New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis

DEMİRKAYA, Erkan; GÖKÇE, İbrahim

New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis

İbrahim GÖKÇE, (Gülhane Askeri Tıp Fakültesi, Pediatrik Nefroloji ve Romatoloji, Anabilim Dalı, Ankara, Türkiye)

Erkan DEMİRKAYA (Gülhane Askeri Tıp Fakültesi, Pediatrik Nefroloji ve Romatoloji, Anabilim Dalı, Ankara, Türkiye)

Turkish Journal of Rheumatology(.)Archives of Rheumatology

1 0

Yıl: 2011 Cilt: 26 Sayı: 1 Sayfa Aralığı: 71 - 85 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis

Öz:

Juvenil idiyopatik artrit (JİA), 16 yaş altı çocuklarda 10-19/100.000 düzeyinde bir insidansla çocukluk çağının en yaygın kronik romatizmal hastalığıdır ve aynı zamanda, bu yaş grubunda edinilmiş fonksiyon yetersizliklerinin ve hayat kalitesinde bozulmanın önemli nedenlerindendir. Erken ve agresif artrit tedavisi kalıcı fonksiyon yetersizliğini önlemede önemlidir. Metotreksat (MTX) JİA'da kabul edilebilir bir toksik etki profiliyle faydalar sağlamaktadır. Bununla beraber MTX'in özellikle poliartiküler ve sistemik başlangıçlı JİA hastalarında etkili olmaması ve MTX intoleransı araştırmacıları diğer tedavi seçeneklerini denemeye yöneltmiştir. Biyolojik ajanlar JİA patogenezinde sorumlu tutulan interlökin-1 (İL-1), İL-6 ve yanı sıra tümör nekrozis faktör-? (TNF-?) gibi kilit sitokinleri ve T ve B lenfosit yanıtının düzenlenmesinde rol alan sinyal moleküllerini hedef alır. Amerikan Gıda ve İlaç Dairesi (FDA) şimdiye kadar orta seviyeli ila ciddi poliartiküler JİA'da kullanılmak üzere üç biyolojik ajana onay vermiştir. Bu ajanlar etanersept, adalimumab ve abataseptir. Genel olarak TNF-? inhibitörleri poliartiküler hastalığı olan çocuklarda daha faydalıdır ve İL-1 ve İL-6 aktivitesini hedef alan biyolojik ajanlar sistemik başlangıçlı JİA'lı hastalarda da başarılı gibi görünmektedir. T hücresi ko-stimülasyon düzenleyicisi abataseptin orta dereceli ila şiddetli poliartiküler JİA'lı hastaların tedavisinde etkiliolduğu gösterilmiştir. Dirençli JİA hastalarında otolog kök hücre nakli de kullanılmıştır ancak bu işlem tedaviyle ilişkili yüksek bir morbidite ve mortalite riski taşımaktadır. Bu derlemede JİA tedavisindeki son ilerlemelerin özetlenmesi amaçlanmıştır.

Anahtar Kelime:

Konular: Romatoloji

Juvenil İdiopatik Artrit Tedavisinde Yeni Tedavi Yöntemleri

Öz:

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood with an incidence of 10-19/100.000 children below the age of 16 years, and it is also one of the major causes of acquired disability and impairment of quality of life in childhood. Early and aggressive control of arthritis is essential to prevent long-term disability. Methotrexate (MTX) provides clinical benefits in JIA with an acceptable profile of toxic effects. Nevertheless, in many cases, inefficacy, especially in patients with polyarticular and systemic-onset form of JIA (SOJIA) or intolerance to MTX, has led investigators to try other therapeutic options. Biologic agents have been designed to target key cytokines implicated in JIA including tumor necrosis factor-? (TNF-?), Interleukin-1 (IL-1), IL-6 as well as signaling molecules involved in the regulation of T-cell and B-cell lympocyte responses. Up to now, the U.S. Food and Drug Administration (FDA) has approved three biologic agents for use in moderate to severe polyarticular JIA: etanercept, adalimumab and abatacept. In general, TNF-? inhibitors are more beneficial for children with polyarticular disease, and the biological agents that target IL-1 and IL-6 activity appear to be successful also in treating patients with SOJIA. The T-cell costimulation modulator, abatacept, was shown to be effective for the treatment of patients with moderate to severe polyarticular JIA. Autologous stem cell transplantation has also been used in patients with refractory JIA; however, the procedure carries the risk of treatment-related high morbidity and mortality. The purpose of this review is to summarise the recent advances in the treatment of JIA.

Anahtar Kelime:

Konular: Romatoloji

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

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APA	GÖKÇE İ, DEMİRKAYA E (2011). New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis. , 71 - 85.
Chicago	GÖKÇE İbrahim,DEMİRKAYA Erkan New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis. (2011): 71 - 85.
MLA	GÖKÇE İbrahim,DEMİRKAYA Erkan New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis. , 2011, ss.71 - 85.
AMA	GÖKÇE İ,DEMİRKAYA E New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis. . 2011; 71 - 85.
Vancouver	GÖKÇE İ,DEMİRKAYA E New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis. . 2011; 71 - 85.
IEEE	GÖKÇE İ,DEMİRKAYA E "New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis." , ss.71 - 85, 2011.
ISNAD	GÖKÇE, İbrahim - DEMİRKAYA, Erkan. "New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis". (2011), 71-85.

APA	GÖKÇE İ, DEMİRKAYA E (2011). New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis. Turkish Journal of Rheumatology(.)Archives of Rheumatology, 26(1), 71 - 85.
Chicago	GÖKÇE İbrahim,DEMİRKAYA Erkan New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis. Turkish Journal of Rheumatology(.)Archives of Rheumatology 26, no.1 (2011): 71 - 85.
MLA	GÖKÇE İbrahim,DEMİRKAYA Erkan New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis. Turkish Journal of Rheumatology(.)Archives of Rheumatology, vol.26, no.1, 2011, ss.71 - 85.
AMA	GÖKÇE İ,DEMİRKAYA E New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis. Turkish Journal of Rheumatology(.)Archives of Rheumatology. 2011; 26(1): 71 - 85.
Vancouver	GÖKÇE İ,DEMİRKAYA E New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis. Turkish Journal of Rheumatology(.)Archives of Rheumatology. 2011; 26(1): 71 - 85.
IEEE	GÖKÇE İ,DEMİRKAYA E "New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis." Turkish Journal of Rheumatology(.)Archives of Rheumatology, 26, ss.71 - 85, 2011.
ISNAD	GÖKÇE, İbrahim - DEMİRKAYA, Erkan. "New Treatment Strategies in the Treatment of Juvenile Idiopathic Arthritis". Turkish Journal of Rheumatology(.)Archives of Rheumatology 26/1 (2011), 71-85.