prezentare de caz de medicina... · sindrom sjogren sindrom felty pr rhupus alte sd overlap...
TRANSCRIPT
![Page 1: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/1.jpg)
Prezentare de caz
Indrumatori:
Asist. Univ. Dr. Iulia Georgiana Stamate
Conf. Dr. Elena Rezus
Dr. Maria Ciobanu
Medic rezident anul I
![Page 2: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/2.jpg)
Motivele internarii: - fenomen Raynaud - poliartralgii cu caracter mixt, predominant inflamator la nivelul artic. RCC bilateral, MCF I-V si IFP I-V bilateral, fara RM - rahialgii lombare cu caracter mecanic - xerostomie - pirozis - fatigabilitate - cefalee frontala
• P.A, ♀ , 23 ani • Mediul urban • Salariata
![Page 3: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/3.jpg)
• AHC: - mama: DZ tip 2 in tratament cu ADO • APP: - Fenomen Raynaud (18 ani)
- RGE (22 ani) • Comportament: - fumatoare (4 tigari/zi de aproximativ 3 ani) • Istoricul bolii Pacienta, in varsta de 23 de ani, aflata la prima internare in clinica, se adreseaza pentru fenomen Raynaud exprimat spontan si la temperaturi scazute la nivelul mainilor si picioarelor bilateral cu debut de la varsta de 18 ani la care asociaza de aprox 1 an poliartralgii cu caracter mixt predominant inflamator exprimate la nivelul artic. RCC bilat, mainilor bilateral (MCF, IFP), xerostomie, pirozis, fatigabilitate si cefalee, simptome neglijate din punct de vedere al investigarii cauzei si terapeutic.
![Page 4: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/4.jpg)
• Stare generala buna
• Tegumente: - livedo reticularis la nivelul fetei ant a
coapselor bilateral, fenomen Raynaud maini si picioare
bilateral
• Ap. respirator: - murmur vezicular inasprit
(predominant bazal)
• Ap. cardiovascular:- fara modificari patologice
• Ap. digestiv si uro-genital: - fara modificari patologice
![Page 5: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/5.jpg)
![Page 6: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/6.jpg)
![Page 7: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/7.jpg)
Mers si ortostatism posibile
Coloana vertebrala: scolioza dextroconvexa cu raza mare de
curbura la nivelul coloanei dorsale, durere la parparea
apofizelor spinoase lombare, I Schober=10+2,5cm.
Umeri: durere la palparea pct topografice, mobilitate in limite
normale
RCC: durere la palparea interliniului artic bilateral, flexie
dorsala usor limitata bilateral
Maini: durere la palparea artic. MCF II-V bilateral si IFP III-V
bilateral, mobilitate in limite normale
![Page 8: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/8.jpg)
SCLERODERMIE SISTEMICA
• Fenomen Raynaud
Primitiv
Secundar (altor colagenoze) • BMTC
• LES
• PR
• Sd Sjogren
• Colagenoza nediferentiata
• Sd Felty
• PM
• Sd Overlap (PR-LES, LES-
SS, PM-SS, PR-SS, PR-Sd
Sjogren,etc)
• Spondiloartropatii cu
debut periferic
![Page 9: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/9.jpg)
Hemoleucograma
Leucocite-
2600/mmc
Neutrofile-
1130/mmc
Biochimie -
normal
SDR
INFLAMATOR
ABSENT
![Page 10: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/10.jpg)
FR Latex- pozitiv
(64UI/mL)
FR Waaler Rose-
pozitiv (64UI/mL)
![Page 11: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/11.jpg)
desen pulmonar interstitial accentuat, mai evident la baze
cateva microgeode la nivelul carpului bilateral
Rgf toracica si maini bilateral
![Page 12: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/12.jpg)
Ecografie maini bilateral:
-la nivelul mainii drepte: mica colectie lichidiana fara semnal Doppler, vizibila pe fata dorsala a pumnului la nivelul articulatiilor radio-carpiana si carpiene;
chist atrosinovial pe fata ventrala a pumnului,spre marginea radiala, artic. IFP II si III cu minime colectii lichidiene, fara semnal Doppler
-la nivelul mainii stangi: artic. IFP cu mici colectii lichidiene, fara proliferare sinoviala si fara semnal Doppler
![Page 13: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/13.jpg)
Ecografia abdomino-pelvina: - Splina marita in ax bipolar- 140 mm, structura omogena
Tranzit baritat EGD: - Stomac hipokinetic, pliuri hipertrofiate si lichid de secretie in cantitate mare - Spasm piloric prelungit - Staza duodenala - RGE
![Page 14: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/14.jpg)
Deget 4, 5 mana stanga:
densitate capilara normala,
unele capilare tortuase
Deget 5- mana stg
Deget 4- mana stg
![Page 15: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/15.jpg)
COLAGENOZA NEDIFERENTIATA
OBS: BOALA MIXTA DE TESUT CONJUNCTIV
1. Fibroza pulmonara
2. Reflux gastro-esofagian
3. Splenomegalie gradul 1
![Page 16: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/16.jpg)
Sclerodermie
sistemica
Lupus
eritematos
sistemic Sindrom
Sjogren
Sindrom
Felty
PR
Rhupus
Alte Sd
Overlap (PR-
LES,SS-LES, LES-
PM,PR-Sd.
