Wyniki wyszukiwania - Biblioteka Nauki

1

The -2518 A/G MCP-1 polymorphism as a risk factor of inflammatory bowel disease

100%

Walczak A. , Przybyłowska K. , Sygut A. , Dziki Ł. , Chojnacki C. , Chojnacki J. , Dziki A. , Majsterek I.

Polish Journal of Surgery

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2012

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tom 84(5)

238-241

EN

Inflammatory bowel diseases (IBD) are disorders originated from immune disturbances. The aim of the study was to evaluate the association between the -2518 A/G MCP-1 polymorphism and the risk of IBD development. Material and methods. Genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Study group consisted of 197 subjects with IBD (120 with ulcerative colitis and 77 with Crohn’s disease) as well as 210 healthy controls. Results. The presence of the -2518 G/G MCP-1 genotype in the investigated groups seems to be connected with higher risk of inflammatory bowel disease as well as Crohn’s disease only (OR 2.26; 95% CI 1.44-3.54 and OR 2.08; 95% CI 1.21-3.46, respectively). Conclusions. Our data showed that the -2518 A/G MCP-1 polymorphism might be associated with the IBD occurrence and might be used as predictive factor of these diseases in a Polish population.

2

Preferences of patients with inflammatory bowel disease for receiving specialized health services using technology: the role of Internet and other sources of medical information

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Włodarczyk M. , Włodarczyk J. , Zalewska K. , Olczyk M. , Maryńczak K. , Gajewski P. , Małek Z. , Cetnar-Sokołowska Z. , Sobolewska-Włodarczyk A. , Dziki A. , Dziki Ł.

Polish Journal of Surgery

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2019

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tom 91(2)

1-6

EN

Introduction: It is notable that patients with inflammatory bowel disease (IBD) have insufficient knowledge about their disease and are willing to be more involved in their treatment. Nowadays medical information is easily available and health-related topics state the third most frequent reason for using the Internet. Therefore, patient’s health-related self-awareness and willingness to take part in medical decisions have improved. The possibility of choice of specialized health services may have a positive effect on patient’s satisfaction. The aim of the study was to characterize the extent of Internet use for health information among a representative sample of IBD patients and to examine the effects that Internet and other sources of information about specialized health services have on patients’ choices of a doctor and hospital department. Materials and methods: In total, 135 IBD patients admitted to the Department of General and Colorectal Surgery at Medical University of Lodz were asked to complete an anonymous questionnaire. Only 123 fully completed questionnaires were included for analysis. The study group involved 68 women and 55 men. Results: A total of 85.4% IBD patients used Internet in order to gather medical information about their disease. Age of those patients was significantly lower than of those patients who did not use Internet. The most reliable source of information about physicians was Internet. Opinions and recommendations gathered from the Internet have a notable influence on patients’ preference of hospital department and attending physician. Conclusions: A majority of patients used Internet as a source of medical information related to IBD. Opinions obtained from the Internet seem to be the most reliable regarding attending physicians treating IBD patients.

3

Clinical parameters of inflammatory bowel disease in children do not correlate with four common polymorphisms of the transforming growth factor β1 gene

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Liberek A. , Jakóbkiewicz-Banecka J. , Kloska A. , Świderska J. , Kmieć Z. , Łuczak G. , Wierzbicki P. , Liberek T. , Marek K. , Plata-Nazar K. , Sikorska-Wiśniewska G. , Kamińska B. , Węgrzyn G.

