00een studii pentru diferitele manifest\u0103ri ale bolii.<\/p>\n
Scurt CV<\/span><\/p>\nExperien\u021b\u0103 profesional\u0103:<\/strong>
2021 – Profesor universitar disciplina Reumatologie \u2013 Universitatea de Medicin\u0103 \u0219i Farmacie \u201cCarol Davila\u201d Bucure\u0219ti
2007-2021 – Conferen\u021biar universitar –
2004-2007 \u2013 \u0218ef de lucr\u0103ri \u2013
2000-2004 \u2013 Asistent universitar \u2013<\/p>\nEduca\u021bie \u0219i preg\u0103tire:<\/strong>
1990-1991, 1991-1994 – Medic stagiar, medic secundar Medicin\u0103 Intern\u0103
1995 – Medic specialist Medicin\u0103 Intern\u0103
1998 – Medic specialist Reumatologie
2000 – Medic primar Medicin\u0103 Intern\u0103
2004 – Medic primar Reumatologie
2004 – Doctor \u00een Medicin\u0103<\/p>\nActivitate \u0219tiin\u021bific\u0103:<\/strong>
Autor \u0219i co-autor a 3 c\u0103r\u021bi \u0219i 8 capitole \u00een monografii \u0219i tratate.
Autor \u0219i co\u2013autor a peste 45 articole publicate \u00een reviste indexate \u00een baze de date interna\u021bionale.
Autor \u0219i co-autor a peste 50 de articole \u00een reviste listate CNCSIS b+
Autor a peste 200 de prezent\u0103ri \u015fi postere la conferinte \u015fi congrese na\u0163ionale \u015fi interna\u0163ionale<\/p>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”4.9.6″ background_color=”rgba(117,194,33,0.23)” background_image=”https:\/\/pdi.ro\/2021\/wp-content\/uploads\/2021\/05\/PDI2021_header_1920x550px.jpg” background_blend=”multiply” 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” global_module=”9177″ saved_tabs=”all”][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=”4.9.4″ 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
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Prof. Dr. Bojinc\u0103 Mihai Universitatea de Medicin\u0103 \u0219i Farmacie \u201dCarol Davila\u201d, Bucure\u0219ti, Rom\u0203niaSclerodermia dincolo de pieleAutori: F. Vreju1, R. Ionescu2, M. Bojinc\u010321Universitatea de Medicin\u0103 \u0219i Farmacie Craiova2Universitatea de Medicin\u0103 \u0219i Farmacie \u201dCarol Davila\u201d Bucure\u0219ti Dincolo de manifest\u0103rile cutanate bine cunoscute, sclerodermia sistemic\u0103 (scleroza sistemic\u0103 progresiv\u0103) este o boal\u0103 complex\u0103, multiorgan, care influen\u021beaz\u0103 at\u00e2t calitatea vie\u021bii […]<\/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-10442","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/pages\/10442","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/comments?post=10442"}],"version-history":[{"count":3,"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/pages\/10442\/revisions"}],"predecessor-version":[{"id":10446,"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/pages\/10442\/revisions\/10446"}],"wp:attachment":[{"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/media?parent=10442"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Autori: F. Vreju1, R. Ionescu2, M. Bojinc\u01032<\/span>
1Universitatea de Medicin\u0103 \u0219i Farmacie Craiova
2Universitatea de Medicin\u0103 \u0219i Farmacie \u201dCarol Davila\u201d Bucure\u0219ti<\/p>\n