Sjogren)
![Page 17: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/17.jpg)
Prezente(+) Absente(-)
Ac anti U1-RNP Maini edematiate(+ in
antecedente)
Fenomen Raynaud Sinovita
Miozita
Acroscleroza
Diag. pozitiv: criteriul serologic + cel putin 3 criterii
clinice (incluzand fie miozita sau sinovita)
![Page 18: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/18.jpg)
Prezente(+) Absente(-)
Afectarea tegumentului proximal
de articulatiile MCF sau MTF
Fibroza pulmonara Sclerodactilie
Cicatrici stelate
Diag. Pozitiv: 1CM+ 2Cm
![Page 19: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/19.jpg)
Prezente(+) Absente(-)
Artrita neeroziva Rash malar
Afectare hematologica(leucopenie) Lupus discoid
Afectare imunologica( Ac anti Sm –
slab pozitivi)
Fotosensibilitate
Ulceratii orale
Serozita
Afectare renala
Afectare neurologica
ANA
Diag. Pozitiv : 4 CRT/11
![Page 20: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/20.jpg)
Prezente(+) Absente(-)
Ac anti Ro(intens pozitivi) Ac anti La
Xerostomie Simptome oculare
Obiectivarea sdr. sicca oral
Obiectivarea sdr. sicca ocular
Modificari histologice
Diag pozitiv: 4CRT/6 + oligatoriu 1 din biopsie de glanda
salivara minora pozitiva / Ac anti SS-A, SS-B
![Page 21: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/21.jpg)
+ -
Leucopenie PR
Neutropenie Anemie
Splenomegalie Trombocitopenie
![Page 22: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/22.jpg)
IGIENO-DIETETIC
evita expunerea la temperaturi
scazute (frig, apa rece), stres
psiho-emotional
evita si trateaza prompt
infectiile intercurente
oprirea fumatului si evitarea
cofeinei
MEDICAMENTOS
Nifedipin 20 mg 1cp/zi
Pentoxifilin 400 mg 2cp/zi
Metilprednisolon 16 mg 1cp/zi
Omeprazol 20 mg 1cp/zi
Crema cu nitroglicerina
![Page 23: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/23.jpg)
Favorabila ( dupa 1 sapt de tratament – amelioare
importanta a simptomatologiei algice si scaderea
episoadelor de aparitie a fenomenului Raynaud)
![Page 24: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/24.jpg)
VITAL, IMEDIAT– bun
AL STARII DE SANATATE – cronicizare, cu pusee si remisiuni
FUNCTIONAL – decompensare
AL CAPACITATII DE MUNCA – program de lucru cu orar redus
![Page 25: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/25.jpg)
Prezenta celor mai frecvente simptome din Sclerodermia
sistemica (Fenomen Raynaud, fibroza pulmonara, RGE), la
o pacienta tanara care prezinta Ac anti Sm pozitivi.
![Page 26: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/26.jpg)
Paraclinic BMTC LES SS
Leucopenie ++ +++ 0
Ac anti- U1 RNP +++ + 0
Ac anti-Sm +/- +++ 0
Clinic BMTC LES SS
Fen.Raynaud +++ + +++
Afectare
esofagiana
+++ +/- +++
Fibroza pulmonara +++ + +++
Artrita +++ +++ +
![Page 27: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/27.jpg)
BOALA MIXTA DE TESUT CONJUNCTIV
![Page 28: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/28.jpg)
Gordon C. Sharp- 1972 ( Sindromul Sharp)
Sindrom Overlap ce se caracterizeaza prin prezenta
unor elemente clinice ce includ LES, sclerodermie,
miozita si PR.
Ac anti-U1 RNP
1.Sharp GC, Irvin WS, Tan EM, et al. Mixed connective tissue disease--an apparently distinct rheumatic disease syndrome associated with a specific antibody to an extractable nuclear antigen (ENA). Am J
Med. 1972 Feb. 52(2):148-59.
2.Zandman-Goddard G, Solomon M, Rosman Z, Peeva E, Shoenfeld Y. Environment and lupus related diseases. Lupus. 2011 Nov 7.
