revmatoiduli arTriti SemaerTebeli qsovilis qronikuli sistemuri anTebiTi daavadebaa, romelic xasiaTdeba

upiratesad saxsrebis dazianebiT, rac iwvevs maT mniSvnelovan deformacias da sayrden-mamoZravebeli

aparatis funqciis moSlas.
 etiologia da paTogenezi

• paTogenezi saboolood dadgenili ar aris.

• savaraudoa autoimunuri darRvevis da genetikuri faqtorebis monawileoba.
• swored es faqtorebi ganapirobeben xrtilovani da Zvlovani qsovilis dazianebas da sinovitebis
Camoyalibebas.
• dasawyisSi aRiniSneba sinovialuri garsis infiltracia mononuklearebiT, Semdeg viTardeba sinoavialuri
ujredebis proliferacia, xaoebis hipertrofia, sasaxsre xrtilis kideze Cndeba `agresiuli~ granulaciuri qsovili,
romelsac panusi ewodeba.
• panusi TandaTanobiT aRwevs xrtilSi, arRvevs mas da avsebs saxsris Rrus. viTardeba saxsris fibrozuli,
Semdeg ki Zvlovani ankilozi.
• revmatoiduli arTritisaTvis damaxasiaTebelia revmatoiduli kvanZebis gaCena kanqveS, plevraSi, filtvebsa
da perikardSi. kvanZebSi aris nekrozis ubnebi, romlebic garSemortymulia makrofagebiTa da fibroblastebiT
 klinikuri suraTi

prodromuli movlenebi (daavadebis ganviTarebamde ramdenime kviriT an erTi TviT adre SeiZleba
gaCndes):
• uxasiaToba
• wonaSi kleba
• oflianoba
• subfebriliteti
• arTralgia
• dilis SeboWiloba
• anemia
• eds-is `umizezo~ momateba da sxva.

saxsrovan sindroms axasiaTebs:

• mravalricxovani dazianeba
• simetriuloba
• progresirebadi mimdinareoba da recidivisaken midrekileba
• daavadebis dawyeba mtevnebisa da terfebis wvrili saxsrebidan
arTriti vlindeba anTebiTi xasiaTis tkiviliT, SesivebiT da moZraobis mkveTri SezRudviT.
 klinikuri suraTi

zogadi reaqciebi:
• sxeulis temperaturis momateba
• SeboWiloba, gansakuTrebiT dilis saaTebSi.

sistemuri, anu arasaxsrovani dazianebebidan damaxasiaTebelia:

• revmatoiduli kvanZebis gaCena
• polineiropaTia (ziandeba is sisxlZarRvebi, romlebiTac ikvebeba periferiuli nervebi).
 diagnozi

sadiagnostiko kriteriumebi:
1. SeboWiloba saxsarSi aranakleb 1 saaTisa mis srul gaqrobamde
2. erTdroulad sami an meti sasaxsre aris rbili qsovilis Sesiveba da saxsarSida gamonaJoni
3. mtevnebis sasaxsre aris Sesiveba
4. arTritis simetriuloba
5. revmatoiduli kvanZebi saxsrebis maxloblad, umetesad mis gamSlel zedapirze
6. tipiuri rentgenologiuri simptomebi mtevnis suraTze: eroziebi, an gamoxatuli osteoporozi,

Tu avadmyofs ამ kriteriumidan 4 aReniSneba, SeiZleba vifiqroT revmatoiduli arTritis arsebobaze.

 mkurnaloba

1. Tu ar aRiniSneba Sinagani organoebis dazianeba, gamoiyeneba arasteroiduli anTebis sawinaaRmdego

preparatebi (indometacini, diklofenaki, ibuprofeni.)
2. bazisuri preparatebi gamoiyeneba daavadebis aqtiurobis Casaqrobad, progresirebis SesaCereblad,
gamoxatuli saxsarSida dazianebebis SemTxvevaSi (aminoqinolinis warmoebulebi – qloroqili,
hidroqsiqloroqsini... )Tu maTi gamoyeneba uSedegoa kompleqsur mkurnalobaSi unda CavrToT
citostatikuri medikamentebi. gamoxatuli sinovitis SemTxvevaSi mizanSewonilia saxsrebSi
gaxangrZlivebuli moqmedebis glukokortikoidebis Seyvana.
3. rig SemTxvevebSi efeqturia qirurgiuli mkurnaloba. (sinoveqtomia, tenosinoveqtomia, kafsulotomia,
osteotomia, arTrodezi, arTroplastika...).
 mkurnaloba

remisiis periodSi karg Sedegs iZleva fizioTerapia da kurortuli mkurnaloba.

