prikaz prve stranice dokumenta Lokalna kortikosteroidna terapija u bolesnika s uveitisom u sklopu juvenilnoga idiopatskoga artritisa na sistemskoj imunomodularnoj terapiji
  Download
PDF 1.92 MB
doctoral thesis
Lokalna kortikosteroidna terapija u bolesnika s uveitisom u sklopu juvenilnoga idiopatskoga artritisa na sistemskoj imunomodularnoj terapiji
Zagreb: University of Zagreb, School of Medicine, 2021. urn:nbn:hr:105:860805
Barišić Kutija, Marija
University of Zagreb
School of Medicine

Institutional repository: Dr Med - University of Zagreb School of Medicine Digital Repository

Cite this document

Barišić Kutija, M. (2021). Lokalna kortikosteroidna terapija u bolesnika s uveitisom u sklopu juvenilnoga idiopatskoga artritisa na sistemskoj imunomodularnoj terapiji (Doctoral thesis). Zagreb: University of Zagreb, School of Medicine. Retrieved from https://urn.nsk.hr/urn:nbn:hr:105:860805

Barišić Kutija, Marija. "Lokalna kortikosteroidna terapija u bolesnika s uveitisom u sklopu juvenilnoga idiopatskoga artritisa na sistemskoj imunomodularnoj terapiji." Doctoral thesis, University of Zagreb, School of Medicine, 2021. https://urn.nsk.hr/urn:nbn:hr:105:860805

Barišić Kutija, Marija. "Lokalna kortikosteroidna terapija u bolesnika s uveitisom u sklopu juvenilnoga idiopatskoga artritisa na sistemskoj imunomodularnoj terapiji." Doctoral thesis, University of Zagreb, School of Medicine, 2021. https://urn.nsk.hr/urn:nbn:hr:105:860805

Barišić Kutija, M. (2021). 'Lokalna kortikosteroidna terapija u bolesnika s uveitisom u sklopu juvenilnoga idiopatskoga artritisa na sistemskoj imunomodularnoj terapiji', Doctoral thesis, University of Zagreb, School of Medicine, accessed 26 November 2024, https://urn.nsk.hr/urn:nbn:hr:105:860805

Barišić Kutija M. Lokalna kortikosteroidna terapija u bolesnika s uveitisom u sklopu juvenilnoga idiopatskoga artritisa na sistemskoj imunomodularnoj terapiji [Doctoral thesis]. Zagreb: University of Zagreb, School of Medicine; 2021 [cited 2024 November 26] Available at: https://urn.nsk.hr/urn:nbn:hr:105:860805

M. Barišić Kutija, "Lokalna kortikosteroidna terapija u bolesnika s uveitisom u sklopu juvenilnoga idiopatskoga artritisa na sistemskoj imunomodularnoj terapiji", Doctoral thesis, University of Zagreb, School of Medicine, Zagreb, 2021. Available at: https://urn.nsk.hr/urn:nbn:hr:105:860805

