Patient with polymyalgia rheumatica — how to prevent gastrointestinal damage?
https://doi.org/10.31146/1682-8658-ecg-181-9-79-84
Abstract
Basis. The problem of multimorbidity and related polypragmasia is highly relevant for health practitioners. Providing treatment a doctor should keep in mind itsall possible negative consequences that might exacerbate other diseases. One of the most current problems of modern pharmacotherapy is the development of gastropatia and other gastrointestinal lesions because of drug intake. It is extremely important for rheumatologic patients, especially elderly ones, due to side effects of nonsteroidal anti-inflammatory drugs and glucocorticoids. Reasonable approach to the prescription of this therapy and side effects prevention is a significant factor of the preventive work of the therapist and the general practitioner of the outpatient service. In patients with rheumatic polymyalgia we showed an approach to long-term treatment of corticosteroids in elderly patients, the aim of which is to achieve a stable remission of the disease and to minimize the undesirable effect of the medication on the gastrointestinal tract.
Aim. Provide an algorithm for the approach to identifying the risk factors of medicinal gastrointestinal lesions and methods for their prevention.
Material and methods. We analyzed literature sources, including Russian guidelines over the last 10 years.
Results. In the article we present an algorithm for detecting the risk of developing gastrointestinal tract lesions against the background of corticosteroid therapy in elderly patients and ways of preventing it.
Conclusion. The prevention of unwanted drug reactions is an important aspect of a doctor’s work, especially in the treatment of elderly patients. The presented algorithm for identification of risk groups and prevention of side effects is intended to help the practical doctor in working with this category of patients.
About the Authors
E. V. Kudina
Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Ekaterina V. Kudina, Cand. of Med. Sci., Associate Professor of the Department of Outpatient Therapy, Faculty of General Medicine
117997, Moscow, Ostrovitianov str. 1
I. A. Samkova
Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Irina A. Samkova, Assistant Professor of the Department of Outpatient Therapy, Faculty of General Medicine
117997, Moscow, Ostrovitianov str. 1
V. N. Larina
Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Vera N. Larina, Prof. PhD MD, Chief of the Department of the Department of Outpatient Therapy, Faculty of General Medicine
117997, Moscow, Ostrovitianov str. 1
References
1. Гордеев А.В., Галушко Е. А., Насонов Е. Л. Концепция мультиморбидности в ревматологической практике. Научно-практическая ревматология. 2014; 52(4): 362–365. Gordeev A. V., Galushko E. A., Nasonov E. L. The concept of multimorbidity in rheumatologic practice. Scientific and practical rheumatology. 2014, vol. 52, no. 4, pp. 362–365. Doi: https://doi.org/10.14412/1995-4484-2014-362-365
2. Овчаренко С.И., Щендрина И. С., Троицкая М. П. Ревматическая полимиалгия и гигантоклеточный артериит. Лечащий врач. 2011; 7: 29–33. Ovcharenko S. I., Shhendrina I. S., Troiczkaya M. P. Revmaticheskaya polimialgiya i gigantokletochny`j arteriit [Rheumatic polymyalgia and giant cell arteritis]. Lechashhij vrach – Medical doctor, 2011, no. 7, pp. 29–33.
3. Оттева Э.Н., Островский А. Б. Ревматическая полимиалгия: от эпидемиологии до перспектив лечения. Практическая медицина. 2015; 88(3): 88–93. Otteva E. N., Ostrovskij A. B. Revmaticheskaya polimialgiya: ot e`pidemiologii do perspektiv lecheniya [Rheumatic polymialgia – from epidemiology to prospect of treatment]. Prakticheskaya medicina – Practical medicine, 2015, vol. 88, no. 3, pp. 88–93.
4. Сатыбалдыев А.М., Демидова Н. В., Савушкина Н. М., Гордеев А. В. Ревматическая полимиалгия. Научнопрактическая ревматология. 2018; 56(2): 215–227. Satybaldyev A. M., Demidova N. V., Savushkina N. M., Gordeev A. V. Polymyalgia rheumatica. Rheumatology Science and Practice. 2018, vol. 56, no. 2, pp. 215–227. Doi: https://doi.org/10.14412/1995-4484-2018-215-227
5. Кучмин А.Н., Морозов С. Л., Дискаленко О. В. и др. Ревматическая полимиалгия: от знаний к практике. Вестник российской военно-медицинской академии. 2017; 60(4): 50–55. Kuchmin A. N., Morozov S. L., Diskalenko O. V. et al. Revmaticheskaya polimialgiya: ot znanij k praktike [Rheumatic polymyalgia: from knowledge to practice]. Vestnik rossijskoj voenno-medicinskoj akademii – Herald of the Russian Military Medical Academy, 2017, vol. 60, no. 4, pp. 50–55.
6. Щендрина И.С., Троицкая М. П., Овчаренко С. И. Ревматическая полимиалгия: сложности диагностики. Лечащий врач. 2011; 4: 33–37. Shhendrina I. S., Troiczkaya M. P., Ovcharenko S. I. Revmaticheskaya polimialgiya: slozhnosti diagnostiki [Rheumatic polymyalgia: diagnostic difficulties] Lechashhij vrach – Medical doctor, 2011, no. 4, pp. 33–37.
7. Барт Б.Я., Кудина Е. В., Ларина В. Н. Cлучай ревматической полимиалгии. Клиническая медицина 2015; 93(4): 74–78. Bart B. Ya., Kudina E. V., Larina V. N. Cluchaj revmaticheskoj polimialgii [The case of rheumatic polymyalgia]. Klinicheskaya medicina – Clinical medicine, 2015, vol. 93, no. 4, pp. 74–78.
