Klasik tedaviye dirençli romatoid artrit ve ankilozan spondilit hastalarında tümör nekroz faktör alfa blokeri kullanımının böbrek fonksiyonları üzerine etkisi
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Date
2007
Authors
Öztürk, Oğuzhan
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Romatoid Artrit (RA) ve Ankilozan Spondilit (AS) kronik, inflamatuar, sistemik hastalıklardır. Bu hastalıklar kontrol altına alınmadıgında hastalarda morbidite ve mortalitede artısa neden olmaktadır. Genellikle eklem tutulumu görülmesine ragmen inflamatuar süreçten vücudun diger organları da olumsuz etkilenebilmektedir. RA ve AS'nin patogenezinde proinflamatuar sitokin olan tümör nekrozis faktör-a'nın (TNF-a) rolü oldugu anlasılmistır. Bu nedenle tedavi amaçlı anti- TNF-a ajanlar gelistirilmistir. Özellikle de hastalıgı modifiye edici antiromatizmal ilaçlara (DMARD) dirençli hastalarda etkin oldukları gösterilmistir. Bunlardan etanersept, infliksimab ve adalimumab Amerika Ulusal Gıda ve laç kurulu (FDA) onayı almıslardır. Literatürde bu ilaçların böbrek fonksiyonları üzerine etkilerini inceleyen yeterli sayıda çalısma bulunmamaktadır. Biz bu çalısmamızda DMARD'a dirençli RA ve AS hastalarında etanersept tedavisinin böbrek fonksiyonları üzerine etkisi olup olmadıgını arastırmayı amaçladık. Çalısmaya Kasım 2005-Agustos 2006 tarihleri arasında Uludag Üniversitesi ç Hastalıkları Ana Bilim Dalı Romatoloji Bilim Dalı poliklinigine basvuran 11 RA ve 8 AS hastası alındı. Hastalara haftada iki kez subkutan 25 mg dozunda etanersept tedavisi baslandı. Tedavi öncesi, tedaviden sonra 4. hafta ve 16. haftalarda, kreatinin klirensi, serum sistatin-c, serum b-2 mikroglobulin, 24 saatlik idrarda N asetil b-D glukozaminidaz (NAG) ve mikroalbuminüri düzeyleri arastırıldı. Tedavi sonunda hem serum ve hem de idrarda bakılan parametrelerde tedavi öncesine göre istatiksel açıdan anlamlı olmayan degisiklikler gözlendi. Sonuç olarak; çalısmamızda, DMARD tedavisi alan RA ve AS hastalarında etanersept tedavisinin böbregin glomerüler ve proksimal tübül fonksiyonları üzerine olumlu ya da olumsuz bir etkisinin olmadıgını saptadık.
Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS) are chronic, inflamatuar, systemic illnesses. When these illnesses are not under control, they cause increasing in morbidity and mortalitiy. Although generally joint eclipse is seen, the other organs of body are negatively effected by inflamatuar process. It is understood that there is a role of tumor necrosis factor- (TNF- ), which is a proinflamatuar cytokine in the patogenesis in RA and AS. Thus anti TNF- agents are developed with the purpose of treatment. Especially it is shown that they are active in patients who are resistant to rheumatismal medicines. Three of them, etanercept, infliximab and adalimumab have taken the approve of United States Food and Drug Administration (FDA). There is not enough study about the medicines examining their effects on kidney functions. n this study, we have aimed either etanercept cure is effective on kidney functions in RA and AS patients who are resistant to disease modifying antirheumatic drugs (DMARD). 11 RA and 8 AS patients who had appointed to Uludag University Interior Illness Main Science Branch Rheumatology Science Branch Polyclinic between the dates of November 2005 and August 2006, have enrolled to this study. Etanercept cure in the dose of subcutan 25 mg has been started to be given to patients twice a week. Creatinine clerens, serum cystatin-c, serum b-2 microglobulin and N acetyl b-D glucoseaminidase (NAG) in 24 hour urine, have been looked before treatment and in fourth and sixteenth weeks after the treatment. End of the treatment changes which are statistically meaningless are observed in the parameters in both serum and urine according to pre-treatment. As a result in our study we have determined that etanercept cure dose not effect the kidney functions in the patients of RA and AS who take DMARD cure.
Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS) are chronic, inflamatuar, systemic illnesses. When these illnesses are not under control, they cause increasing in morbidity and mortalitiy. Although generally joint eclipse is seen, the other organs of body are negatively effected by inflamatuar process. It is understood that there is a role of tumor necrosis factor- (TNF- ), which is a proinflamatuar cytokine in the patogenesis in RA and AS. Thus anti TNF- agents are developed with the purpose of treatment. Especially it is shown that they are active in patients who are resistant to rheumatismal medicines. Three of them, etanercept, infliximab and adalimumab have taken the approve of United States Food and Drug Administration (FDA). There is not enough study about the medicines examining their effects on kidney functions. n this study, we have aimed either etanercept cure is effective on kidney functions in RA and AS patients who are resistant to disease modifying antirheumatic drugs (DMARD). 11 RA and 8 AS patients who had appointed to Uludag University Interior Illness Main Science Branch Rheumatology Science Branch Polyclinic between the dates of November 2005 and August 2006, have enrolled to this study. Etanercept cure in the dose of subcutan 25 mg has been started to be given to patients twice a week. Creatinine clerens, serum cystatin-c, serum b-2 microglobulin and N acetyl b-D glucoseaminidase (NAG) in 24 hour urine, have been looked before treatment and in fourth and sixteenth weeks after the treatment. End of the treatment changes which are statistically meaningless are observed in the parameters in both serum and urine according to pre-treatment. As a result in our study we have determined that etanercept cure dose not effect the kidney functions in the patients of RA and AS who take DMARD cure.
Description
Keywords
Romatoid artrit, Ankilozan spondilit, Etanersept, N asetil β-D glukozaminidaz, Sistatin-c, Rheumatoid arthritis, Ankylosing spondylitis, Etanercept, N acetyl β-D glucoseaminidase, Cystatin-c
Citation
Öztürk, O. (2007). Klasik tedaviye dirençli romatoid artrit ve ankilozan spondilit hastalarında tümör nekroz faktör alfa blokeri kullanımının böbrek fonksiyonları üzerine etkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.