fizioTerapia:
1. ultraiisferi sxivebi
2. fonoforezi - hidrokortizonis an analginis Seyvana organizmSi kanis gziT ultrabgeris saSualebiT. (kursi 10-
15 procedura).
3. sinusoiduri modulirebuli deni
4. ultramaRali sixSiris eleqtroveli
 mkurnaloba
kurortuli:
a) balneoTerapia
• gogirdwyalbadiani abazana radonuli wylebi
• Termuli wylebi (ujarma) –
• kombinirebuli abazanebi – wyalqvesa varjiSi.
 mkurnaloba

b) peloidoTerapia
talaxis moqmedebis ZiriTadi arsi mdgomareobs mis mZlavr siTbur efeqtSi. axasiaTebs maRali
Tbotevadoba. didxans inarCunebs siTbos da TandaTanobiT gascems mas.

talaxi qimiur zemoqmedebasac axdens. is Seicavs sxvadasxva saxis organul da araorganul nivTierebas,
romelTa SeRweva organizmSi kanis gziT ganapirobebs talaxis maRal samkurnalo Sedegs.
sistemuri daavadebebi
vaxtang WumburiZe
Aautoimunuri daavadebebi: definicia
• Qautoimunuri sindromebis dros imunuri sistema
uSvebs Secdomas:
paTogenurad ganixilavs organizmis sakuTar ujredebs
da qsovilebs, Sesabamisad viTardeba
araadeqvaturi imunuri pasuxi
• Aautoimunuri daavadebisaTvis damaxasiaTebelia
hipersensitiuroba (II, III da IV tipebi) da
autoantisxeulebis gamomuSaveba
Aautoimunur daavadebaTa (ad) mokle
CamonaTvali:
Aarsebobs 80-ze meti autoimunuri sindromi da
daavadeba
• pirveladi biliaruli cirozi
• Aai alopecia
• fsoriazi
• Aai hepatiti
• vitiligo
• Ddiabeti tipi 1
• Sjogren -is sindromi
• Aai Tireoiditi
• revmatoiduli arTriti
• Hashimoto-s daavadeba
• sklerodermia
• hemolizuri anemia
• sistemuri wiTeli mglura
• Trombocitaruli purpura
• kvanZovani periarterriti
• kronis daavadeba
• polimioziti da dermatomioziti
• mravlobiTi sklerozi
• miastenia gravis
ra specialobis eqimebi mkurnaloben autoimunur
daavadebebs?
• revmatologi
• nevrologi
• endokrinologi
• nefrologi
• rematologi
• gasroenterologi
• dermatologi
• Terapevti
rogoria mkurnalobis proncipebi?
• simptomebis mkurnaloba (anTebis sawinaamRdego,
analgetikebi, anidepresantebi da a.S)
• CanacvlebiTi Terapia (Tiroqsini, insulini da a.S)
• imunosupresantebi
• alternatiuli medicina
sistemuri wiTeli mglura (SLE)

SLE aris SemaerTebeli qsovilis sitemuri,

autoimunuri daavadeba, romelmac
SeiZleba daazianis nebismieri organo an
qsovili, zogadad: daavadebis safuZvels
warmoadgens imunuri sistemis
autoagresiuli reaqcia , rodesac es sistema
azianebs sakuTari organizmis ujredebs da
qsovilebs da iwvevs maT imunokompleqsur
anTebas
Kklinikuri mimdinareoba:
• SLE upiratesad azianebs guls, saxsrebs, kans,
filtvebs, sisxlzarRvebs , RviZls, Tirkmelebs da nervul
sistemas.
• Daavadeba mimdinareobs perioduli gamwvavebi da
remisiis fonze, 10-jer ufro xSiria qalebSi.
• tipiuri gamovlinebaa saxis kanze” pepliseburi”
gamonayari da fotosensitiuroba
Kklinikuri suraTi
Kklinikuri simptomatika “didi imitatori”:
• zogadi simptomatika: artralgia, mialgia,
temperaturis mateba
• dermatologiuri cvlilebebi: 30-65%
• kunTebis da saxsrebis dazianeba
• hematologiis cvlilebebi
• gulis dazianebis suraTi
• filtvis dazianebis suraTi
• Tirkmlis dazianebis klinika
• neirofsiqiatriuli simptomebi
sistemuri dazianebis suraTi
paTfiziologia: apoptozis Teoria
FpaTfiziologia : apoptozis Teoria:
DpaTfiziologia: apoptozis Teoria
SLE-s diagnostika:
• LE-ujredebi

