Nörosarkoidoz ve Tedavisi
Özet
Nörosarkoidoz, sarkoidozun santral ve periferik sinir sistemini etkileyen, nadir ancak morbiditesi yüksek bir formudur ve çoğu olguda uzun süreli tedavi gerektirir. Klinik seyri heterojen olup, tedavi yaklaşımı hastalığın tutulum tipi ve şiddetine göre bireyselleştirilmelidir. Bu bölümde, nörosarkoidozda güncel tedavi stratejileri ön planda tutulmakta; kortikosteroidlerin birinci basamak tedavideki yeri, steroid azaltıcı immünosupresif ajanlar ve biyolojik tedavilerin endikasyonları ayrıntılı olarak ele alınmaktadır. Metotreksat, azatioprin, mikofenolat mofetil, hidroksiklorokin ve TNF-α inhibitörleri gibi ajanların etkinlikleri, dozlama prensipleri ve yan etki profilleri klinik pratik açısından incelenmektedir. Ayrıca tedaviye dirençli olgularda rituksimab, radyoterapi ve cerrahi seçenekler değerlendirilmektedir. Tedavi sürecinde klinik ve radyolojik izlem, nükslerin erken saptanması ve uzun dönem prognozun iyileştirilmesi açısından vurgulanmaktadır.
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