Proposta di percorso clinico-assistenzialeper la

Oftalmopatia basedowiana

23 giugno 2008

Michele Zini

Servizio di Endocrinologia - Arcispedale S. Maria Nuova, Reggio Emilia

michele.zini@asmn.re.itMichele 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

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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