Dincolo de manifest\u0103rile cutanate bine cunoscute, sclerodermia sistemic\u0103 (scleroza sistemic\u0103 progresiv\u0103) este o boal\u0103 complex\u0103, multiorgan, care influen\u021beaz\u0103 at\u00e2t calitatea vie\u021bii c\u00e2t \u0219i supravie\u021buirea. De aceea, complexitatea suferin\u021bei trebuie cunoscut\u0103 de to\u021bi speciali\u0219tii care trateaz\u0103 pacien\u021bi cu sclerodermie. Cateodat\u0103, demersul diagnostic are nevoie de explor\u0103ri paraclinice speciale; elementele clinice, utile pentru conturarea nosologic\u0103 a suferin\u021bei pacientului, pot include manifest\u0103ri complexe digestive, renale, pulmonare, cardiace; \u00een fine, din p\u0103cate, scelrodermia este o suferin\u021b\u0103 \u00een care tratamentele cu viz\u0103 patogenic\u0103, sunt pu\u021bine, \u00eens\u0103 \u00een dezvoltare continu\u0103. \u00cen aceast\u0103 mas\u0103 rotund\u0103 ne propunem s\u0103 trecem \u00een revist\u0103 o parte din aceste elemente; de aceea, prezent\u0103m date actuale privind explor\u0103ri paraclinice utile, principalele manifest\u0103ri clinice extracutanate \u0219i modalit\u0103\u021bi moderne de tratament.<\/p>\n
Terapii actuale \u00een sclerodermia sistemic\u0103 Tratamentul sclerodermiei sistemice (sclerozei sistemice progresive) trebuie f\u0103cut de o echip\u0103 multidisciplinar\u0103 \u0219i este o provocare pentru fiecare specialist \u0219i pentru orice echip\u0103. \u00cen 2016 EULAR (European League Against Rheumatism – organiza\u021bia reumatologilor europeni) \u0219i EUSTAR (EULAR Scleroderma Trials and Research group – grupul european de studiu al sclerodermiei) au elaborat un set de recomand\u0103ri de tratament pentru scleroza sistemic\u0103. Modul \u00een care sunt structurate aceste recomand\u0103ri, pe grupe de manifest\u0103ri ale bolii, arat\u0103 \u0219i progresele terapeutice dar \u0219i limitele \u00een\u021belegerii patogeniei cu inexisten\u021ba unei terapii globale. Recomand\u0103rile se refer\u0103 ini\u021bial la fenomenul Raynaud din scleroza sistemic\u0103 pentru care prima linie de tratament continu\u0103 s\u0103 fie blocan\u021bii canalelor de calciu de tip dihidropiridinic respectiv nifedipina \u0219i medica\u021biile derivate. Aceast\u0103 medica\u021bie reduce frecven\u021ba \u0219i severitatea atacurilor Raynaud. Principalele reac\u021bii adverse au fost hipotensiunea, ame\u021belile \u0219i edemele. O alt\u0103 clas\u0103 de medicamente cu eficien\u021b\u0103 dovedit\u0103 \u00een reducerea frecven\u021bei, duratei \u0219i severit\u0103\u021bii fenomenului Raynaud este clasa inhibitorilor de fosfodiesteraza – 5 (PDE-5) din care au fost studiate sildenafil, tadalafil \u0219i vardenafil. Aceste medicamente se recomand\u0103 s\u0103 fie utilizate la pacien\u021bii cu r\u0103spuns insuficient la blocan\u021bii de calciu. Ca reac\u021bii adverse au fost raportate reac\u021bii vasomotorii, reac\u021bii alergice, dureri toracice, mialgii, tulbur\u0103ri vizuale. Iloprost poate fi utilizat \u00een formele severe de fenomen Raynaud dup\u0103 e\u0219ecul terapiei oral\u0103. Eficien\u021ba terapiei cu Iloprost este dovedit\u0103 \u00een administrare intravenoas\u0103 cu ritmul de 0,5-3 ng\/kg\/min 3-5 zile succesiv. Fluoxetina medicament antidepresiv prin efectul de inhibare a recapt\u0103rii serotoninei s-a dovedit eficient \u00een fenomenul Raynaud \u00een doze de 20 mg\/zi. Evaluarea a fost f\u0103cut\u0103 \u00een c\u00e2teva studii mici, \u00een unele dintre aceste studii efectele fluoxetinei fiind mai semnificative dec\u00e2t ale nifedipinei dar \u0219i reac\u021biile adverse care au dus la ie\u0219irea din studiu. 