Treatment of Wegener's granulomatosis

The purpose of the therapy is to achieve remission and exacerbation of the disease and then to maintain it. The main principles of treatment tactics are possible early and timely initiation of treatment, individual selection of the drug, doses, and the timing of treatment for exacerbation, long-term treatment taking into account the progressive nature of the disease.

Medication for 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), with insufficient effectiveness, the dose is increased to 100-120 mg. If in this case it is not possible to control the disease, so-called pulse therapy is used-prescribe 1000 mg of methylprednisodone for 3 consecutive days, the drug is injected intravenously calve in a 0.9% solution of sodium chloride.

A significant improvement in the prognosis for life is associated with the use of cytotoxic drugs. Preference is given to cyclophosphamide, but good results were obtained with the use of azathioprine, methotrexate, mycophenolate mofetil. In the period of severe clinical symptoms, cyclophosphamide is administered intravenously or intramuscularly at a dose of 2-3 mg / kg of body weight per day, with a decrease in the activity of the disease go to maintenance doses (50-100 mg / sug or 200-400 mg per week). Treatment with cyclophosphamide is continued for 1 year after reaching a stable remission, then the dose is gradually reduced.

To maintain remission, prednisolop is used in a minimal maintenance dose (5-7.5 mg / day) in combination with cyclophosphamide. With prolonged remission of the disease, complete cancellation of glucocorticoids is possible while maintaining the therapy with cytostatics.

Surgical treatment of Wegener's granulomatosis

Operative treatment for Wegener's granulomatosis must be carried out according to vital indications. Wounds do not heal for 3-4 months. In this case, it is recommended to increase the dose of hormones before the operation, and in the postoperative period gradually reduce it to the initial level. If necessary, surgical treatment should temporarily cancel immunosuppressants and prescribe broad-spectrum antibiotics.

Further management

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

Forecast

The outlook is unfavorable. The main criterion for predicting the course of the disease is, first of all, the nature of the disease began (acute, subacute, chronic). The sharper the onset of Wegener's granulomatosis, the heavier the further course. The bottom of the remaining criteria (duration of remission and life expectancy) depends on the flow options, but due to the effectiveness of modern methods of treatment 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 are referred first of all to the otorhinolaryngologist. From the timely diagnosis and the appointment of adequate treatment depends on their future fate.

[1], [2], [3]

Prevention of Wegener's granulomatosis

Wegener does not have reliable methods for preventing granulomatosis. However, it should be borne in mind that the development of Wegener's granulomatosis is preceded by such common diseases and conditions as influenza, acute respiratory infections, exacerbation of chronic focal infection, cooling, trauma, pregnancy or childbirth.