REUMATSKE BOLESTI U DJECE – PER ASPERA AD ASTRA

Miroslav Harjaček

Progress in the field of pediatric rheumatolgy has been extraordinary; subspecialty is accepted as essential, vital, indispensible and distinct from adult rheumatology. It is clear that arthritis in children is more heterogeneous than RA. Although there are similarities between the inflammatory arthritides occuring in adults and children, RA and JIA appear to be distinct phenotypically with exception for the older child with RF-positive polyarticular arthritis. Progress in molecu lar biology has enabled us to diagnose those children earlier, and treat them more efficaciously with variety of drugs and biologic agents. In recent years a new group of hereditary autoinflammatory disorders has emerged. These rare syndromes are charaterized by recurrent episodes of seemingly unprovoked, intermittent inflammation. In the near future we will be able to distinguish various subtypes of autoimune/autoinflammatory diseases earlier in the course, have a better understanding of the biomarkers and other prognostic factors, and most importantly treat them earlier with extended set of various new exciting drugs and biological therapy.

Dječja reumatologija je relativno mlada i dinamična subspecijalistička struka koja se bavi dijagnostikom i intradisciplinarnim liječenjem sistemskih i mišićnokoštanih bolesti koje nastaju kao posljedica poremećaja u regulaciji imunološkog sustava, a najčešće razultiraju razvojem autoimunosti ili autoinflamatorne reakcije te upalom. Postoje brojne razlike između djece i odraslih osoba koje boluju od reumatskih bolesti. Novija istraživanja pokazala su da se bolesti poput juvenilnog idiopatskog artritisa mogu ranije i preciznije dijagnosticirati korištenjem suvremenih metoda molekularne biologije i efikasnije liječiti ranijom primjenom biološke terapije. S druge strane rano prepoznavanje različitih autoinflamatornih bolesti je ključno za adekvatnu terapiju tih vrlo složenih stanja. Dakle, samo je pitanje vremena kada će moderne dijagnostičke metode molekularne biologije poput genetskog čipa radi određivanja “profila” i biomarkera bolesnika postati dio rutinske prakse, a rana biološka terapija po modernim principima farmakogenomike, prilagođena za svakog bolesnika ponaosob, biti temelj svakodnevne kliničke prakse.