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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=”7203,7204,9252,9464,10156,10157″ fullwidth=”on” _builder_version=”4.9.7″ 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. Bojinc\u0103 Mihai Universitatea de Medicin\u0103 \u0219i Farmacie \u201dCarol Davila\u201d, Bucure\u0219ti, Rom\u0203niaSclerodermia dincolo de pieleAutori: F. Vreju1, R. Ionescu2, M. Bojinc\u010321Universitatea de Medicin\u0103 \u0219i Farmacie Craiova2Universitatea de Medicin\u0103 \u0219i Farmacie \u201dCarol Davila\u201d Bucure\u0219ti Dincolo de manifest\u0103rile cutanate bine cunoscute, sclerodermia sistemic\u0103 (scleroza sistemic\u0103 progresiv\u0103) este o boal\u0103 complex\u0103, multiorgan, care influen\u021beaz\u0103 at\u00e2t calitatea vie\u021bii […]<\/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-10442","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/pages\/10442","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/comments?post=10442"}],"version-history":[{"count":3,"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/pages\/10442\/revisions"}],"predecessor-version":[{"id":10446,"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/pages\/10442\/revisions\/10446"}],"wp:attachment":[{"href":"https:\/\/pdi.ro\/2021\/wp-json\/wp\/v2\/media?parent=10442"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Autor: M. Bojinc\u0103<\/span><\/p>\n
Apari\u021bia ulcera\u021biilor digitale este frecvent\u0103 \u0219i asociat\u0103 cu complica\u021bii locale \u0219i generale. \u00cen afara tratamentului local, ghidul EULAR recomand\u0103 prostaglandine intravenos, \u00een special iloprost \u00een administrare intravenoas\u0103 \u00een doze de 0,5-2 ng\/kg\/min 3-5 zile succesiv. De\u0219i s-a \u00eencercat \u0219i utilizarea prostanoizilor orali totu\u0219i eficacitatea este mai semnificativ\u0103 \u00een administrare intravenoas\u0103. Alte variante de tratament sunt reprezentate de inhibitorii de PDE-5 dintre care Tadalafil 20 mg\/2 zile are rezultatele cele mai bune. Bosentan, un inhibitor dual al receptorilor de endotelin\u0103 (ERA) s-a dovedit eficient nu \u00een tratamentul ulcera\u021biilor digitale din sclerodermie ci \u00een prevenirea apari\u021biei de noi ulcera\u021bii \u00een doze ini\u021biale de 62,5 mg x 2\/zi \u0219i apoi 125 mg x 2 \/zi.
\u00cen hipertensiunea arterial\u0103 pulmonar\u0103 (HTP) din sclerodermie se recomand\u0103 de asemenea utilizarea antagoni\u0219tilor receptorilor de endotelin\u0103 (ERA) ca Bosentan, Ambrisentan, Macitentan care au demonstrat \u00eembun\u0103t\u0103\u021birea capacit\u0103\u021bii de efort \u0219i \u00eencetinirea agrav\u0103rii clinice. Au fost raportate mai multe reac\u021bii adverse la aceste medicamente cum ar fi: cre\u0219terea transaminazelor, edeme, palpita\u021bii, cefalee, anemie \u0219i altele.
Inhibitorii PDE-5, Sildenafil \u0219i Tadalafil au demonstrat o bun\u0103 eficacitate \u00een ameliorarea capacit\u0103\u021bii de efort \u0219i \u00eencetinirea agrav\u0103rilor. Riociguat este un membru al unei noi clase de medicamente utilizate \u00een HTP din boli conjunctivo-vasculare respectiv stimulatorii de guanilat ciclaz\u0103. Riociguat a demonstrat o ameliorare a capacit\u0103\u021bii de efort, o \u00eencetinire a agrav\u0103rii clinice dar \u0219i o ameliorare a parametrilor hemodinamici. \u00cen general, aceste medica\u021bii se utilizeaz\u0103 \u00een monoterapie dar \u00een cazul unei evolu\u021bii severe, progresive a HTP se poate utiliza o combina\u021bie de dou\u0103 tipuri de medica\u021bii cum ar fi ERA + inhibitor PDE-5.
Prostanoizii administra\u021bi intravenos ca Epoprostenol, Iloprost sunt utiliza\u021bi \u00een special \u00een formele severe, avansate de HTP (stadiile III – IV). \u00cen doz\u0103 de 2 ng\/kg\/min, perfuzie continu\u0103, Epoprostenol a demonstrat ameliorarea capacit\u0103\u021bii de efort \u0219i parametrilor hemodinamici \u0219i \u00eencetinirea agrav\u0103rii clinice.