Acta Biochimica Polonica

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2011

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tom 58

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nr 4

641-644

EN

Transforming growth factor β1 (TGF-β1) is a cytokine affecting cell proliferation and development, which also has an immunomodulatory activity. Correlations between polymorphisms of the TGF-β1 gene and clinical parameters of inflammatory bowel disease (IBD) were reported previously in adults. Here, we tested whether such correlations occur in pediatric patients suffering from IBD. One hundred and four pediatric IBD patients were involved in this study. Among them, 36 were diagnosed with Crohn's Disease (CD) and 68 were diagnosed with ulcerative colitis (UC). The control group consisted of 103 children, in which IBD was excluded. TGF-β1 levels were determined in plasma and intestinal mucosa samples. The presence of the TGF β1 protein and the amount of TGF β1 mRNA were estimated in intestinal mucosa by immunohistochemistry and reverse transcription Real-Time PCR, respectively. Four common polymorphisms of the TGF-β1 gene were investigated: -800G/A, -509C/T, 869T/C and 915G/C. No significant correlation between TGF-β1 genotypes and (i) TGF-β1 levels in plasma and tissue samples, (ii) TGF-β1 gene expression efficiency in intestinal mucosa, (iii) IBD clinical parameters and (iv) inflammatory activity could be detected in children suffering from IBD. We conclude that, contrary to previous suggestions, the four common polymorphisms of the TGF-β1 gene do not influence the susceptibility to or clinical parameters of IBD in the tested population of children.

4

Fecal lactoferrin, a marker of intestinal inflammation in children with inflammatory bowel disease

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Borkowska A. , Liberek A. , Łuczak G. , Jankowska A. , Plata-Nazar K. , Korzon M. , Kamińska B.

Acta Biochimica Polonica

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2015

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tom 62

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nr 3

541-545

EN

The aim of this study was to analyze the usefulness of fecal lactoferrin in the diagnosis and monitoring of inflammatory bowel disease (IBD) in children. The study included 52 children with IBD (24 with Crohn's disease and 28 with ulcerative colitis) aged between 0.92 and 18 years, and 41 IBD-free controls of similar age. Fecal concentration of lactoferrin was determined with a quantitative immunoenzymatic test. Fecal concentration of lactoferrin in children with IBD was significantly higher than in the controls. The cut-off value of fecal lactoferrin concentration optimally distinguishing between the children with IBD and the controls was identified as 13 μg/g. The sensitivity and specificity of this cut-off value equaled 80.7% and 92.7%, respectively, and its positive and negative prognostic values were 96.8% and 63.3%, respectively. Patients diagnosed with moderate Crohn's disease had significantly higher fecal concentrations of lactoferrin than children with the mild or inactive disease. Similarly, children with moderate ulcerative colitis showed significantly higher fecal concentrations of lactoferrin than individuals with the mild condition. No significant relationship was found between the fecal concentration of lactoferrin and the severity of endoscopic lesions. Patients with IBD and a positive result of fecal occult blood test were characterized by significantly higher concentrations of lactoferrin than the individuals with IBD and a negative result of this test. In conclusion, fecal concentration of lactoferrin seems to be a useful parameter for diagnosis and monitoring of IBD in children.

5

Evaluation of effect CAT -262C/T, SOD + 35A/C, GPx1 Pro197Leu polymorphisms in patients with ibd in the polish population

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Mrowicki J. , Mrowicka M. , Majsterek I. , Mik M. , Dziki A. , Dziki Ł.

Polish Journal of Surgery

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2016

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tom 88(6)

565-575

EN

Inflammatory bowel disease (IBD) are a heterogeneous group of disorders in the course dominated by chronic, recurrent gastrointestinal inflammation. It is believed that the activation of IBD occurs in patients with a genetic predisposition to their development. Chronic inflammation develops as a result of an excessive reaction of the immune system principally under the influence of environmental risk factors. Among them, it has been shown that the mechanism of oxidative stress is associated with the pathophysiology of inflammatory bowel disease, responsible for the commencement and progress of these diseases. The aim of the study was the relationship between single nucleotide polymorphisms (SNPs) of individual antioxidant enzymes, and the prevalence of inflammatory bowel disease that may be associated with increased levels of oxidative stress. Material and methods. A total of 111 IBD patients, including 65 patients with ulcerative colitis (UC) and 46 with Crohn’s disease (CD) and 125 healthy controls recruited from the Polish population, were genotyped for CAT -262C / T (rs1001179), SOD + 35A / C (rs2234694), GPx Pro 197 Leu polymorphisms. Genotyping of CAT, SOD, GPx gene polymorphism was performed by a RFLP-PCR. Results. The performed analysis of genetic polymorphisms of antioxidant enzymes showed that polymorphic variant of the CAT -262 C / T may have protective effects in patients with ulcerative colitis in the range of genotype C / T; OR = 0.49 (0.25-0.99), p = 0.044. Trend protective, but statistically unrelated, it was also observed for genotype T / T and T allele of the same polymorphism and genotypes and alleles + 35A / C SOD1 in UC as well as polymorphic variants CAT -262 C / T, Pro197Leu of GPx1, + 35A / C SOD1 in CD. The results were compared with a control group of potentially healthy individuals without such diseases. Conclusions. It has been shown that the polymorphism of antioxidant enzymes CAT gene -262 C / T may have protective effects in patients who are carriers of a genotype C / T at the UC. The potential protective effect without statistical relationships were also observed for other genotypes and alleles studied polymorphic variants of antioxidant enzymes in CD and CAT- 262C / T and + 35 A / C SOD1 in UC. Conducted our audit should be extended to more group of patients in order to assess whether or not to confirm the observed during analysis, the protective effect of CAT-262 C / T in ulcerative colitis and other trends observed for other polymorphic variants tested genes.