• anti – dnm antisxeulebi

• 6 klinikuri kriteriumis arseboba 11-dan:

revmatiduli arTriti: definicia
• revmatoiduli artriri aris qronikuli, sistemuri, anTebiTi
daavadeba, romelic SesaZloa azinebdes sxvadasxva
organoebs da qsovilebs, magram principialurad
azianebs saxsrebs
ra procesis daxasiaTeba:

• saxsris kafsulis anTeba

• saxsris kafsulis hiperplazia
• saxsris sxeulis fibrozi, ankilozi
Ggarda amisa, ra SeiZleba iwvevdes difuzur anTebas:
filtvebSi, plevraSi, perikadiumSi da kanqveSa
kvanZebis gaCenas.
e.w. “saxsrebs gareT” ra moicavs SemTxvevaTa 15 -
20%
Dra-s eTiopaTogenezi: secvlili imunuri pasuxi
• Ezogadi StamomavlobiTi winaswar ganwyoba
• Mgenetikuri kavSiri: HLA-DR4-Tan asociacia
• Mautoimunurobis markerebi: revmatoiduli faqtori
(RF,autoantisxeulebi IgGFc), antisxeulebi mocirkulire
peptidebis winaaRmdeg - ACPA.
• SesaZlebelia kavSiri infeqciasTan: “molekuluri
mimikriis” Teoria, zogadad persistiulad damaxinjebuli
imunuri pasuxi
• vitamin D-s deficiti?
ra-s diagnostika:
• saxsrebis da “sasxris gareSe” dazianebis diagnostika
• rentgenologiuri kvleva
• imunologiuri testebi: ACPA
• damatebiTi testebi: eds-I, anemia, CRP,RviZlis
enzimebi da a.S
• “seronegatiuli SemTxvevebi”: 72%, 99%
sistemuri sklerodermia: definicia
• sklerodermia, an sistemuri sklerozi aris SemaerTebeli
qsovilis qronikuli daavadeba, romelic klasificirdeba
rogorc erT-erTi autoimunuri revmatiuli sindromi
• warSulSi gamoiyeneboda termini “progresuli
sistemuri sklerozi”, sclero -gauxeSeba , dermo -
kani
sklerodermiis tipebi
• lokaluri sklerodermia • sistemuri sklerodermia:

1. laqebi kanze 1. SezRuduli

2. xazebi kanze 2. difuzuri
SezRuduli sklerodermia: CREST sindromi:
• reinos sindromi
• saylapavis disfunqcia
• sklerodaqtilia
• Kalcinozi
• teleangioeqtaziebi
Ddifuzuli sistemuri sklerodermia
(sistemuri sklerozi)
• swrafad progresirebs kanis didi nawilis CarTviT
• Aazianebs erT an ramodenime Sinagan organos: guli,
Tirkmeli, filtvi, saylapavi, saWmlis momnelebeli
traqti
• Kkani da saxsrebi
• Llaboratoruli diagnostika: autoantisxeulebis
aRmoCena
CREST syndrome: calcinosis cutis
Abnormal motility
Facial changes

Tight, thin lips with vertical perioral furrows

kvanZovani periarteriti Periarteritis nodoza
• sinonimebi: kvanZovani poliarteriti, sistemuri
autoimunuri vaskuliti, panvaskuliti, kusmaul-maeris
daavadeba
• specifiuri terminologia:
1. GgudpasCeris sindromi
2. Temporaruli arteriiti
3. vegeneris granulomatozi
Ddefinicia:

• kvanZovani periarteriti ucnobi eTiologiis

daavadebaa, romelic azianebs arteriebs da
iwvevs sxvadasxva organos da qsovilis
iSemizacias.
• pacientTa 30-40% gadatanili aqvs B /C
hepatiti
Kkp –s klinikuri suraTi
• simptomebi gamowveulia im organoTa daavadebiT,
romelsac azianebs vaskuliti: muclis tkivili, umadoba,
temperaturis mateba, wonis dakleba, advilad daRla,
sisuste, kunTebis da saxsrebis tkivili
Kkp-s diagnostika
• Aar arsebobs specifiuri diagnostikuri testebi,
gamoiyeneba:
sisxlis saerTo analizi: (leikocitozi), eds-is aCqareba,
CRP-mateba, qsovilis biopsia, antineitrofiluri
antisxeulebi, angiografia
Kkp-s garTulebebi
• miokardiumis infarqti
• cerebruli insulti
• Tirkmlis ukmarisoba
• nawlavTa nekrozi da perforacia

Mkurnaloba: prednizoloni, ciklofosfamidi, metotraqsati