• MeSH
• Diagnosis, Differential MeSH
• Amyloidosis, Familial diagnosis   drug therapy   genetics   MeSH
• Interleukin-6 administration & dosage   MeSH
• Humans MeSH
• Antibodies, Monoclonal therapeutic use   MeSH
• Mutation MeSH
• Immunoglobulin Light-chain Amyloidosis * diagnosis   genetics   MeSH
• Serum Amyloid A Protein genetics   MeSH
• Check Tag
• Humans MeSH

Castlemanova nemoc je velmi vzácné onemocnění. Multicentrická forma se projeví nejčastěji systémovou zánětlivou reakcí, lokalizovaná forma pak Castlemanova nemoc je velmi vzácné onemocnění. Multicentrická forma se projeví nejčastěji systémovou zánětlivou reakcí, lokalizovaná forma pak lokálními příznaky z místní expanze ložiska. Pro léčbu multicentrické formy je v Evropě registrován siltuximab (protilátka proti interleukinu 6). Mimo Evropu se používá také tocilizumab, protilátka proti receptoru pro interleukin 6. Na patofyziologii této nemoci se podílejí výrazně B-lymfocyty, a proto je velmi účinná protilátka anti-CD20, rituximab, který je v ČR stále nejvíce používán. Další léky, u nichž byla formou popisů případů potvrzena účinnost, je thalidomid, lenalidomid, anakinra. Pro léčbu TAFRO syndromu, což je vzácná varianta Castlemanovy nemoci vedoucí až k anasarce, byl s úspěchem použit cyklosporin. V případě velmi agresivního průběhu (sepsis-like) při neúčinnosti výše uvedených postupů lze použít chemoterapeutické režimy používané u lymfomů.

Castleman disease is a very rare illness. The multicentric form most often presents as a systemic inflammatory reaction, while the unicentric form involves local symptoms induced by a localised mass. Siltuximab (an interleukin 6 antibody) is registered in Europe for the treatment of the multicentric form. Tocilizumab, an antibody against the interleukin receptor, is also used outside Europe. B-lymphocytes are involved in the pathophysiology of this disease, which is why the anit-CD20 antibody is also highly effective and its use is rising in the Czech Republic. Other drugs with efficacy confirmed in case reports include thalidomide, lenalidomide and anakinra. TAFRO syndrome, a rare variant of Castleman disease that may lead to anasarca, has been successfully treated with ciclosporine. Chemotherapy based regimens used in lymphomas may be considered in cases with a highly aggressive course (sepsis like).

• Keywords
• syndrom TAFRO, siltuximab, Anakinra, Tocilizumab,
• MeSH
• Interleukin 1 Receptor Antagonist Protein administration & dosage   therapeutic use   MeSH
• Glucocorticoids administration & dosage   therapeutic use   MeSH
• Antibodies, Monoclonal, Humanized MeSH
• Castleman Disease * classification   physiopathology   therapy   MeSH
• Interleukin-6 antagonists & inhibitors   administration & dosage   therapeutic use   MeSH
• Humans MeSH
• POEMS Syndrome MeSH
• Antineoplastic Combined Chemotherapy Protocols MeSH
• Rituximab therapeutic use   MeSH
• Practice Guidelines as Topic MeSH
• Severity of Illness Index MeSH
• Rare Diseases MeSH
• Check Tag
• Humans MeSH

Předmětem článku je komentář k doporučením Španělské revmatologické společnosti pro léčbu pacientů s revmatoidní artritidou, kteří nemohou být léčeni metotrexátem. Autoři těchto doporučení provedli rešerši literatury a na základě analýzy i syntézy evidence a formou delfské metody vytvořili uvedený text. Doporučení jsou rozdělena do čtyř částí, a to kontraindikace metotrexátu, metotrexátová toxicita, nedostatek adherence k metotrexátu a terapeutické strategie. Analýzy evropských registrů ukazují, že asi 30 % pacientů léčených biologickými léky podstupuje monoterapii, protože nemůže metotrexát užívat. U těchto nemocných se zdá být nejvhodnějším postupem použití inhibitoru interleukinu 6 nebo inhibitoru Janusových kináz.