Pentru afectarea pulmonar\u0103 \u0219i cutanat\u0103 se pot utiliza mai multe tipuri de medicamente. Metotrexat \u00een doz\u0103 de 10-15 mg\/s\u0103pt\u0103m\u00e2n\u0103 intramuscular este eficient \u00een formele cutanate difuze de sclerodermie. Ciclofosfamida, Azatioprina, Micoenolatul mofetil sunt de asemenea eficiente \u00een formele cutanate difuze. Ciclofosfamida poate fi utilizat\u0103 \u00een afectarea pulmonar\u0103 intersti\u021bial\u0103 din sclerodermie, unde deterin\u0103 ameliorarea clinic\u0103, ameliorarea testelor ventilatorii \u0219i calit\u0103\u021bii vie\u021bii chiar dac\u0103 nu a fost demonstrat\u0103 ameliorarea capacit\u0103\u021bii de transfer gazos. Ciclofosfamida a fost utilizat\u0103 \u00een studii at\u00e2t oral c\u00e2t \u0219i intravenos. Transplantul de celule stem hematopoetice este eficient at\u00e2t \u00een manifest\u0103rile cutanate c\u00e2t \u0219i \u00een cele pulmonare din sclerodermie. \u021ain\u00e2nd seama de reac\u021bii adverse \u0219i de riscuri transplantul de celule stem hematopoetice este recomandat pacien\u021bilor cu forme severe progresive de sclerodermie cu risc major de insuficien\u021b\u0103 de organ.
Criza renal\u0103 sclerodermic\u0103 este o cauz\u0103 important\u0103 de mortalitate \u00een sclerodermie. Se recomand\u0103 ini\u021bierea terapiei cu inhibitori de enzim\u0103 de conversie a angiotensinogenului (IEC) c\u00e2t mai repede cu putin\u021b\u0103 dup\u0103 diagnosticul de criz\u0103 renal\u0103 sclerodermic\u0103. IEC nu au dovedit un efect preventiv \u00een raport cu apari\u021bia crizei renale sclerodermice. Deoarece criza renal\u0103 sclerodermic\u0103 este asociat\u0103 cu utilizarea glucocorticoizilor (GC) se recomand\u0103 utilizarea cu pruden\u021b\u0103 a GC la pacien\u021bii cu sclerodermia \u0219i monitorizarea atent\u0103 a acestora.
Pentru afectarea digestiv\u0103 din sclerodermie se recomand\u0103 utilizarea inhibitorilor de pomp\u0103 protonic\u0103 (IPP) \u00een special la pacien\u021bii cu simptome digestive superioare de tip boal\u0103 de reflux gastroesofagian. La pacien\u021bii f\u0103r\u0103 simptome digestive utilizarea IPP trebuie f\u0103cut\u0103 cu pruden\u021ba. Utilizarea pe termen lung a IPP poate genera malabsorb\u021bie, deficite nutri\u021bionale \u0219i risc crescut de infec\u021bii. Tulbur\u0103rile de motilitate digestiv\u0103 din sclerodermie pot fi tratate cu prokinetice (metoclopramid, domperidon\u0103, cisaprid \u00een func\u021bie de medica\u021biile aprobate \u00een diferite \u021b\u0103ri) de\u0219i nu exist\u0103 studii controlate semnificative. \u00cen cazul apari\u021biei sindroamelor de proliferare bacterian\u0103 se pot utiliza cure periodice de antibiotice cu spectru larg cum ar fi chinolone, amoxicilin\u0103 + acid clavulanic, metronidazol etc. O serie de complica\u021bii specifice cum ar fi microstomia sau incontinen\u021ba anal\u0103 pot fi ameliorate prin kinetoterapie \u0219i alimenta\u021bie adecvat\u0103. \u00cen anumite situa\u021bii cum ar fi stricturile, hemoragiile digestive, necesitatea alimenta\u021biei pe sond\u0103 se poate apela la interve\u021bii endoscopice sau chirurgicale.