8. Ревматология. Клинические рекомендации / под ред. Е. Л. Насонова – М.: ГЭОТАР-Медиа, 2020. – с. 207–212. Rheumatology. Clinical guidelines. Moscow. GEOTAR-Media, 2020. pp. 207–212.
9. https://empendium.com/ru/chapter/B33.II.16.9
10. Hammoda H.M.B., Al Saleh J., Mahmood K. et al. Polymyalgia Rheumatica (PMR) and Lung Involvement: The Forgotten Association. Oman Med J. 2020; 35(2): e105. doi:10.5001/omj.2020.23
11. Сатыбалдыев А. М. Эволюция диагностики ревматической полимиалгии. Научно-практическая ревматология. 2019; 57(6): 693–698. Satybaldyev A. M. The evolution of diagnosis of polymyalgia rheumatica. Rheumatology Science and Practice. 2019, vol.57, no. 6, pp. 693–698. DOI: https://doi.org/10.14412/1995-4484-2019-693-698
12. Лазебник Л. Б., Ли Е. Д., Михеева О. М. и др. Трудности диагностики ревматической полимиалгии у больной с хроническим гастродуоденитом. Экспериментальная и клиническая гастроэнтерология. 2014; 106(6): 85–89. Lazebnik L. B., Li E. D., Mixeeva O. M. et al. Trudnosti diagnostiki revmaticheskoj polimialgii u bol`noj s xronicheskim gastroduodenitom [Difficulties in diagnosing rheumatic polymyalgia in patients with chronic gastroduodenitis]. Experimental and clinical gastroenterology, 2014, vol.106, no.6, pp. 85–89.
13. Ватутин Н.Т., Смирнова А. С., Тарадин Г. Г., ЭльХатиб М. А. Обзор рекомендаций по лечению ревматической полимиалгии (EULAR/ACR2015). Архивъ внутренней медицины. 2016; 6(1): 3–5. Vatutin M. T., Smyrnova G. S., Taradin G. G., ElKhatib M. A. Review of recommendations for the management of polymyalgia rheumatica (ACR/EULAR2015). The Russian Archives of Internal Medicine. 2016; 6(1): 3–5. DOI: https://doi.org/10.20514/2226-6704-2016-6-1-3-5
14. Бекетова Т.В., Сатыбалдыев А. М., Денисов Л. Н. Международные рекомендации по ведению больных гигантоклеточным артериитом и ревматической полимиалгией: итоги 2015 года. Научно-практическая ревматология. 2016; (54)4: 390–394. Beketova T. V., Satybaldyev A. M., Denisov L. N. International guidelines for the management of giant cell arteritis and polymyalgia rheumatica: The 2015 results. Rheumatology Science and Practice, 2016, vol. 54, no. 4, pp. 390–394. DOI: https://doi.org/10.14412/1995-4484-2016-390-394
15. Борисова Е. О. Нежелательные эффекты системной глюкокортикостероидной терапии. Клиническая геронтология. 2009; 8–9: 19–26. Borisova E. O. Unfavourable effects of systemic glucocorticoid therapy (Practitioners assistance). Clinical gerontology, 2009, no. 8–9, pp. 19–26.
16. Комердус И.В., Будул Н. А., Чеканова А. В. Системное действие глюкокортикоидных препаратов: в помощь врачу общей практики (обзор литературы). Русский медицинский журнал. 2017; 1: 45–48. Komerdus I. V., Budul N. А., Chekanova A. V. Systemic effects of glucocorticoid drugs: a guide for the General practitioner (literature review). Russian medical journal, 2017, no. 1, pp. 45–48.
17. Решетняк Т.М., Середавкина Н. В., Дыдыкина И. С., Насонов Е. Л. Глюкокортикоиды в терапии системной красной волчанки. Клиницист. 2013; 3–4: 14–26. Reshetnyak T. M., Seredavkina N. V., Dydykina I. S., Nasonov E. L. Glucocortocoids in the therapy of systemic lupus erythematosus. The Clinician, 2013, no. 3–4, pp. 14–26, Doi: https://doi.org/10.17650/1818-8338-2013-3-4-14-26.
18. Башкова И.Б., Мадянов И. В. Принципы рациональной глюкокортикоидной терапии при лечении ревматических заболеваний. Лечащий врач. 2019; 4: 24–27. Bashkova I. B., Madyanov I. V. Principy` racional`noj glyukokortikoidnoj terapii pri lechenii revmaticheskix zabolevanij [Principles of Rational Glucocorticoid Therapy for Rheumatic Diseases]. Lechashhij vrach – Medical doctor, 2019, no. 4, pp. 24–27.
19. Каратеев А.Е., Гонтаренко Н. В., Цурган А. В. Комор бидная патология пищеварительной системы у больных ревматическими заболеваниями: не только НПВП-гастропатия. Научно-практическая ревматология. 2016; 54(4): 382–389. Karateev A. E., Gontarenko N. V., Tsurgan A. V. Digestive comorbidity in patients with rheumatic diseases: Not only NSAID-induced gastropathy. Scientific and practical rheum atology. 2016, vol. 54, no. 4, pp. 382–389. Doi: https://doi.org/10.14412/1995-4484-2016-382-389
Review
For citations:
Kudina E.V., Samkova I.A., Larina V.N. Patient with polymyalgia rheumatica — how to prevent gastrointestinal damage? Experimental and Clinical Gastroenterology. 2020;(9):79-84. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-181-9-79-84
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