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Proposta di percorso clinico-assistenzialeper la
Oftalmopatia basedowiana
23 giugno 2008
Michele Zini
Servizio di Endocrinologia - Arcispedale S. Maria Nuova, Reggio Emilia
[email protected] Zini 2008
Michele Zini 2008
Perché occuparsi della GO ?
• patologia invalidante e potenzialmente grave
• patologia “fraught with difficulties”
• pochi se ne interessano a fondo
• disomogeneità di comportamento tra i clinici
• prevalenza contenuta ma non irrilevante
• buoni documenti scientifici di riferimento
European Group on GO (EUGOGO) represents a multidisciplinary consortium of clinicians from the European centers, who share a commitment to improving the management of patients with GO (www.eugogo.org).
A working group was formed and met in November 2006. Subsequent discussions took place electronically and at a further meeting in May 2007.
After revision, the document was posted on the European Thyroid Association (ETA) and the European Society of Ophthalmic Reconstructive and Plastic Surgeons websites for wider consultation.
The document was presented at the ETA Annual Meeting in Leipzig, Germany, in September 2007.
Michele Zini 2008
Copyright ©1995 BMJ Publishing Group Ltd. Glasziou, P. P et al. BMJ 1995;311:1356-1359
FIG 1--Benefit increases with risk, but harm is constant.Net benefit occurs only when risk is above threshold
Making treatment decisions
Making treatment decisions for patients with GO
• detailed assessment of the eyes
• understanding of the natural history of the disease
• insight into the impact of GO on the individual patient
• appreciation of the efficacy
• side effects of therapiesMichele Zini 2008
Activity and severity of GO
Wiersinga & PrummelTrends EndocrinolMetab 2002
Michele Zini 2008
Management issues of GO that should be addressed in specialist centers
Grading activity of GOActive GOInactive GO
Grading severity of GOSight-threatening GOModerate to severe GOMild GO
Claudio Marcocci 2007
Michele Zini 2008
a) Activity measures based on the classical features of inflammation: clinical activity score (CAS) is the sum of all items present
Michele Zini 2008
b) Severity measures
Michele Zini 2008
Michele Z
ini 2008 DON – Neuropatia ottica distiroidea
Michele Zini 2008
Glucocorticoids or orbital radiotherapy alone vs combined therapy for GO
(Bartalena, 1983, Marcocci, 1991)
p< 0.005
p< 0.01
0
1
2
3
4
5
6
7
8
Gluc RT+Gluc RT
Oph
thal
mop
athy
inde
x
Pre
Post
Claudio Marcocci 2007
Terapia cortisonica e.v.
“once weekly iv methylprednisolone 0.5 g, then 0.25 g, 6 wk each”
Kahali GJ et al., J Clin Endocrinol Metab 90: 5234–5240, 2005
Schema:Solumedrol 500 mg e.v. 1 volta alla settimana – 6 cicli +Solumedrol 250 mg e.v. 1 volta alla settimana – 6 cicli
Durata totale del trattamento: 12 settimane
Michele Zini 2008
Michele Zini 2008
Michele Zini 2008
Michele Zini 2008
Michele Z
ini 2008
Michele Z
ini 2008
Prummel MF et al., European Journal of Endocrinology (2003) 148 491–495
PROPOSTA• ENDOCRINOLOGIA
– management stato tiroideo– terapia cortisonica e.v.– DON
• OCULISTICA– valutazione ATTIVITA’ e SEVERITA’ di malattia– chirurgia ? (con ORL ?)– DON– forme lievi
• RADIOTERAPIA– radioterapia orbitaria
Michele Zini 2008
ALTRE POSSIBILITA’
• raccolta dati a scopo scientifico• call for patients• audit clinico• software
Michele Zini 2008