\u00cen ultimii ani, dupa publicarea ghidului EULAR au ap\u0103rut foarte multe date noi privind diferite forme de terapii utile \u00een sclerodermie. Micofenolatul mofetil (MFM) s-a dovedit eficient \u00een tratamentul afect\u0103rii pulmonare intersti\u021biale din sclerodermie, determin\u00e2nd ameliorarea dispneei, probelor func\u021bionale respiratorii, capacit\u0103\u021bii de difuziune \u0219i leziunilor pulmonare eviden\u021biate prin tomografie computerizat\u0103. Ca urmare tinde s\u0103 egaleze sau s\u0103 \u00eenlocuiasc\u0103 ciclofosfamid\u0103 \u00een tratamentul afect\u0103rii pulmonare din sclerodermie. Dintre tratamentele biologice evaluate \u00een tratamentul sclerodermiei Rituximabul a dovedit efecte favorabile \u00een afectarea pulmonar\u0103 \u0219i cutanat\u0103 cu ameliorarea scorului Rodnan \u0219i probelor func\u021bionale pulmonare. S-a propus evaluarea comparativ\u0103 cu Ciclofosfamida penru a stabili mai precis eficien\u021ba tratamentului cu Rituximab. Pentru tratamentul HTP din sclerodermie s-a propus utilizarea Selexipag, un agonist selectiv al receptorilor de prostaciclin\u0103. Primele date sunt \u00eencurajatoare: tratamentul cu Selexipag reduce progresia HTP \u0219i mortalitatea.
Nintedanib. \u00cen tratamentul HTP au ap\u0103rut multe date privind eficien\u021ba \u0219i siguran\u021ba combina\u021biilor de medicamente. \u00cen sclerodermie au fost recent studiate o serie de medicamente cu efect antifibrozant cum ar fi Dasatinib, un inhibitor de tirozin kinaz\u0103 care nu a demonstrat efecte favorabile cutanate sau pulmonare \u00een sclerodermie dar \u0219i Nintedanib, un alt inhibitor de tirozin kinaz\u0103 care a demonstrat efecte favorabile \u00een pneumopatia fibrozant\u0103 idiopatic\u0103 dar \u0219i \u00een afectarea pulmonar\u0103 intersti\u021bial\u0103 din sclerodermie. De remarcat c\u0103 efectul pulmonar al Nintedanib este semnificativ dar nu exist\u0103 efecte favorabile pe alte tipuri de manifest\u0103ri sclerodermice inclusiv pe manifestarea cutanat\u0103.
\u00cen concluzie, de\u0219i \u00eenc\u0103 nu exist\u0103 \u00eenc\u0103 un tratament eficient pentru toate manifest\u0103rile sclerodermiei sistemice, exist\u0103 numeroase op\u021biuni terapeutice validate \u00een studii pentru diferitele manifest\u0103ri ale bolii.<\/p>\n
2021 – Profesor universitar disciplina Reumatologie \u2013 Universitatea de Medicin\u0103 \u0219i Farmacie \u201cCarol Davila\u201d Bucure\u0219ti
2007-2021 – Conferen\u021biar universitar –
2004-2007 \u2013 \u0218ef de lucr\u0103ri \u2013
2000-2004 \u2013 Asistent universitar \u2013<\/p>\n
1990-1991, 1991-1994 – Medic stagiar, medic secundar Medicin\u0103 Intern\u0103
1995 – Medic specialist Medicin\u0103 Intern\u0103
1998 – Medic specialist Reumatologie
2000 – Medic primar Medicin\u0103 Intern\u0103
2004 – Medic primar Reumatologie
2004 – Doctor \u00een Medicin\u0103<\/p>\n
Autor \u0219i co-autor a 3 c\u0103r\u021bi \u0219i 8 capitole \u00een monografii \u0219i tratate.
Autor \u0219i co\u2013autor a peste 45 articole publicate \u00een reviste indexate \u00een baze de date interna\u021bionale.
Autor \u0219i co-autor a peste 50 de articole \u00een reviste listate CNCSIS b+
Autor a peste 200 de prezent\u0103ri \u015fi postere la conferinte \u015fi congrese na\u0163ionale \u015fi interna\u0163ionale<\/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