M olej rov subkatedra revmatologie ipvz revmatologick stav praha
This presentation is the property of its rightful owner.
Sponsored Links
1 / 16

Osteoartróza. Současné možnosti farmakoterapie PowerPoint PPT Presentation


  • 124 Views
  • Uploaded on
  • Presentation posted in: General

M.Olejárová Subkatedra revmatologie IPVZ Revmatologický ústav Praha. Osteoartróza. Současné možnosti farmakoterapie. Klasifikace léků pro OA. Strukturu modifikující léky OA. Symptomatické léky OA. s dlouhodobým efektem chondroitinsulfát glukosaminsulfát kyselina hyaluronová

Download Presentation

Osteoartróza. Současné možnosti farmakoterapie

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


M olej rov subkatedra revmatologie ipvz revmatologick stav praha

M.Olejrov

Subkatedra revmatologie IPVZ

Revmatologick stav Praha

Osteoartrza.Souasn monosti farmakoterapie


Klasifikace l k pro oa

Klasifikace lk pro OA

Strukturu modifikujc

lky OA

Symptomatick lky

OA

s dlouhodobm efektem

  • chondroitinsulft

  • glukosaminsulft

  • kyselina hyaluronov

  • hylany

  • diacerhein aj.

s krtkodobm efektem

  • analgetika

  • NSA


Doporu en pro l bu osteoartr zy

Doporuen pro lbu osteoartrzy

ACR - OA kyle a kolene - 2000 ACR subcom., Arthritis Rheum 2000;43:1905

EULAR - OA kolene

Pendleton et al., Ann RheumDis2000;59: 936-44

EULAR - OA kyle

Zhang et al. Ann Rheum Dis 2005;64:669-81

EULAR - OA rukou

Ann Rheum Dis 2006


Paracetamol

Paracetamol

Paracetamol je perorln analgetikum 1. volby a v ppad spchu i preferovan lk pro lbu dlouhodobou.

Pincus T et al. Arthritis Rheum 1999; 42: 404

Wolfe O et al. Arthritis Rheum 2000; 43: 378-89

Rodriguez G et al. Epidemiology 2001; 12: 570-6

Chandrascaran. PNAP 2002; 99: 1326


Nesteroidn antirevmatika

Nesteroidn antirevmatika

Lokln lba NSA je klinicky inn a bezpen (koleno, ruce).

Altman RD, Sem Arthritis Rheum 1994;23:25-32

Moore RA, BMJ 1998; 316: 333-342

Vail J, Drugs 1998; 56: 783-799

Systmov NSA jen u nedostaten reakce na paracetamol.

U zvenho GI rizika - neselektivn NSA s gastroprotektivy nebo COX-2 specifick inhibitory.

Laine L, Gastroenterology 1999; 117: 776

Hawkey C et al. Arthritis Rheum 2000; 43: 370

Hochberg M, Arthritis Res 2003; 5: 28-31


Opioidy

Opioidy

Opioidn analgetika (v monoterapii nebo kombinaci s paracetamolem) jsou alternativou v ppad, kdy jsou NSA, vetn koxib, kontraindikovna, neinn nebo patn tolerovna.

Roth SH. J Rheumatol 1998; 25: 1358-63

Pavelka K et al. Clin drug Invest 1998; 16: 1-9


Symptomatick pomalu p sob c l ky oa sysadoa

Symptomatick pomalu psobc lky OA (SYSADOA)

SYSADOA - symptomaticky pomalu psobc lky OA - jsou symptomaticky inn a mohou modifikovat i strukturu.

Glukosamin sulft, chondroitin sulft, kyselina hyaluronov, hylan GF-20, diacerhein, ASU

Reginster J et al. Lancet 2001; 357: 251-56

Pavelka K et al. Arch Inter Med 2002; 162: 2113-23

Dougados et al. Arthritis Rheum 2001; 44: 2539


Osteoartr za sou asn mo nosti farmakoterapie

Dlouhodob symptomatick efekt glukosamin sulftu

Lequesnv index


Osteoartr za sou asn mo nosti farmakoterapie

0

.

4

(n=84,68,65)

)

G

l

u

c

o

s

a

m

i

n

s

u

l

f

t

m

(n=83,57,55)

P

l

a

c

e

b

o

m

0

.

3

(

0

.

2

*

*

0

.

1

-

0

.

0

-

0

.

1

-

0

.

2

-

0

.

3

-

0

.

4

0

1

2

3

Roky

*p<0.05

p<0.01

P

A

V

J

S

N

A

C

.

F

W

P

#

3

2

6

0

Vvoj ky kloubn trbiny na RTG kolen u terapie GS a placebem

Pavelka K et al, Arch Intern Med 2002;162:2113-23


Osteoartr za sou asn mo nosti farmakoterapie

Zmna ky kloubn trbiny kolennho kloubu bhem 2 let u pacient lench CHS a placebem

Michel B. et al. Arthritis Rheum 2005;52:779-786


Osteoartr za sou asn mo nosti farmakoterapie

Chondroitin sulft u OA rukou

  • Systems to assess the progression of finger joint OA and the effects of disease modifying OA drugs

  • Dv dvojit slep, placebem kontrolovan, tlet studie, n=165

  • Terapie

    • Chondroitin polysulft, n = 46

    • Chondroitin sulft, n = 34

    • Placebo, n = 85, po dobu 3 let

  • Zvry

    • CHS nezabrnil vvoji OA na dosud nepostiench kloubech

    • U CHS a CHPS men RTG progrese

    • Ni rozvoj EOA u CHS a CHPS

Verbruggen G et al., Clin Rheumatol 2002;21:231-43


Osteoartr za sou asn mo nosti farmakoterapie

Kyselina hyaluronovVvoj bolesti pi chzi (gonartrza)

VAS (mm)

Carraba at al. 1996


Struktur ln efekt diacereinu u koxartr zy dvojit slep t let studie

Strukturln efekt diacereinu u koxartrzy (dvojit slep, tlet studie)

Dougados et al. Arthritis Rheum 2001;44:2539-47


Osteoartr za sou asn mo nosti farmakoterapie

Intraartikulrn injekce depotnho kortikosteroidu je indikovna pi vzplanut bolesti, zvlt pi ptomnosti vpotku.

Jones A, Doherty M, Ann Rheum Dis, 1996


Z v ry

Zvry

Adekvtn analgetick terapie

Paracetamol analgetikum volby

NSA

Opioidy (slab, stedn siln)

Mon kombinace

SYSADOA

U symptomatick OA II.-III.st. podle Kellgrena-Lawrence

i.a. injekce kortikosteroid

Pi sekundrn zntliv reakci (koleno, ruce)


Ot zky odpov di

Otzky ? Odpovdi !


  • Login