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2009, Número 2

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Gac Med Mex 2009; 145 (2)


Granulomatosis de Wegener, abordaje diagnóstico y terapéutico

Vera-Lastra O, Olvera-Acevedo A, McDonal-Vera A, Pacheco-Ruelas M, Gayosso-Rivera JA

Idioma: Español
Referencias bibliográficas: 81
Paginas: 121-129
Archivo PDF: 127.13 Kb.


RESUMEN

La granulomatosis de Wegener es una vasculitis sistémica, necrosante y granulomatosa que afecta el tracto respiratorio superior e inferior y el riñón; es la vasculitis anticuerpos anticitoplasma del neutrófilo (ANCA) positiva más frecuente. El diagnóstico se basa en las manifestaciones clínicas, la biopsia de los órganos afectados y la presencia de ANCA en el suero. Los criterios de clasificación según el Colegio Americano de Reumatología son inflamación oral o nasal, alteraciones en la radiografía de tórax (nódulos, infiltrado pulmonar fijo, cavitaciones), anormalidades urinarias (hematuria), biopsia con infiltrado granulomatoso. El tratamiento se divide en dos fases: de inducción a la remisión y de mantenimiento. En la primera es necesario el uso de terapia inmunosupresora intensiva: ciclofosfamida más esteroides para controlar la actividad de la enfermedad (tres a seis meses). En la fase de mantenimiento, menos intensa, se emplean inmunosupresores como azatioprina, metotrexate, micofenolato de mofetilo, entre otros; su objetivo es mantener la remisión y disminuir los efectos adversos asociados a la ciclofosfamida. El etanercept no ha sido útil para la fase de mantenimiento. El rituximab y la 15-desoxipergualina son terapias alternativas en casos refractarios.


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