‹letiflim / Correspondence

‹laca ba¤l› sarkoidoz

Anti-TNF ajanlar tedaviye dirençli sarkoidoz hastalar›-

n›n tedavisinde baflar›yla kullan›lsa da, sarkoidoz hastal›¤›

olmayan ve baflka nedenlerle anti-TNF ajanlar› kullanan

baz› hastalarda bu tedaviye ba¤l› sarkoidoz geliflebildi¤i de

bildirilmifltir.

[75]

Bunun mekanizmas› tam olarak bilinmese

de, anti-TNF tedavisi sonucunda TNF-

α ile IFN-α sito-

kinleri aras›ndaki dengenin bozulmas› ve sonuçta IFN-·

düzeyinin yükselmesi ile ilgili oldu¤u düflünülmektedir.

Gerçekten, IFN-

α tedavisinde de sarkoidoz ortaya ç›kabil-

mektedir. Anti-TNF tedavisi zemininde geliflen sarkoido-

zun, patogenetik süreç aç›s›ndan anti-TNF tedaviye ba¤l›

psoriyazis veya lupus tablosu ile de benzerlik gösterdi¤i

düflünülmektedir.

[76]

Prognoz

Ço¤u hastada spontan remisyon görülür (%60). Akut

sarkoidozlu hastalar spontan remisyona girme olas›l›klar›

daha fazlad›r. Löfgren sendromlu hastalar genellikle teda-

visiz ve spontan remisyona girerler; prognoz iyidir.

[46]

Sar-

koidoz hastalar›n›n %10-20’sinde KS tedavisi gerekir.

%10-30 olgu kronikleflir. Mortalite oran› %1-5 oran›nda

bildirilmifltir.

[77]

Tüm ölümlerin yar›s› ilerleyici pulmoner

hastal›k, di¤er yar›s› kardiyak/nörolojik hastal›k kaynakl›-

d›r. Tablo 3’te sarkoidozda kötü prognoz ile iliflkili özel-

likler gösterilmifltir.

[50]

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Tablo 3.

Sarkoidozda kötü prognoz göstergeleri.

• 40 yafl üzeri

• Afrika kökenli Amerikal›lar

• Steroid tedavisi ihtiyac› olanlar

• Ekstra pulmoner tutulumu olanlar

- Kardiyak

- Nörolojik

- Lupus Pernio

- Splenomegali

- Hiperkalsemi

- Kemik tutulumu

• Pulmoner tutulum olanlar

- Evre 3-4 gö¤üs radyografi bulgular›

- Pulmoner Hipertansiyon

- Belirgin akci¤er fonksiyon bozuklu¤u

- Dispne (orta-fliddetli)

- Bronkoalveoler lavaj s›v›s›nda nötrofili varl›¤›

Tarhan F, Keser G.

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