İnflamatuar Miyopatilerin Tedavisi
Özet
İnflamatuar Miyopatiler (İM), kas inflamasyonu ile karakterize sıklıkla deri, akciğer, eklemleri tutan ve kas dışı belirtilerin de gorulduğu heterojen bir hastalık grubudur . Dermatomiyozit (DM),poliomiyozit (PM), sporadik inkluzyon cisimcikli miyozit (S-İCM) , nekrozitan otoimmun miyozit (NOM), overlap miyozit, immun kontrol inhibitorlerine bağlı miyozit (ICI Miyozit) olarak alt gruplara ayrılır. İnflamatuar miyopatilerin tedavi secenekleri geniştir fakat tedavi secim ve kombinasyonu önemlidir. Tedavide immunsupresif ,ımmunmodulator ve biyolojik ajanlar kullanılır .İlk basamakta kortikosteroidler (KS) vardır ve genel olarak İM’lerin coğu iyi yanıt verir. KS’e yanıt iyi ancak azaltırken relaps görülürse, KS komplikasyan riski yüksek hasta ise, KS başlanmış fakat progresyon devam ediyor ise yada başlangıçta ağır ve multisistem tutuluşu olan hastalarda ikinci basamak ilaçlar eklenir. Bunlar; metotreksat, mikrofenolat mofetil, azatioprin ,ımmunglobulinlerdir. İkinci basamak tedavi kullanımı sonrası 4-6 ay beklendikten sonra progresyon devam eder ise ya birinci basamak ve ikinci basamak ilaç kombinasyonları denenebilir yada üçüncü basamak ilaçlara geçilir. Üçüncü basamak ilaçlar ise; rituksimab, siklofosfamid, siklosporindir. Dahada yanıt alınmaz ise abatacept ,tocılızumab ,tofacıtınıb, barıcıtınıb gibi etkinlikleri IM’de hala kanıtlanmamış yeni tedaviler denenebilir. Tedavinin biran önce başlanması gerekir çünkü tedaviye başlamadaki gecikme hastada kalıcı hasara neden olur ve tedaviden goreceği faydayı azalatabilir.
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