6

Potential of the Adolescents, Suffering from Inflammatory Bowel Disease, for Overcoming Difficulties and Achieving the Intended Goals

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Wardak K. , Celińska-Cedro D.

Polish Journal of Public Health

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2015

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tom 124

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nr 4

178-182

EN

Introduction. Self-efficacy is one of the most important determinants of behavior of adults and adolescents. The degree of self confidence attributable to oneself in order to overcome the difficulties of life and to achieve one's goals, both in healthy subjects and patients, determines the size of the effort and perseverance in taking action. According to The World Health Organization till 2020, chronic diseases will be the major cause of disability, and can be one of the most costly health problems. Therapy of chronic illness on the threshold of adult life requires, in addition to a comprehensive medical approach, the patient's active participation in the implementation of the treatment process. Therefore, the potential of young people entering adult life with the burden of diagnosed disease may indicate the direction of education of the chronically ill adolescents. Aim. The aim of this study was to assess the potential of young people, both healthy and diagnosed with a chronic disease, to overcome difficulties of life. Material and methods. The study used a questionnaire and KompOs scale (Personal Competence Scale), a standardized test in the field of Health Psychology. The study included 80 subjects aged 15-18 years, 40 patients with inflammatory bowel disease treated in the IP-CZD in Warsaw and 40 healthy students from Rzeszow. The study used a questionnaire and KompOs scale (Personal Competence Scale), a standardized test in the field of Health Psychology. It allows the evaluation of such features in subjects such as strength and endurance needed to take action and then to continue it. Results. For young people despite of their health state the age of majority is mainly associated with a sense of autonomy, pursuing the job and the sense of responsibility for themselves and their families, without arousing fear in any of those groups. Parents of adolescents with IBD, however, still show too excessive protectiveness, and only 32.5% of children has a different view on that in comparison with 82.5% a group of healthy children. The sum of the results obtained on a scale KompOs, in both studied groups is at the same level of average values, (6 sten). The differences can be seen in correlation with sociodemographic characteristics such as: place of residence, financial situation or fertility families. Youth without chronic disease burden had the average level of self-efficacy (sten 6), whereas young patients diagnosed with IBD had a higher sense of efficacy (sten 7). Children with IBD, residing in large cities, have a higher average number of points in both the overall scale and subscales KompOs like (strength, endurance) than their healthy peers. Conclusions. Young people with non-specific inflammatory bowel disease have a greater sense of strength and perseverance than their peers. The statistical significance between the number of points was obtained in the KompOs scale in the city of <100 thousand. The financial situation of families is different in both groups, especially in the persistence subscale.

7

Contribution of the -173 G/C Polymorphism of Macrophage Migration Inhibitory Factor Gene to the Risk of Inflammatory Bowel Diseases

100%

Przybyłowska K. , Mrowicki J. , Sygut A. , Narbutt P. , Dziki Ł. , Dziki A. , Majsterek I.

