Title Plućne manifestacije sustavnih autoimunih bolesti Title (english) Pulmonary manifestations of systemic autoimmune diseases Author Barbara Goršeta Mentor Marija Gomerčić Palčić (mentor)Committee member Sanja Popović-Grle (predsjednik povjerenstva)Committee member Jasenka Markeljević (član povjerenstva)Committee member Marija Gomerčić Palčić (član povjerenstva)Granter University of Zagreb Defense date and country 2021-07-16, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Sustavne autoimune bolesti (SAD – engl. systemic autoimmune diseases) su heterogena skupina imunološki posredovanih upalnih poremećaja u kojima je zatajila funkcija organizma zaslužna za razlikovanje vlastitih od tuđih antigena. Organizam posljedično reagira na vlastite antigene i uzrokuje multisustavnu upalu organizma. Najčešće SAD u kojima se javljaju plućne komplikacije su: sistemski eritematozni lupus, reumatoidni artritis, sistemska skleroza, Sjögrenov sindrom, polimiozitis/dermatomiozitis, te miješana bolest vezivnog tkiva. Teško je odrediti točnu prevalenciju plućnih manifestacija jer često budu asimptomatske, a dokaz o njihovom postojanju nađe se tek na obdukciji ili slučajno tijekom provođenja određenih dijagnostičkih postupaka. Najčešći simptomi su kašalj, zaduha u naporu, bolovi u prsima i povišena temperatura, ali mogu varirati i ovise o tome koji je prevladavajući patofiziološki mehanizam bolesti i koji dio respiratornog sustava je pretežno zahvaćen. Iako se plućne komplikacije većinom javljaju u razvijenim stadijima SAD-a, ponekad već prva manifestacija može biti od strane respiratornog sustava. Klinički se SAD na plućima najčešće prezentira kao: intersticijska bolest pluća, pleuritis, pleuralni izljev, plućna hipertenzija, bronhiolitis i upala pluća. Kod pojave prvih simptoma ili znakova bolesti vade se rutinski laboratorijski nalazi te se snima rentgen srca i pluća. Iako se većina promjena može vidjeti već na rentgenu, kompjuterizirana tomografija visoke rezolucije se pokazala superiornijom za daljnju klasifikaciju promjena na plućima. Za dokazivanje funkcionalnih promjena na plućima potrebno je napraviti testove plućne funkcije. Ako se uz to ne uspije doći do dijagnoze, dalje je indicirana bronhoskopija s bronhoalveolarnom lavažom te u krajnjem slučaju biopsija pluća. Opće mjere liječenja uključuju prestanak pušenja, redovito cijepljenje protiv gripe i pneumokoka, održavanje bronhopulmonalne higijene te plućnu rehabilitaciju. Kod snižene saturacije indicirana je primjena kisika. Od lijekova se koriste protuupalni i imunomodulatorni lijekovi poput nesteroidnih antireumatika, kortikosteroida, lijekova koji modificiraju tijek bolesti te imunosupresiva. U posljednje vrijeme sve se više koristi i biološka terapija. Bitno je bolest dijagnosticirati u ranom stadiju kako bi se na vrijeme započela adekvatna terapija i spriječio razvoj ireverzibilnih promjena respiratornog sustava.
Abstract (english) SAD are a heterogeneous group of immune-mediated inflammatory disorders in which the body's function to distinguish its own from other people's antigens has failed. The body, consequently reacts to its own antigens and causes multisystem inflammation of the organism. The most common SADs in which pulmonary complications occur are: systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, Sjögren's syndrome, polymyositis /dermatomyositis and mixed connective tissue disease. It is hard to determine the exact prevalence of pulmonary manifestations in SAD because they are often asymptomatic and the proof of their existence is found on autopsy or accidentally during performing regular diagnostic procedures. The most common symptoms are cough, dyspnea on exertion, chest pain and fever, but they can vary and depend on which is the predominant pathophysiological mechanism and which part of the respiratory system is predominantly affected. Although pulmonary complications occur predominantly in developed stages of SAD, sometimes the first manifestation can be from the respiratory tract. Clinical manifestations of SADs include: interstitial lung disease, pleuritis, pleural effusion, pulmonary hypertension, bronchiolitis and pneumonia. At the appearance of the first symptoms or signs of the disease, routine laboratory findings and a chest X-ray are taken. Although most of the changes can already be seen on X-ray, high-resolution computed tomography has been proven superior then the X-ray for further classification of changes of the lungs. Pulmonary function tests should be performed to demonstrate functional lung changes. If that is not enough for establishing the diagnosis, bronchoscopy with bronchoalveolar lavage is indicated as the next step, and the lung biopsy is the final choice. General treatment measures include smoking cessation, administration of flu and pneumococcal vaccinations, maintenance of bronchopulmonary hygiene and pulmonary rehabilitation. In case of reduced saturation, the use of oxygen is indicated. Drug treatment includes anti-inflammatory and immunomodulatory drugs such as nonsteroidal antirheumatic drugs, corticosteroids, drugs that modify the course of the disease and immunosuppressants. Recently, biological therapy has become more represented. It is very important to diagnose the disease in its early onset in order to start adequate therapy in time and prevent irreversible changes of the respiratory system.
Keywords
sustavne autoimune bolesti
plućne manifestacije
dijagnostika
liječenje
Keywords (english)
systemic autoimmune diseases
pulmonary manifestations
diagnosis
treatment
Language croatian URN:NBN urn:nbn:hr:105:716849 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2022-02-03 11:53:19
