{"id":10506,"date":"2007-12-14T10:22:42","date_gmt":"2007-12-14T07:22:42","guid":{"rendered":"https:\/\/www.synevo.ro\/afectiuni\/profil-poliartrita-reumatoida\/"},"modified":"2020-07-10T13:28:54","modified_gmt":"2020-07-10T10:28:54","slug":"profil-poliartrita-reumatoida","status":"publish","type":"synevo_diseases","link":"https:\/\/old.synevo.md\/ru\/afectiuni\/profil-poliartrita-reumatoida\/","title":{"rendered":"Profil poliartrit\u0103 reumatoid\u0103"},"content":{"rendered":"<p style=\"text-align: justify;\"><span style=\"color: #00539f;\"><strong>Poliartrita reumatoid\u0103 (PR)<\/strong><\/span> este o boal\u0103 inflamatorie sistemic\u0103 cronic\u0103, cea mai frecvent\u0103 suferin\u0163\u0103 reumatic\u0103 de tip inflamator, caracterizat\u0103 clinic printr-o artropatie cu evolu\u0163ie deformant\u0103 \u015fi distructiv\u0103, al\u0103turi de manifest\u0103ri generale \u015fi extra-articulare (ex. cutanate \u2013 nodulii reumatoizi \u2013 cea mai frecvent\u0103 manifestare extra-articular\u0103, cardiace, pulmonare, oculare).<\/p>\n<p style=\"text-align: justify;\">PR afecteaz\u0103 aproximativ 1% din popula\u0163ie, femeile de 2-3 ori mai frecvent dec\u00e2t b\u0103rba\u0163ii \u015fi debuteaz\u0103 la orice v\u00e2rst\u0103, de obicei \u00eentre 25-50 ani.<\/p>\n<hr \/>\n<p style=\"text-align: justify;\"><strong>Etiologia<\/strong>\u00a0este necunoscut\u0103, posibil mutifactorial\u0103, factorii favorizan\u0163i (de mediu, infec\u0163io\u015fi, hormonali, imunologici) ac\u0163ion\u00e2nd pe un teren genetic predispozant (HLA-DR4\/DR1).<\/p>\n<p style=\"text-align: justify;\">Poliartrita reumatoid\u0103 este asociat\u0103 cu fenomene autoimune, dar nu se cunoa\u015fte \u00eenc\u0103 dac\u0103 autoimunitatea este un eveniment secundar sau primar.<sup>1,2<\/sup><\/p>\n<p style=\"text-align: justify;\">Hiperplazia celulelor sinoviale \u015fi activarea celulelor endoteliale sunt evenimente ini\u0163iale \u00een cadrul procesului patologic, acesta progres\u00e2nd spre inflama\u0163ie necontrolat\u0103 cu distrugeri consecutive cartilaginoase \u015fi osoase.<\/p>\n<p style=\"text-align: justify;\">Factorii genetici \u015fi anomaliile sistemului imun contribuie la progresia afec\u0163iunii. Celulele care au un rol major \u00een procesul patogenic sunt: celulele T CD4, fagocite mononucleare, fibrobla\u015fti, osteocla\u015fti \u015fi neutrofile, limfocitele B (care produc autoanticorpi ex. factorul reumatoid).<\/p>\n<p style=\"text-align: justify;\">De asemenea, la pacien\u0163ii cu PR a fost demonstrat\u0103 o produc\u0163ie anormal\u0103 de numeroase citokine, chemokine \u015fi al\u0163i mediatori ai inflamatiei (ex. TNF-alfa, IL-1, IL-6).<\/p>\n<p style=\"text-align: justify;\">Manifest\u0103rile extra-articulare foarte diferite ca expresie \u015fi severitate \u00een func\u0163ie de durat\u0103 \u015fi severitatea bolii, sunt determinate de infiltrate limfoplasmocitare sau procese vasculitice \u015fi apar de obicei la bolnavii cu titru mare de factor reumatoid, complement seric sc\u0103zut, complexe imune circulante \u00een concentra\u0163ie crescut\u0103, crioglobuline \u015fi factori antinucleari prezen\u0163i\u00b2.<\/p>\n<p style=\"text-align: justify;\">Poliartrita reumatoid\u0103, datorita asocierii cu fenomene autoimune, se caracterizeaz\u0103 prin prezen\u0163a unei variet\u0103\u0163i de autoanticorpi \u00een ser \u015fi \u00een lichidul sinovial; ace\u015ftia o diferen\u0163iaz\u0103 de alte afec\u0163iuni articulare precum: artrita psoriazic\u0103, artrita reactiv\u0103 sau artroza, situa\u0163ii \u00een care fenomenele autoimune sunt rare.