Metadata
TitleLokalna kortikosteroidna terapija u bolesnika s uveitisom u sklopu juvenilnoga idiopatskoga artritisa na sistemskoj imunomodularnoj terapiji
Title (english)Local corticosteroid treatment in patients with juvenile idiopathic arthritis-associated uveitis on systemic immunomodulatory therapy
AuthorMarija Barišić Kutija
VIAF: 316025892
MentorNenad Vukojević (mentor)
Committee memberMiro Kalauz (predsjednik povjerenstva)
Committee memberJakov Šikić (član povjerenstva)
Committee memberMarija Jelušić (član povjerenstva)
GranterUniversity of Zagreb
School of Medicine
Zagreb
Defense date and country2021-01-19, Croatia
Scientific / art field,
discipline and subdiscipline		BIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Ophthalmology
Universal decimal classification
(UDC)		617 - Surgery. Orthopaedics. Ophthalmology
Abstract
Uvod i cilj. Unatoč napredcima u strategijama skrbi bolesnika s uveitisom u sklopu juvenilnog idiopatskog artritisa (JIA-U), zbog komplikacija kronične intraokularne upale i primjene lokalnih kortikosteroida (LKS), JIA-U je još uvijek jedan od vodećih uzroka oštećenja vida pa čak i sljepoće u dječjoj dobi. Cilj ovog istraživanja bio je procijeniti učinkovitost imunomodularne terapije (IMT) u kontroli intraokularne upale u bolesnika s JIA-U-om i njen potencijal smanjenja potrebe za primjenom LKS-a te nastanka komplikacija. ----- Ispitanici i metode. Iz baze podataka Klinike za očne bolesti Kliničkog bolničkog centra Zagreb prikupljeni su podaci o tijeku liječenja 38 bolesnika (69 očiju) s JIA-U od 2 do 15 godina, koji su primali i IMT i LKS. Medijan praćenja bio je 4,4 god. Analizirani su podaci o kretanju dnevnih doza LKS-a i stupnja upale u prednjoj očnoj sobici (POS) sa svih kontrolnih pregleda te presječno u određenim odabranim vremenskim točkama prema različitim kriterijima ishoda. Također je analizirana združenost upotrebe IMT-a s potrebnom dozom LKS-a, kretanje i učestalost komplikacija JIA-U-a i oštećenje vidne oštrine tijekom praćenja. ----- Rezultati. U našem istraživanju jasno je pokazan trend smanjenja broja doza LKS-a i smanjenje stupnja upale u POS-u tijekom vremena, kako je uvođen IMT i što je duže korišten. Rezultati kontrole JIA-U-a u odabranim vremenskim točkama bili su povoljni, ali su se razlikovali ovisno o odabranim kriterijima ishoda. U dugoročnom praćenju (u 48. mjesecu), u 50 % očiju s JIA-U-om na biološkoj terapiji nije bio potreban LKS, a drugih 50 % zahtijevalo je 1-2 doze LKS-a za održavanje niske razine intraokularne upale u POS-u (≤ 0,5+). Broj dnevnih doza LKS-a kod JIA-U uz IMT na kraju praćenja je statistički značajno manji u odnosu na broj doza na početku praćenja. Statistički je značajno i poboljšanje vidne oštrine na kraju u odnosu na početak praćenja. Liječenje biološkim lijekovima, ali ne i metotreksatom (MTX), nezavisno je združeno sa smanjenom potrebom za LKS-om, nižim stupnjem upale u POS-u i smanjenjem rizika nastanka katarakte. ----- Zaključak. Uvođenje biološke sistemne IMT za liječenje JIA-U-a pokazuje kortikosteroid-štedeći potencijal, utjecaj na smanjenje intraokularne upale, komplikacija JIA-U-a i poboljšanje vidne oštrine u odnosu na početak praćenja. Ovo istraživanje ističe važnost uniformnog odabira mjera ishoda u budućim studijama, jer pokazuje da rezultati ishoda liječenja prikazani na istoj bazi podataka uvelike ovise o odabranim kriterijima ishoda. Naši rezultati pokazuju da je biološka terapija uz MTX i u dugoročnom praćenju učinkovita i korisna opcija za bolesnike s JIA-U-om.
Abstract (english)
Introduction and aim. Despite advances in juvenile idiopathic arthritis-associated uveitis (JIA-U) management, due to the chronic intraocular inflammation and topical corticosteroid (TCS) use, JIA-U is still one of the leading causes of vision impairment and even blindness in childhood. The aim of this study is to evaluate the efficacy of immunomodulatory treatment (IMT) in controlling intraocular inflammation in JIA-U patients and its potential to reduce the need for TCS and occurrence of complications. ----- Patients and methods. 38 children (69 eyes) aged 2 to 15 years who fullfilled inclusion criteria of having active JIA-U and taking IMT and TCS treatment for JIA-U were included. Patient disease data from Department of Children Ophthalmology, University Hospital Centre Zagreb were collected. The average follow-up time was 4,4 years. Trend analysis of daily TCS doses and the state of anterior chamber (AC) inflammation from all control examinations was performed. Separately, specific time points analysis according to different outcome criteria was performed. Association of IMT use with the applied daily TCS dose, JIA-U complications and visual acuity impairment during follow-up were also analysed. ----- Results. Our study clearly showed the decreasing trend of TCS dose and degree of intraocular inflammation during IMT use. The results of good JIA-U control at specific time points were favorable, but different depending on outcome criteria selected. In longterm follow-up (in 48th month), 50 % JIA-U eyes on biologic treatmet did not need TCS, and the other 50 % required 1-2 daily TCS doses to maintain low intraocular inflammation levels (stage ≤0.5 + in AC). The number of daily TCS doses in JIA-U on IMT at the end of follow-up was statistically significantly lower than at baseline. Visual acuity improvement during follow-up was also statistically significant. Biological treatment use but not with methotrexate (MTX), was independently associated with reduced need for TCS, a lower inflammation grade in CA and reduced risk of cataract. ---- Conclusion. Introduction of biological systemic therapy for JIA-U shows corticosteroid-sparing potential, and the impact on reducing intraocular inflammation, JIA-U complication rate and visual acuity improvement. This study highlights the importance of uniform selection and reporting outcome measures in future studies, because treatment outcomes presented largely depend on selected outcome criteria and time frames. Our results show that biologic therapy along with MTX is an effective and useful option for JIA-U patients.
Keywords
Keywords (english)
Languagecroatian
URN:NBNurn:nbn:hr:105:860805
Study programmeTitle: Biomedicine and Health Sciences
Study programme type: university
Study level: postgraduate
Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
Type of resourceText
File originBorn digital
Access conditionsOpen access
Terms of useLicence In copyright icon
Created on2021-03-19 09:12:09