Polish Journal of Surgery

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2011

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tom 83

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nr 2

76-80

EN

Inflammatory bowel disease (IBD) represents a heterogeneous group of chronic disorders characterized by inflammation of gastrointestinal tract, typically with a relapsing and remitting clinical course of unknown etiology. Presumably, IBD develops with response exogenous environmental factors only in persons with genetic predisposition. This predisposition was suggested to be associated with polymorphism and mutations in genes encoding proinflammatory immune system proteins. Enhanced production of macrophage migration inhibitory factor (MIF) was found in patients with inflammatory bowel disease (IBD) and mice with experimental colitis. These results suggest that MIF plays a critical role in etiology of the colitis.The aim of the study was determine whether the MIF -173 G/C gene polymorphism is associated with the susceptibility to inflammatory bowel disease (IBD).Material and methods. A total of 99 IBD patients, including 58 patients with ulcerative colitis (UC) and 41 with Crohn's disease (CD) and 436 healthy controls recruited from the Polish population, were genotyped for MIF polymorphisms. Genotyping of MIF gene polymorphism was performed by a RFLP-PCR.Results. We found an increased risk of UC for the C allele of the MIF-173 G/C polymorphism. The distribution of the genotypes was not significantly different in the CD group compared with the controls.Conclusions. We demonstrated that the C allele is associated with an increased risk for development of UC. This suggests that the G/C polymorphism in the MIF gene promoter may be a potential risk factor for UC in Polish population.

8

Ultrasound findings in extragenital endometriosis

88%

Dong Y. , Braden B. , Klinger C. , Ripolles T. , Dietrich C. F.

Journal of Ultrasonography

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2018

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tom 18

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nr 74

247-254

EN

We present a report on ultrasound findings in extragenital endometriosis and a literature review accompanied by illustrations. Intestinal endometriosis should be considered in female patients of reproductive age who present with constipation, gastrointestinal bleeding, nausea, vomiting, cramp-like abdominal pain, diarrhoea and pelvic pain. Although definitive preoperative diagnosis of endometriosis is difficult, clinical suspicion and appropriate imaging might prevent extensive surgical procedures with higher morbidity. Contrast-enhanced ultrasound is an efficient non-invasive imaging method without any radiation exposure that supports the early diagnosis of intestinal endometriosis and may help assess the vascularization of endometriotic lesions within the distinct layers of the intestinal wall.

PL

Autorzy przedstawiają sprawozdanie dotyczące badań ultrasonograficznych przeprowadzonych u pacjentek z endometriozą zlokalizowaną poza narządami rozrodczymi wraz z przeglądem piśmiennictwa poparte przykładami klinicznymi. U pacjentek w wieku rozrodczym, u których występują zaparcia, krwawienie z przewodu pokarmowego, nudności, wymioty, bolesne skurcze brzucha, biegunka i ból w obrębie miednicy mniejszej należy rozważyć endometriozę jelitową. Choć postawienie ostacznego rozpoznania przedoperacyjnego jest trudne, wysunięcie klinicznego podejrzenia oraz odpowiednie badania obrazowe mogą pozwolić na uniknięcie rozległego zabiegu chirurgicznego obarczonego wyższą częstością powikłań. Badanie ultrasonograficzne z użyciem środka kontrastującego to skuteczna i nieinwazyjna metoda obrazowania, która nie wiąże się z narażeniem pacjentki na promieniowanie oraz która może zasugerować wczesne rozpoznanie endometriozy jelitowej i pomóc w ocenie unaczynienia zmian endometrialnych w obrębie poszczególnych warstw ściany jelita.

9

Mesenchymal stem cells for the treatment of complex perianal fistulas in patients with Crohn disease

88%

Borycka-Kiciak K. , Pietrzak A. , Kielar M. , Tarnowski W.

Polish Journal of Surgery

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2020

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tom 92(1)

38-47

EN

Treatment of perianal fistulizing Crohn’s disease is demanding and burdened with a high percentage of failures, which forces clinicians to search for new, more effective therapeutic options. One of these options is the use of adipose-derived mesenchymal stem cells in local administration. Due to their multipotentiality and complex mechanism of action, stem cells are the promising new therapeutic approach for the treatment-refractory complex perianal fistulas – demonstrating both high efficacy and a favorable safety profile. The paper presents current knowledge on the mechanisms of action and manner of administration of mesenchymal stem cells, as well as the effectiveness and safety of their use in the treatment of perianal Crohn’s disease based on available literature.

10

Results of home parenteral nutrition in patients with severe inflammatory bowel disease – an alternative for surgery of malnourished patients

88%

Turkot M. , Sobocki J.

