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7mediterranean journal
of RHEUMATOLOGY
EAAHNIKH PEYMATQAOriA
26 1
2015
AP0PO XYNTAEHI EDiTORIAL
Ta véa KpiTnpia Yia in ouoinMaiiKn OKÀnpoôepMÎa avoiyouv to ôpôpo Yia Bepaneia oe npo-aKÀripoôepMaTiKOûç aoBeveiç.
AàZapoç I. ZaKKàç, MD, DM, PhD, reœpYioç BaiônouÀoç1 MD, PhD IcnpiKô ÏMHMa, navenioTrpo OeaaaÀlaç Kai 1 EKnA
The new 2013 ACR/EULAR classification criteria for systemic sclerosis pave the way for treatment in pre-scleroderma patients
Lazaros I Sakkas, MD, DM, PhD, George Vaiopoulos1 , MD, PhD
Medical School, University of Thessaly and 1Medical School, National and Kapodistrian University of Athens
npôo0aTa ôr|MOOieû9r|Kav Ta KpiTnpia TaÇivôpnonQ Tou ApepiKaviKoû KoÀÀeYÎou peupaToAoYiaQ (ACR) Kai EupwnaÏKnQ EvwonQ Yia T|v KaTanoAépnonQ twv peupaTiopwv(EULAR) Yia T| ouoTnpaTiKn oKAnpuvon (zzka) (nivaKaQ 1) 1.
H ZZkA xapaKTnpiZeTai anô unepßoAiKn Kai eKTeTapé-vn evanô9eon KoAAaYôvou Kai e^wKuTTâpiaQ ôepéAiaQ ouoiaç, evepYonoinon tou avooonoi|TiKoû pe nAnôw-pa auToavTiowpaTwv, Kai piKpoaYYeionâôeia. H ôia-Yvwon Kai öepaneia TnQ ZZkA, péxpi onpepa oTnpi-ZeTai oTa ACR KpiTnpia TaÇivôpnonQ tou 1980 Yia Tn ZZkA (nivaKaç 2) 2. Ta KpiTnpia tou 1980 ßaoiZovTai oTn oKAnpia ôéppaToQ, ônAaôn oTnv evanôôeon KoAAaYôvou. H öepaneia TnQ ZZkA eivai ev noAAoÎQ ava-noTeAeopaTiKn a0oû n evanôôeon KoAAaYôvou ôev pnopei va avTipeTwnioôei anoTeAeopaTirâ pe Kapia öepaneia péxpi onpepa Kai ôewpeÎTai ôavaTn^ôpa eKônAwon.3
H piKpoaYYeionâôeia pe Tn pop0n 0aivopévou Raynaud Kai aAAoiwoewv twv Tpixoeiôwv oe TpixoeiôooKônnon
twv ovuxiKwv nTu-xwv, pe Tnv napou-oia auToavTiowpaTwv nou oxeTÎZovTai pe Tn ZZkA, ônwQ avTi-To-noioopepaonQ Kai avTiKevTpopepiôiaKwv auToavTiowpaTwv, ep0aviZovTai npiv va eKônAwôei oKAnpia tou ôéppaTOQ, ônAaôn evanôôeon KoAAaYôvou. EnionQ ôi-nônon tou ôéppaToQ
Ynsu8uvoq aAAr|Aoypa0iac;
Ka8nvnTnQ AäZapoQ I ZaKKäq PeupaxoAoyiKn KAiviKii, laTpiKÖ TMlMa,
ZxoAq EniCTTHM^v YyeiaQ,
naveniCTTHMio QeaaaAiaq
BiönoAiQ 41110, Aäpiaa
TnA +241350 2813, Fax: +2413501016,
Corresponding author:
Professor Lazaros I. Sakkas
Department of Rheumatology
Faculty of Medicine,
School of Health Sciences,
University of Thessaly and University
General Hospital of Larissa
Biopolis 41110, Larissa
Tel:+241350 2813, Fax:+241350 1016,
email:[email protected]
pe T Aep0oKÙTTapa Kai paKpo0âYa ep0aviZeTai npiv avixveuôei evanôôeon KoAAaYôvou oe ßio^ieQ ôéppaToQ.4 £tt| ZZkA Ta T Aep0oKÛTTapa Kai Ta B Aep0oKûT-Tapa pe tiq KuTTapoKÎveQ nou napâYouv euoôwvouv T|v ivwon, evw pepiKa anô Ta auToavTiowpaTa nou eupioKovTai oe aoôeveÎQ pe ZZkA enionQ euoôwvouv T|v ivwon.4 MeAéTeQ oe povTéAa ZZkA enionQ unoôn-Awvouv ôTi n vôooQ e^eAiooeTai oauTô to npooKAnpo-ôeppaTiKô oTaôio oe enôpevo oTaôio pe evanôôeon KoAAaYôvou. Eivai Aoyikô enopévwQ va oupnepâvei KânoioQ ôti auTô to oTaôio eivai KaTaAAnAo Yia anoTe-AeopaTiKn öepaneia.4
Ze pia peAéTn 20eToûQ napaKoAoûônonQ, 80% twv aoôevwv pe 0aivôpevo Raynaud ouv oxeTiZôpeva pe T| ZZkA auToavTiowpaTa ouv TuniKéQ t|Q ZZkA aA-AoiwoeiQ TpixoeiôooKônnonQ twv ovuxiKwv nTuxwv, ep0âvioav ZZkA.5 naAaiôTepeQ peAéTeQ napaKoAoûônonQ aoôevwv pe 0aivôpevo Raynaud Kai auToavTiowpaTa oônYnoav oe npoTâoeiQ Yia KpiTnpia TaÇi-vôpnonQ npwipnQ ZZkA 6 , nou paZi pe t| onpavmn peAéTn twv Koenig Kai ouv 5 wpipaoav to xpôvo Yia Ta véa 2013 KpiTnpia TaÇivôpnonQ.1 Ta véa KpiTnpia ne-piAapßavouv wq nâoxovTeQ pe ZZkA aoôeveÎQ pe npw-ipn ZZkA xwpÎQ oKAnpia ôéppaToQ (npo-oKAnpoôeppa-tikoûq aoôeveÎQ). Aôyou xapiv, aoôevnQ pe 0aivôpevo Raynaud (oKop 2) Kai TuniKn TpixoeiôooKônnon (oKop 2) Kai auToavTiowpaTa (oKop 3) Kai ôioYKwpéva ôôktu-Aa (oKop 2) TaÇivopeÎTai wq ZZkA. Ta véa KpiTnpia avoÎYouv tov ôpôpo Yia xopnYnon ôe-paneiaQ oe aoôeveÎQ oto npooKAnpoôeppaTiKô oTaôio, ônou avapéveTai anoTeAeopaTiKôT|Ta, oTa nAai-oia Tuxaionoinpévwv peAeTwv. Me tov Tpôno auTô, Ta KpiTnpia tou 2013 oToxeûouv va KaAû^ouv pia peYaAn ôepaneuTiKn avaYKn ot| ZZkA.
