Системная склеродермия.Схемы лечения

[Igor V]

Есть определенные бенефиты от использвания интерферонов, но существуют и многие но!- это весьма серьезные лекарства с вероятностью значит побочных действийThe interferons have been reported to be beneficial in the therapy of various diseases, including SSc. In particular, an antifibrotic effect has been reported in vitro. However recent data have implicated interferons in the pathogenesis of some autoimmune diseases. Interferon gamma (IFN-gamma) is a more potent inhibitor of collagen synthesis in vitro than IFN-alpha. It has other effects, however, which might contribute to aberrant cellular activation in SSc. (See Pathogenesis of systemic sclerosis (scleroderma).) As examples, in vitro IFN gamma can lead to:Macrophage activationClass II antigen expression (DR, DP, DQ) on endothelial and fibroblasts cellsIncreased interleukin-2 receptor expressionIncreased intracellular adhesion molecule-1 expression on endothelial cellsIgG Fc receptor expressionThese concerns have been apparently confirmed in uncontrolled studies in which IFN-gamma was associated with considerable vascular side effects, including renal hypertensive crisis [38]. As a result, no controlled studies are currently planned.IFN-alpha has received less attention than IFN-gamma. A pilot study of 14 patients with early diffuse disease of less than three years in duration found a significant measurable reduction in type-1 collagen synthesis from fibroblasts cultured from uninvolved skin, stabilization or improvement in the skin test in 10 of the patients [39].However, a multicenter double-blind study of 35 patients found that IFN-alpha provides no increased benefit compared with placebo and may be deleterious [40]. In this report, patients with early SSc were randomized to interferon-alpha (13.5 million units per week given subcutaneously for 12 months) or placebo. Compared with the placebo group, intent-to-treat analysis found that the group treated with IFN-alfa had more substantial skin involvement (as assessed by the skin score), and a significantly greater deterioration in lung function (as assessed by the forced vital capacity [p = 0.01] or the diffusing capacity for carbon monoxide [p = 0.002])

[Ольга Лобанова Фитасова Гутман]

Карциноид

Юрий я оссылке о статинах.никакой смысловой нагрузки.

[Виктору Тутунову]

Игорь, там справа ещё ссылка на статью японцев

[Igor V]

Виктор,Очень сложно понять место аторвастатина,как впрочем и др. статина в лечении склеродермии.Просто ,сегодня широко применяемый препарат,занимает свою нишу по факторам риска.Нет никаких убедительных доказательств его веса в патогенезе.Лечим ,как и др. и без вообще заболеваний,пациента с кард-васк факторами риска.Говроя иначе-можно сделать подобную работу с ...огурцами при склеродермии

[Елена Пугачева_Филипповa]

Вообще,лечение посиндромное,при сист.склеродермии.Сегодня нет времени писать.Конечно,если пациент с высокими кард-вас.факторами риска-лечить факторы риска независимо от заболевания.Сижу и смеюсь,надо было эту работу показать терапевту.Точно читать не будет.