Polish Journal of Surgery

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2017

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tom 89(5)

23-28

EN

Introduction: In the world, the inflammatory bowel disease affects an increasing number of younger and younger patients, and in some of them parenteral nutrition is an alternative to high-risk surgical intervention due to advancement of the disease and malnutrition. Aim: The aim of the study was to assess the results of home parenteral nutrition in patients with severe bowel inflammatory disease, in whom surgical treatment is associated with high risk of complications. Materials and methods: A retrospective analysis was conducted on 46 patients, who received home parenteral nutrition instead of another surgical intervention. The inclusion criteria included home parenteral nutrition and diagnosis of Crohn’s disease or ulcerative colitis. Results: Mean number of complications requiring hospital admission per patient was 1.76, the BMI increased by 4.3 on average [kg/m2]. During parenteral nutrition, the percentage of patients, in whom anti-inflammatory or immunosuppressant drugs were completely discontinued, was 17.4%. In the whole group, at least one immunosuppressive drug was discontinued in onefifth of patients. Mean albumin level increased by 2.4 g/L, lymphocyte count dropped by 474 lymphocytes/mm3, and leukocyte count increased by 747.6/mm3. The patients described their condition as good in 87%, and 7.4% of patients were able to work. Conclusions: Home parenteral nutrition positively affects patient’s general condition by increasing BMI and normalizing biochemical test results. The results indicate the need to consider this method as an alternative to surgical intervention in severe bowel inflammatory disease with high perioperative risk, which could reduce the complication rate.

11

Samodzielność i samokontrola młodzieży z Nieswoistym Zapaleniem Jelit w związku z koniecznością zmiany gastroenterologa po osiągnięciu pełnoletności

75%

Wardak K. , Celińska-Cedro D. , Nagórska M.

Medical Review

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2016

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nr 1

16-26

PL

Wstęp. Nieswoiste Zapalenie Jelit plasuje się w grupie pięciu najczęściej występujących chorób przewodu pokarmowego i jest najczęstszą przewlekłą chorobą przewodu pokarmowego u dzieci. Dzieci z uwagi na wczesny okres rozpoznania będą chorowały najdłużej i najciężej, ale mają możliwość prowadzenia życia zbliżonego do ich zdrowych rówieśników. Celem podjętych badań było poznanie stopnia samokontroli dorastającej młodzieży z NZJ w związku z koniecznością przejścia pod opiekę poradni gastroenterologicznych dla osób dorosłych po 18 roku życia. Materiał i metody. Badanie przeprowadzono wśród młodzieży od 15 do 18 roku życia ze zdiagnozowanym NZJ, pacjentów Poradni Gastroenterologicznych w Warszawie i Rzeszowie. Wyniki. Rozpoznanie wrzodziejącego zapalenie jelita grubego podało 50,67% dzieci, natomiast chorobę Leśniowskiego- Crohna, 42,67% . Średni wiek zachorowania wśród dzieci wynosił ok. 12,13 ±3,82. Ponad połowa respondentów ocenia zakres posiadanych informacji o jednostce chorobowej za raczej wystarczający. W ogólnej populacji badanej młodzieży znacząca większość potrafi samodzielnie formułować swoje obserwacje i wątpliwości dotyczące terapii. Ponad 90% chorych objętych badaniami deklaruje znajomość nazw oraz dawek przyjmowanych leków, jednak u 1/5 regularność ich stosowania nadal nadzorują rodzice. Podczas wizyt u specjalisty wszystkim respondentom towarzyszą rodzice. Ponad połowa badanych w razie potrzeby nie potrafiłaby samodzielnie skontaktować się ze specjalistą. Tematyka zachowań ryzykownych (palenie, picie, narkotyki) oraz współżycia seksualnego nie jest podejmowana podczas wizyt. Wnioski. 1. Młodzież zna istotę choroby, jednakże tylko w małym zakresie jest włączana w proces samodzielnej kontroli. 2. W poradniach gastroenterologicznych dla dzieci tematyka pozamedyczna, jak: styl życia, płodność, rozwój zawodowy nie jest podejmowana.

