Treatment of Wegener's granulomatosis

The goal of the therapy is to achieve remission during an exacerbation of the disease and then maintain it. The main principles of treatment tactics are the earliest and most timely initiation of treatment, individual selection of the drug, doses, and duration of treatment during an exacerbation, long-term treatment taking into account the progressive nature of the disease.

Drug treatment of Wegener's granulomatosis

The basis of treatment is the use of glucocorticoids in combination with cytostatics. As a rule, the initial suppressive dose of glucocorticoids is 6080 mg of prednisolone per day orally (1-1.5 mg/kg of body weight per day), if insufficient effectiveness, the dose is increased to 100-120 mg. If in this case it is not possible to achieve control over the disease, so-called pulse therapy is used - 1000 mg of methylprednisodone is prescribed for 3 days in a row, the drug is administered intravenously by injection in a 0.9% sodium chloride solution.

Significant improvement of prognosis for life is associated with the use of cytostatic drugs. Preference is given to cyclophosphamide, but good results have been obtained with the use of azathioprine, methotrexate, mycophenolate mofetil. During the period of pronounced clinical symptoms of the disease, cyclophosphamide is administered intravenously or intramuscularly at a dose of 2-3 mg / kg of body weight per day, with a decrease in disease activity, they switch to maintenance doses (50-100 mg / day or 200-400 mg per week). Treatment with cyclophosphamide is continued for 1 year after achieving stable remission, then the dose is gradually reduced.

To maintain remission, prednisolone is used in a minimal maintenance dose (5-7.5 mg/day) in combination with cyclophosphamide. In case of long-term remission of the disease, complete withdrawal of glucocorticoids is possible while maintaining cytostatic therapy.

Surgical treatment of Wegener's granulomatosis

Surgical treatment for Wegener's granulomatosis should be performed for vital indications. Wounds do not heal for 3-4 months. It is recommended to increase the dose of hormones before surgery, and gradually reduce it to the initial level in the postoperative period. If surgical treatment is necessary, immunosuppressants should be temporarily discontinued and broad-spectrum antibiotics should be prescribed.

Further management

All patients after discharge from the hospital need to continue the course of treatment with a reduction in the dose of drugs (under the control of blood counts and general condition). Once every 1-2 months, it is advisable to conduct a detailed examination of the patient and consult him with related specialists (primarily with rheumatologists),

Forecast

The prognosis is unfavorable. The main criterion for predicting the course of the disease is, first of all, the nature of the onset of the disease (acute, subacute, chronic). The more acute the onset of Wegener's granulomatosis, the more severe the further course. The remaining criteria (duration of remission and life expectancy) depend on the course options, but due to the effectiveness of modern treatment methods, they are more relative than the onset of the disease. The severity of the onset of the disease and the rate of progression can be objective factors determining the prognosis.

In conclusion, it should be noted that most patients with Wegener's granulomatosis first consult an otolaryngologist. Their future depends on timely diagnosis and adequate treatment.

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Prevention of Wegener's granulomatosis

There are no reliable methods for preventing Wegener's granulomatosis. However, it should be taken into account that the development of Wegener's granulomatosis is preceded by such common diseases and conditions as influenza, acute respiratory viral infections, exacerbation of chronic focal infection, hypothermia, trauma, pregnancy or childbirth.