Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Feb 2021
Cardiovascular disease and antiphospholipid syndrome: how to predict and how to treat?
Antiphospholipid syndrome (APS) is an autoimmune systemic disease characterized by a hypercoagulable state secondary to the presence of antiphospholipid antibodies and associated with vascular thromboses and / or pregnancy complications. Although venous thrombosis represents approximately 60% of thrombotic manifestations, also cardiovascular events can occur in patients with APS, including coronary and / or noncoronary complications. Moreover, several studies consistently showed a more significant atherosclerosis in patients with APS than controls. ⋯ Low-dose aspirin should be considered in arterial APS in addition to vitamin K antagonists in a high-risk subset, or alone for primary prophylaxis in high-risk antiphospholipid antibodies carriers. Furthermore, statins and immunomodulation therapies have an emerging role in the treatment of APS. Overall, ad hoc designed high-quality studies are needed to definitely determine optimal therapeutic strategies for arterial APS.
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Pol. Arch. Med. Wewn. · Feb 2021
Biologic agents and small-molecule inhibitors in systemic autoimmune conditions: an update.
The progress in the understanding of the pathophysiology of rheumatic diseases provided a rational basis for the development of biologic disease‑modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs), which have completely revolutionized the treatment of inflammatory conditions. These agents differ in terms of their effectiveness for controlling specific rheumatic diseases depending on the pivotal cytokine driving the inflammatory process. Cytokine blockers were the first to be developed and rapidly expanded. ⋯ Whenever possible, the choice of bDMARDs and tsDMARDs should be guided by the patient's comorbidities. There have been limited data on the use of these drugs during pregnancy, but anti‑TNF‑α therapy, rituximab, and anakinra seem to be safe. Biologic agents are expensive, but biosimilars have emerged as a cost‑effective option with a potential to treat a greater number of patients.