BEHÇET HASTALIĞININ TEDAVİSİ VE GÜNCEL YAKLAŞIMLAR

Year 2022, Volume: 46 Issue: 2, 619 - 650, 29.05.2022

Gözde Yenice Çakmak , Ahmet Özer Şehirli

https://doi.org/10.33483/jfpau.1036803

Abstract

Amaç: Behçet Hastalığı (BH), nükslerle seyreden, oral aft, genital ülser, deri lezyonları ve oküler lezyonlar olmak üzere dört majör bulgu ve eklem tutulumu, gastrointestinal ülserler, epididimit, vasküler lezyonlar ve nörolojik tutulum dahil olmak üzere beş minör bulguyla karakterize multisistemik inflamatuar bir hastalıktır. BH' de tedavi hastalığın başladığı yaşa, cinsiyete, tutulan organlara ve hastalığın klinik seyrine göre değişir; bu nedenle tedavi kişiye ve semptomlara göre yapılmalıdır. BH' nin ampirik tedavisi halen devam ederken; son zamanlarda altta yatan hastalığın patogenezinin daha iyi tanımlanması nedeniyle etkili protokoller uygulanmış ve tedavi için birçok geniş spektrumlu terapötik ajan sunulmuştur. Bu derleme, hastalığın progresyonu döneminde uygulanan spesifik tedavi prosedürlerini bir araya getirme hedefiyle ortaya koyulmuştur.

Sonuç ve Tartışma: Lokal ve sistemik tutulumlar ile karakterize inflamatuar bir hastalık olan BH’nin belirli bir tedavi stratejisi olmamakla beraber; tutulumlara yönelik tedavi, semptomların tipi ve şiddetine göre belirlenen lokal kortikosteroidlerden monoklonal antikorlara kadar değişir. BH’ de görülen vasküler ve gastrointestinal sistemi etkileyen tutulumlar üzerinde halen çalışmalar devam etmektedir. BH tedavisinde kortikosteroidler, kolşisin ve azatiyoprin ve siklosporin dahil olmak üzere geleneksel immünosupresif ajanlar kullanılmaktadır. Son zamanlarda, tümör nekroz faktörü (TNF) inhibitörleri, çeşitli romatizmal hastalıklar için kullanılabilir hale gelmiş ve yayınlanmış veriler, TNF inhibitörlerinin, ciddi ve dirençli hastalığı olan hastaların yanı sıra bu tedavilere karşı kontrendikasyonları veya intoleransı olan hastalar için önemli bir terapötik ilerlemeyi temsil ettiğini göstermektedir.

Keywords

Behçet Hastalığı, glukokortikoidler, anti-TNF-α, mukokutenoz ülserasyon, majör organ tutulumları

TREATMENT OF BEHÇET’S DISEASE AND CURRENT APPROACHES

Abstract

Objective: Behçet's Disease (BD) is a multisystemic inflammatory disease which courses with relapses and characterized by four major symptoms of oral aphthous ulcers, genital ulcers, skin lesions and ocular lesions; and five minor symptoms including joint involvement, gastrointestinal ulcers, epididymitis, vascular lesions and neurological involvement. Treatment in BD varies according to the clinical course of age at which the disease begins, gender, the organs involved and the clinical course of the disease; therefore, it should be performed according to the person and the symptoms. While empirical treatment of BD is still continuing; recently, effective protocols have been implemented due to the pathogenesis of the underlying disease that is better defined and many broad-spectrum therapeutic agents have been presented for the treatment. This review is presented to bring together the specific treatment procedures applied during the progression of the disease.

Result and Discussion: Although there is no specific treatment strategy for BD, which is an inflammatory disease characterized by local and systemic involvements, treatment procedures range from local corticosteroids to monoclonal antibodies, determined by the type and severity of symptoms. Studies are still continuing on diseases affecting the vascular and gastrointestinal system in BD. Conventional immunosuppressive agents, including corticosteroids, colchicine and azathioprine, and cyclosporine are used in the treatment of BD. Recently, tumor necrosis factor (TNF) inhibitors have become available for a variety of rheumatic diseases, and published data indicate that TNF inhibitors represent a significant therapeutic advance for patients with severe and resistant disease as well as those with contraindications or intolerance to these therapies.

Keywords

Behçet’s Disease, glucocorticoids, anti-TNF-α, mucocutaneous ulceration, major organ involvements.

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