Çoklu ilaç tedavisine yetersiz cevabı olan romatoid artrit ve Hasimoto tiroiditli bir hastada ozon tedavisi. 4 yıllık takip.

Öz

Giriş: Çoklu ilaç kombinasyonlarına yetersiz yanıt gösteren Romatoid artrit (RA), tedavinin planlanmasında zorluk oluşturmaktadır. Ozon tedavisi (OT) mücadelede ümit verici olabilir. Olgu Sunumu: 53 yaşında kadın hasta. 22 yıl içerisinde farklı, çoklu-ilaç kombinasyonları kullanmasına rağmen (non steroid antiinflamatuar ilaçlar - (NSAID), hidroksiklorokin, Sulfasalazin, Metotreksat (MTX), Kortiko steroid (KS) ve Leflunomid) orta düzey RA aktivitesine bağlı eklemlerde şişlik, ağrı ve deformasyon şikayetleri ile müracaat etti. Hastalık Aktivite Skoru (DAS 28 – CRP) 4.48 bulundu. İlave olarak pangastrit, düşük B12 seviyesi ve Hashimoto tiroiditi mevcuttu. İlaçlarını kullanmakta isteksizdi. Intravenöz tıbbi OT uygulanmasına 2/hafta, 2000 gamma/seans, 8 hafta süre ile başlandı. Daha sonra 1/ay olacak şekilde uygulama kademeli azaltılarak 1 yıla tamamlandı. OT başlangıcından 1 ay sonra KS, 5 ay sonra Leflunomid alımı durduruldu. Daha sonra hasta ihtiyacı kalmadığını belirterek pangastrit ilaçlarını durdurdu. OT başlangıcından 4 yıl sonra yapılan değerlendirmede son 3.5 yılın komplikasyon olmadan ve ilaç kullanılmadan gerçirildiği görüldü. DAS 28 – CRP değer farkı 2.66 (düşüş > 1.2) bulundu ki bu “majör düzelmeyi” göstermektedir. Ellerin X-Ray kontrollerinde, deformitelerde minimal artış görülmüştür. Anti-Tiroglobulin seviyesindeki azalma incelenmeye değer bulunmuştur. Sonuç: Çoklu-ilaç tedavisine yetersiz yanıt gösteren Romatoid artititli hastalarda uygun şekilde yapılan ozon terapi yeni ufuklar açabilir.

Anahtar Kelimeler

• Ozon terapi
• Romatoid Artrit
• kortikosteroidler
• csDMARD
• Haşimoto tiroiditi

Proje Numarası

NONE

Ozone therapy for the treatment of a patient with rheumatoid arthritis and Hashimoto’s thyroiditis who had insufficient respond to multidrug therapy. 4 years follow up.

Öz

Introduction: Rheumatoid Arthritis (RA) with insufficient respond to multidrug-therapy combinations constitutes a challange in therapeutic planning. Ozone therapy (OT) may bring new dimensions in the management. Case Presentation: A 53-year-old woman had different multidrug-therapy combinations (non steroid anti inflammatory drugs (NSAID), Hydroxychloroquine, Sulphasalazine, Metothrexate (MTX), Cortico steroids (CS) and Leflunomide) in 22 years but still had swollen and painful joints with multipl deformities due to moderate activity of RA. Disease Activity Score (DAS 28 - CRP) was found to be 4.48. She also had pangastritis, low vitamin B12 levels and euthyroid Hashimoto’s thyroiditis. She was unwilling to carry on with her medicines. She received medical intravenous ozone application starting as 2/week, 2000 gamma/session for 8 weeks, then lowered gradually to 1/month for a year. She stopped taking CS and Leflunomid after the 1st and 5th months of OT. She also stopped taking her pangastritis medications. After 4 years of initial OT, the last 3.5 years were free from medication and complaints. DAS 28 - CRP value difference was 2.26 (decrease > 1.2) wich denotes to a "major improvement". X-ray control of hands showed minimal increase in deformities. Decrease in Anti-Tiroglobulin levels has been found to be worth investigating. Result: Appropriate ozone therapy may bring new horizons for patients with insufficient respond to multidrug-therapy combinations in Rheumatoid arthritis.

Anahtar Kelimeler

• ozone therpy
• Rheumatoid arthiritis
• corticosteroids
• csDMARD
• Hashimoto's thyroiditis

Destekleyen Kurum

NONE

Proje Numarası

NONE

Teşekkür

NONE

Kaynakça

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