This article is a commentary to Recommendations by the Spanish Society of Rheumatology for the management of patients diagnosed with rheumatoid arthritis who cannot be treated with methotrexate. The authors of the cited Recommendations had searched the literature and formulated their text based on analysis and synthesis of evidence, using so called Delphi technique. The Recommendations are divided into four parts: contraindications of methotrexate, methotrexate toxicity, lack of adherence to methotrexate, and therapeutic strategies. As shown by analyses of European registries, about 30% of patients treated with biologics undergo monotherapy since they cannot take methotrexate. The most suitable approach to the treatment of these patients seems to be the use of interleukin 6 inhibitor or inhibitor of Janus kinases.

• MeSH
• Biological Therapy * methods   standards   trends   MeSH
• European Union MeSH
• Janus Kinase Inhibitors therapeutic use   MeSH
• Interleukin-6 antagonists & inhibitors   administration & dosage   therapeutic use   MeSH
• Humans MeSH
• Methotrexate * administration & dosage   adverse effects   therapeutic use   MeSH
• International Agencies standards   organization & administration   MeSH
• Arthritis, Rheumatoid * diagnosis   drug therapy   prevention & control   MeSH
• Practice Guidelines as Topic MeSH
• Societies, Medical standards   organization & administration   MeSH
• Statistics as Topic MeSH
• Tumor Necrosis Factor-alpha antagonists & inhibitors   administration & dosage   adverse effects   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH
• Geographicals
• Czech Republic MeSH
• Spain MeSH

• MeSH
• Animal Experimentation MeSH
• Hepatocytes cytology   immunology   drug effects   MeSH
• Interleukin-6 administration & dosage   pharmacology   MeSH
• Multipotent Stem Cells transplantation   MeSH
• Liver Neoplasms surgery   MeSH
• Swine MeSH
• Cell Proliferation physiology   drug effects   MeSH
• Liver Regeneration * immunology   drug effects   MeSH
• Embolization, Therapeutic methods   MeSH
• Tumor Necrosis Factor-alpha administration & dosage   pharmacology   MeSH
• Animals MeSH
• Check Tag
• Animals MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

• MeSH
• Biological Therapy * methods   trends   utilization   MeSH
• Hereditary Autoinflammatory Diseases diagnosis   etiology   drug therapy   genetics   immunology   classification   pathology   therapy   MeSH
• Child * MeSH
• Antibodies, Monoclonal, Humanized administration & dosage   classification   adverse effects   therapeutic use   MeSH
• Interleukin-1 antagonists & inhibitors   administration & dosage   therapeutic use   MeSH
• Interleukin-6 antagonists & inhibitors   administration & dosage   therapeutic use   MeSH
• Arthritis, Juvenile diagnosis   etiology   drug therapy   classification   therapy   MeSH
• Clinical Trials as Topic MeSH
• Physicians, Primary Care MeSH
• Humans MeSH
• Adolescent MeSH
• Rheumatic Diseases * diagnosis   etiology   classification   pathology   prevention & control   therapy   MeSH
• Systemic Vasculitis diagnosis   therapy   MeSH
• Tumor Necrosis Factor-alpha antagonists & inhibitors   administration & dosage   classification   therapeutic use   MeSH
• Check Tag
• Child * MeSH
• Humans MeSH
• Adolescent MeSH

• Keywords
• Anakinra,
• MeSH
• Adalimumab MeSH
• Antirheumatic Agents administration & dosage   pharmacology   chemistry   MeSH
• Biological Therapy methods   MeSH
• Double-Blind Method MeSH
• Etanercept MeSH
• Infliximab MeSH
• Interleukin-6 administration & dosage   pharmacology   MeSH
• Arthritis, Juvenile drug therapy   immunology   MeSH
• Antibodies, Monoclonal administration & dosage   pharmacology   adverse effects   MeSH
• Rituximab MeSH
• Tumor Necrosis Factors physiology   immunology   MeSH
• Publication type
• Review MeSH