<\/p>\n<hr \/>\n<p style=\"text-align: justify;\">Primul element autoreactiv identificat (\u00een 1940) \u00een serul pacien\u0163ilor cu PR, a fost <span style=\"color: #00539f;\"><strong>factorul reumatoid (FR)<\/strong><\/span>, autoanticorp specific anti-imunoglobulina G. FR interac\u0163ioneaz\u0103 cu por\u0163iunea Fc a IgG. Izotipul major este IgM, dar \u00een serul \u015fi lichidul sinovial al pacien\u0163ilor cu PR sunt prezen\u0163i \u015fi FR-IgG sau FR-IgA. FR-IgM poate fi detectat la 60-80% din pacien\u0163ii cu PR instalat\u0103, prevalen\u0163a fiind considerabil sc\u0103zut\u0103 la pacien\u0163ii cu PR la debut. Specificitatea FR pentru PR cre\u015fte considerabil o dat\u0103 cu cre\u015fterea titrului, un FR &gt;50UI\/ml fiind specific pentru poliartrita reumatoid\u0103. Cu toate acestea, FR &gt;50mUI\/ml se g\u0103se\u015fte doar la 50% din pacien\u0163ii cu PR la debut, c\u00e2nd criteriile de diagnostic pentru PR nu sunt complet \u00eentrunite. \u00cen prezent, FR este cel mai utilizat marker serologic, constituind unul din cele \u015fapte criterii ACR de diagnostic a poliartritei reumatoide, de\u015fi se accept\u0103 faptul c\u0103 acest test are specificitate redus\u0103 \u015fi este uneori negativ \u00een aceast\u0103 afec\u0163iune\u00b3.<\/p>\n<p style=\"text-align: justify;\"><strong>\u00cen func\u0163ie de prezen\u0163a sau absen\u0163a factorului reumatoid<\/strong>, poliartrita reumatoid\u0103 este clasificat\u0103 \u00een 2 categorii:<\/p>\n<ul>\n<li style=\"text-align: justify;\">seropozitiv\u0103<\/li>\n<li style=\"text-align: justify;\">seronegativ\u0103<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Pacien\u0163ii seropozitivi au un risc mai mare dec\u00e2t cei seronegativi de a dezvolta artrit\u0103 eroziv\u0103 cu impoten\u0163\u0103 func\u0163ional\u0103 articular\u0103 \u015fi manifest\u0103ri extraarticulare, cum ar fi: noduli reumatoizi, determinare pulmonar\u0103 de boal\u0103, vasculit\u0103, sindrom Felty (neutropenie \u015fi splenomegalie asociate cu artrita reumatoid\u0103), polineuropatie, serozite \u015fi sindrom Sj\u00f6gren secundar<sup>4<\/sup><span style=\"font-size: inherit;\">.<\/span><\/p>\n<hr \/>\n<p style=\"text-align: justify;\"><strong>Diagnosticul<\/strong> poliartritei reumatoide se face conform criteriilor clinice, biologice \u015fi radiologice elaborate de ACR (American College of Rheumatology), revizuite ultima oar\u0103 \u00een 1987; aceasta are multe limite baz\u00e2ndu-se \u00een principal pe simptome clinice care nu se reg\u0103sesc de multe ori \u00een stadiile precoce de boal\u0103. Este unanim acceptat faptul c\u0103 interven\u0163ia terapeutic\u0103 precoce este vital\u0103 \u00een prevenirea distruc\u0163iei articulare ireversibile \u015fi de aceea este foarte important ca aceast\u0103 boal\u0103 s\u0103 fie diagnosticat\u0103 \u00een stadii ini\u0163iale. Din acest motiv, ar fi esen\u0163ial s\u0103 poat\u0103 fi utilizat un marker serologic specific care s\u0103 identifice acei pacien\u0163i care ar putea beneficia de un regim terapeutic agresiv<sup>5<\/sup>.<\/p>\n<p style=\"text-align: justify;\">\u00cen acest sens, una din cele mai spectaculoase descoperiri \u015ftiin\u0163ifice \u00een cercetarea afec\u0163iunilor autoimune din ultimii zece ani a fost identificarea \u00een serul pacien\u0163ilor cu poliartrita reumatoid\u0103, a unor autoanticorpi care recunosc epitopii citrulina\u0163i, cunoscu\u0163i sub numele de <strong>anticorpi antiproteine citrulinate (ACPA)<\/strong>.<\/p>\n<p style=\"text-align: justify;\">ACPA pot fi m\u0103surate folosind ca antigen proteine citrulinate ca filagrina, vimentina \u015fi fibrinogenul sau peptide ciclic citrulinate (CCP).<\/p>\n<p style=\"text-align: justify;\">Cele mai utilizate teste folosesc peptide ciclic citrulinate, iar ACPA determina\u0163i prin astfel de metode sunt cunoscu\u0163i ca anticorpi antipeptide ciclic citrulinate (anti-CCP). <span style=\"color: #00539f;\"><strong>ACPA constituie markerii serologici<\/strong><\/span> cu specificitatea cea mai ridicat\u0103\u00a0\u00een PR, prezen\u0163i \u00een stadiile precoce de boal\u0103, put\u00e2nd chiar precede debutul clinic.