![Page 29: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/29.jpg)
Prevalenta: 2,7- 10/100 000 loc
Mortalitate: 10,4-20% la pacientii cu afectiuni cardiace
Femei/barbati = 9/1 16/1
Varsta de debut = 15-35 ani (max.20 ani)
![Page 30: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/30.jpg)
Factori de mediu – clorura de vinil si siliciu
Factori infectiosi- unele retrovirusuri
Flåm ST, Gunnarsson R, Garen T, Lie BA, Molberg O. The HLA profiles of mixed connective tissue disease differ distinctly from
the profiles of clinically related connective tissue diseases. Rheumatology (Oxford). 2014 Sep 3.
![Page 31: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/31.jpg)
Factori imunologici
Hiperactivitatea Ly B Ac anti U1-RNP si anti U1-70 kd
Activarea Ly T
Modificarea apoptozei Ag UI-70kd
Raspuns imun impotriva auto Ag
Proliferare vasculara endoteliala cu infiltrat limfoplasmocitar tisular
Terenul genetic
Asocierea genetica cu (HLA)-DRB
Flåm ST, Gunnarsson R, Garen T, Lie BA, Molberg O. The HLA profiles of mixed connective tissue disease differ distinctly from the profiles of clinically related connective tissue diseases. Rheumatology
(Oxford). 2014 Sep 3.
-
HLA-B08 si DRB1.04:01 fact de risc
HLA DRB1.04:04, DRB1.13:01 si DRB1.13:02 fact
protectivi
![Page 32: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/32.jpg)
Debut insidios ,nespecific
Modificari
cutaneo-
mucoase
Manifestari
articulare
Manifestari
renale
Manifestari
pulmonare
Manifestari
digestive
Manifestari
cardio-vasculare
Manifestari
musculare
Afectare
nervoasa
Manifestari
cardio-
vasculare
![Page 33: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/33.jpg)
Fenomen Raynaud (+ 74% la debut; 96% in evolutie)
Artralgii/artrite (+68%la debut; 96% in evolutie)
Hipomotilitate esofagiana ( +9% la debut; 66% in evolutie)
Fibroza pulmonara ( + rara la debut; 66% in evolutie)
Leucopenie (+ 9% la debut; 53% in evolutie)
Edemul mainilor ( +45% la debut; 66% in evolutie)
Miozita (+ 2% la debut; 51% in evolutie)
Rash (+13% la debut; 53% in evolutie)
Sclerodactilie (+ 11% la debut; 49% in evolutie)
Pleurezie/pericardita (+19%la debut; 43 % in evolutie)
Hipertensiune arterial pulmonara (rara la debut; 23% in evolutie)
Szodoray P, Hajas A, Kardos L, et al. Distinct phenotypes in mixed connective tissue disease: subgroups and survival. Lupus. 2012 Nov.
21(13):1412-22.
![Page 34: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/34.jpg)
![Page 35: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/35.jpg)
HTAP
Miocardita
Afectarea renala
Afectarea neurologica
Infectiile
Gunnarsson R, Molberg O, Gilboe IM, Gran JT. The prevalence and incidence of mixed connective tissue disease: a national multicentre survey of Norwegian
patients. Ann Rheum Dis. 2011 Jun. 70(6):1047-51.
![Page 36: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/36.jpg)
Tratament corticosteroid (prednison, metilprednisolon)
Antimalarice de sinteza (hidroxiclorochina)
Blocanti ai canalelor de Ca ( Nifedipin 20 mg/zi, Amlodipina)
Vasodilatator periferic (Pentoxifilin 400 mgx2/zi)
Bosentan (antagonist al receptorului de entotelina – HTAP)
IPP ( omeprazol 20 mg/zi)
Terapie imunosupresoare ( Ciclofosfamida , Azathioprina – asociere cu corticosteroizi)
IGIENO-DIETETIC
MEDICAMENTOS
![Page 37: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/37.jpg)
Complicatiile bolii
Ulceratii la niv. degetelor
Esofag Barrett
Glomerulonefrita
membranoasa
Insuficienta renala
HTAP
HTA reno-vasculara
Miocardita
Complicatii ale terapiei
Infectii
Supresie medulara
Neoplazii
Necroza aseptica
Osteoporoza
Cataracta
Crestere in greutate
Acroscleroza accelerata
![Page 38: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/38.jpg)
![Page 39: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/39.jpg)
![Page 40: Prezentare de caz de Medicina... · Sindrom Sjogren Sindrom Felty PR Rhupus Alte Sd Overlap (PR-LES,SS-LES, LES-PM,PR-Sd. Sjogren) ... Sindrom Overlap ce se caracterizeaza prin prezenta](https://reader030.vdocuments.mx/reader030/viewer/2022021520/5b909ddb09d3f2b86e8c623f/html5/thumbnails/40.jpg)
Va multumesc pentru atentie!