mediterranean journal
of RHEUMATOLOGY
EAAHNIKH PEYMATQAOriA
26 1
2015
nivaKaq 1. Ta Kpmipia Ta^ivoMnoriQ 2013 twv ACR/EULAR Yia Tn ouoTriMaTiKn okahpuvoh
Kpirnpio IKOP
1. iKArpia 5spjaToc; 5aKTi>Att>v nou snsKTsivsTai nEpav toiv j£raKapno$aAaYYiKwv ap0pwo£tt>v 9
2. iKAipia tou 5spjaToc; twv 5aKTi>Att>v jovo -5ioYKtt>or 5aKTi>Att>v (puffy fingers) 2 -oKAr|po5aKTuAia 4
3. BAdpsq paYaq 5aKTi>Att>v
-eakh 2
-po0pia-ouA£Q 3
4.Tr|A£aYY£i£KTaoi£Q 2
5. AvwjaAa rpixo£i5r| ovuxiKr|Q nruxnQ 2
6. nv£upoviKn aprrpiaKri unspraor Kai /r| 5iaj£or nv£ujoviKr| voooc; 3
7. ®aivoj£vo Raynaud 3
8. AuToavnowjara ouox£TiZoj£va j£ ouorrjariKri oKAripuvor (jeyioto oKop, 3) 3 -avTi-K£vrpoj£pi5iou
-avri-Tonoiooj£paorQ I -avri-RNA noAuj£pdo|Q III OpioriK| ouorrjariKri oKAnpuvor orav to oKop >9
KpiTnpia anoKAsioMOu: vs0poYsvnQ ivaiori, Y£viKeu|Jsvr| |jop0ia, r|woivo0iAiKn muikq nspiTovmSa (eosinophilic fasciitis), nop0upia, scleredema diabeticorum, scleromyxedema, lichen sclerosus, voooq MooxsupaTOQ KaTa ^eviotq (graft-versus-host disease), SiapnTiKn xsipoap0pona0sia (diabetic cheiroarthropathy), spuGpoixAaYia (erythromyalgia).
nivaKaq 2. Kpmipia Ta^ivopnonQ thq ApepiKaviKHQ EvworiQ peu|jaTio|Jwv (ARA) tou 1980 Yia Tr|
M£iZov Kpirnpio
-oKArpia 5spjaroQ 5aKTi>Att>v £yyuq to>v j£raKapno Kai j£Tarapoo-$aAaYYiKwv ap0pwo£tt>v
EAaooova Kpirnpia
-!KArpo5aKTuAia
-ouAsq paYaq 5aKTi>Att>v n anwA£ia iorou otic; paY£Q 5aKTuAtt>v -Aj^oT£ponA£upr ivwor nv£ujoviKwv pao£tt>v or|v anAr| aKTivoYpa^ia
Ao0£vr|Q j£ UkA npsn£i va ¿x£i to j£iZov Kpirnpio n rouAaxiorov 2 £Aaooova Kpirnpia (£uaio0roia:97%, £i5iKOTrTa 98%)
BIBAIOrPAOIA 4.
1. Van der Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, et al. 2013 classification criteria for systemic sclerosis:an americal college of rheumatology/European 5. league against rheumatism collaborative initiative. Arthritis Rheum 2013;65:2737-47.
2. Preliminary criteria for the classification of systemic sclerosis (scleroderma): Subcommittee for scleroderma criteria of the American Rheumatism Association diagnostic and therapeutic criteria committee. Arthritis Rheum 1980;23: 581-90
3. Ho YY, Laqares D, Tager AM, Kapoor M. Fibrosis-a lethal 6. component of systemic sclerosis. Nat Rev Rheumatol 2014;10:390-402
Sakkas LI, Chikanza IC, Platsoucas CD. Mechanism of disease: the role of immune cells in the pathogenesis of systemic sclerosis. Nat Clin Pract Rheumatol 2006;2:679-85. Koenig M, Joyal F, Fritzler MJ, Roussin A, Abrahamowicz M, Boire G, et al. Autoantibodies and microvascular damage are independent predictive factors for the progression of Raynaud's phenomenon to systemic sclerosis: a twenty-year prospective study of 586 patients with validation of proposed criteria for early systemic sclerosis. Arthritis Rheum 2008;58:3902-12
LeRoy EC, Medsger TA Jr. Criteria for the classification of early systemic sclerosis. J Rheumatol 2001;28:1573-76