<\/p>\n<p style=\"text-align: justify;\">C\u00e2teva studii au ar\u0103tat o corela\u0163ie semnificativ\u0103 \u00eentre prezen\u0163a ACPA \u015fi progresia radiologic\u0103 a bolii (a leziunilor osoase). ACPA se asociaz\u0103 semnificativ cu prezen\u0163a alelelor HLA-DR specifice poliartritei reumatoide, pacien\u0163ii prezent\u00e2nd aceast\u0103 asociere av\u00e2nd un risc crescut de a dezvolta forme severe de PR.<\/p>\n<p style=\"text-align: justify;\">\u00cen concluzie, ACPA sunt anticorpii markeri cei mai valoro\u015fi \u015fi determinarea lor este deosebit de util\u0103\u00a0\u00een cazul pacien\u0163ilor cu artrit\u0103 la debut c\u00e2nd nu sunt \u00eendeplinite toate criteriile pentru PR\u00b3.<\/p>\n<p>\u00a0<\/p><div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-1 wp-block-columns-is-layout-flex\"><div class=\"wp-block-column is-vertically-aligned-center is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\"><p><strong>Analize medicale disponibile \u00een laboratoarele Synevo:<\/strong><\/p><\/div>\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\"><div class=\"synevo-shop-products\">\r\n    <div class=\"sysprod\">\r\n        \r\n        <div class=\"sysprod-products\">\r\n                            <div class=\"sysprod-product\">\r\n                    <a class=\"sysprod-product-title\" href=\"https:\/\/old.synevo.md\/ru\/shop\/factor-reumatoid\/\">Factor reumatoid<\/a>\r\n                    <div class=\"sysprod-product-price\">\r\n                        <span>Pre\u021b:<\/span>\r\n                        <span>105 lei<\/span>\r\n                    <\/div>\r\n                                            <div class=\"sysprod-product-addcart\">\r\n                            <a\r\n                                href=\"?add-to-cart=9234\"\r\n                                data-quantity=\"1\"\r\n                                class=\"addToCart button product_type_simple add_to_cart_button ajax_add_to_cart \"\r\n                                data-product_id=\"9234\"\r\n                                data-product_sku=\"IM21\"\r\n                                rel=\"nofollow\"\r\n                            ><div><\/div><\/a>\r\n                        <\/div>\r\n                                    <\/div>\r\n                            <div class=\"sysprod-product\">\r\n                    <a class=\"sysprod-product-title\" href=\"https:\/\/old.synevo.md\/ru\/shop\/factor-reumatoid-waaler-rose\/\">Factor reumatoid-Waaler Rose<\/a>\r\n                    <div class=\"sysprod-product-price\">\r\n                        <span>Pre\u021b:<\/span>\r\n                        <span>110 lei<\/span>\r\n                    <\/div>\r\n                                            <div class=\"sysprod-product-addcart\">\r\n                            <a\r\n                                href=\"?add-to-cart=9235\"\r\n                                data-quantity=\"1\"\r\n                                class=\"addToCart button product_type_simple add_to_cart_button ajax_add_to_cart \"\r\n                                data-product_id=\"9235\"\r\n                                data-product_sku=\"IM22\"\r\n                                rel=\"nofollow\"\r\n                            ><div><\/div><\/a>\r\n                        <\/div>\r\n                                    <\/div>\r\n                            <div class=\"sysprod-product\">\r\n                    <a class=\"sysprod-product-title\" href=\"https:\/\/old.synevo.md\/ru\/shop\/anticorpi-anti-ccp\/\">Anticorpi anti-CCP<\/a>\r\n                    <div class=\"sysprod-product-price\">\r\n                        <span>Pre\u021b:<\/span>\r\n                        <span>440.00 lei<\/span>\r\n                    <\/div>\r\n                                            <div class=\"sysprod-product-addcart\">\r\n                            <a\r\n                                href=\"?add-to-cart=9143\"\r\n                                data-quantity=\"1\"\r\n                                class=\"addToCart button product_type_simple add_to_cart_button ajax_add_to_cart \"\r\n                                data-product_id=\"9143\"\r\n                                data-product_sku=\"IM64\"\r\n                                rel=\"nofollow\"\r\n                            ><div><\/div><\/a>\r\n                        <\/div>\r\n                                    <\/div>\r\n                    <\/div>\r\n        \r\n    <\/div>\r\n<\/div>\r\n\r\n<style>\r\n.synevo-shop-products {\r\n    padding: 24px 0;\r\n    margin: 24px 0;\r\n    border-radius: 10px;\r\n    background: #F6F7F9;\r\n}\r\n.synevo-shop-products .sysprod-product {\r\n    position: relative;\r\n    margin: 0 24px;\r\n    margin-bottom: 24px;\r\n    border-radius: 10px;\r\n    background: #fff;\r\n    display: flex;\r\n    flex-direction: row;\r\n    align-items: center;\r\n}\r\n.synevo-shop-products .sysprod-product:last-child {\r\n    margin-bottom: 0;\r\n}\r\n.synevo-shop-products .sysprod-product-title {\r\n    flex-grow: 1;\r\n    padding: 15px;\r\n    margin-left: 14px;\r\n    font-family: Poppins,sans-serif;\r\n    font-weight: 600;\r\n    font-size: 16px;\r\n    color: #29263F;\r\n}\r\n.synevo-shop-products .sysprod-product-price {\r\n    flex-shrink: 0;\r\n    font-family: Poppins,sans-serif;\r\n    font-weight: 600;\r\n    font-size: 18px;\r\n    color: #FDB813;\r\n}\r\n.synevo-shop-products .sysprod-product-addcart {\r\n    flex-shrink: 0;\r\n    position: relative;\r\n    width: 38px;\r\n    height: 38px;\r\n    margin-left: 24px;\r\n    margin-right: 24px;\r\n}\r\n.synevo-shop-products .sysprod-product-addcart .button {\r\n    top: unset;\r\n    right: unset;\r\n}\r\n<\/style><\/div><\/div><p><small><strong>Bibliografie:<\/strong><\/small><\/p><p><small>1. Andra B\u0103l\u0103nescu, Poliartrita reumatoid\u0103, \u00een Esen\u0163ialul \u00een reumatologie, coordonator Ruxandra Ionescu, Ed.a 2-a, 2007, 214-235<br>2. Howard R. Smith, MD, Rheumatoid Arthritis, www.emedicine.com 2006, Ref Type: Internet Communication<br>3. Carmen Stentel, Diagnosticul serologic \u00een poliartrita reumatoid\u0103, www.presspro-medic.ro 2007, Ref Type: Internet Communication<br>4. Francesco Dati &amp; Erwin Metzmann. Autoimmune Diseases. In Proteins Laboratory Testing and Clinical Use, Media Print Taunusdruck GmbH, Frankfurt am Main; 2005, 214, 225-226<br>5. Pooja Khosla, S. Shankar, Lalit Duggal. Anti-CCP Antibodies in Rheumatoid Arthritis. In J.Indian Rheumatolog.Assoc 12:143-146. 2004. Ref Type: Journal (Full)<\/small><\/p><hr class=\"wp-block-separator\"\/><p>Mai multe informa\u021bii despre testele disponibile \u00een laboratoarele Synevo:<\/p><ul class=\"wp-block-list\"><li><a href=\"\/shop\/factor-reumatoid\/\" class=\"rank-math-link\">Factor reumatoid<\/a><\/li><li><a href=\"\/shop\/factor-reumatoid-waaler-rose\/\" class=\"rank-math-link\">Factor reumatoid Waaler-Rose<\/a><\/li><li><a href=\"\/shop\/anticorpi-anti-ccp\/\" class=\"rank-math-link\">Anticorpi anti-CCP<\/a><\/li><\/ul>","protected":false},"featured_media":0,"template":"","synevo_diseases_category":[901],"class_list":["post-10506","synevo_diseases","type-synevo_diseases","status-publish","hentry","synevo_diseases_category-reumatologie"],"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/synevo_diseases\/10506","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/synevo_diseases"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/synevo_diseases"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=10506"}],"wp:term":[{"taxonomy":"synevo_diseases_category","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/synevo_diseases_category?post=10506"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}