EN

Inflammatory bowel disease (IBD) is among five most frequent gastrointestinal diseases and is the most common chronic disease of the gastrointestinal tract in children. Although children due to the early diagnosis will suffer the longest and the most acute, they may lead a life similar to their healthy peers. The aim of the study was to investigate the degree of selfcontrol in adolescents with IBD in connection with the necessity of the transition to the care of gastroenterology clinic for adults at the age of 18. Material and methods. The survey was conducted among young people aged 15 to 18 diagnosed with IBD, the patients of Gastroenterological Clinics in Warsaw and Rzeszow. Results. Ulcerative colitis was diagnosed in 50.67% of the children while Crohn’s disease was found in 42.67%. The average age of the onset was approx. 12.13 ± 3.82 among the children. More than a half of the respondents assessed the range of possessed information about the disease entity as rather sufficient. Vast majority of young people in the overall study population could formulate their observations and concerns regarding the treatment independently. Over 90% of patients in the study declared knowing the names and doses of medicines, however, in one fifth of the subjects the regularity of their administration was still supervised by parents. All respondents were accompanied by parents during a visit at a specialist. More than a half of the respondents would not be able to contact a specialist alone if necessary. The subject of hazardous behaviour (smoking, drinking, drugs) and sexual intercourse was not discussed during the visits. Conclusions. 1. Adolescents knew the essence of the disease, but were engaged in the process of self-control only to a limited extend. 2. Nonmedical issues like lifestyle, fertility, professional development were not discussed in the gastroenterological clinics for children.

12

Działania opiekuńcze i terapeutyczne pielęgniarki w opiece nad dzieckiem z chorobą Leśniowskiego-Crohna w okresie jej zaostrzenia

63%

Szklarczyk K.

Innowacje w Pielęgniarstwie i Naukach o Zdrowiu

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2021

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tom 6

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nr 4

89-108

EN

Introduction. Crohn’s disease is an inflammatory bowel disease of unknown etiology. It is most often diagnosed in children and adolescents. The symptoms characteristic of the disease include abdominal pain, passing diarrheal stools, often with the presence of pathological admixtures: blood, pus or mucus and weight loss. The basic step in the therapeutic process is the intravenous or oral rehydration of the child, pharmacotherapy and nutritional treatment. The aim of the implemented therapy is to keep the patient in remission that lasts as long as possible. The aim. The aim of the work is to show the care and therapeutic problems of a child with exacerbation of Crohn’s disease in hospital conditions and the nursing staff towards the patient. Case presentation. A 15-year-old patient on the second day of hospitalization was admitted to the ward with suspected exacerbation of Crohn’s disease. The patient reports numerous diarrhea (from 10 to 15 bowel movements a day) and abdominal pain. On admission, the patient’s body temperature was 38.4°C. The girl and her parents show a lack of knowledge about the disease and what to do in case of exacerbation. Conclusion. A very important aspect in the treatment of Crohn’s disease in the described patient is compliance with dietary recommendations and systematic use of prescribed pharmacological agents. It is not possible to cure the disease completely, but the measures taken to combat the disease allow for long remission and reduce the risk of its serious complications.

PL

Wstęp. Choroba Leśniowskiego-Crohna jest chorobą zapalną jelit o nieznanej etiologii. Rozpoznana zostaje najczęściej u dzieci oraz nastolatków. Do objawów charakterystycznych dla choroby należą bóle brzucha, oddawanie biegunkowych stolców często z obecnością patologicznych domieszek: krwi, ropy czy śluzu, a także ubytek masy ciała. Podstawowym krokiem w procesie terapeutycznym jest nawodnienie dziecka drogą dożylną lub doustną, włączenie farmakoterapii oraz leczenia żywieniowego. Celem wdrożonej terapii jest utrzymanie pacjenta w jak najdłużej trwającej remisji. Cel. Praca ma na celu ukazać problemy opiekuńcze oraz terapeutyczne u dziecka z zaostrzeniem choroby Leśniowskiego-Crohna w warunkach szpitalnych oraz zadania personelu pielęgniarskiego wobec tego pacjenta. Prezentacja przypadku. Pacjentka lat 15 w drugiej dobie hospitalizacji przyjęta w oddział z podejrzeniem zaostrzenia choroby Leśniowskiego-Crohna. Pacjentka zgłasza liczne biegunki (od 10 do 15 wypróżnień na dobę) oraz ból brzucha. Przy przyjęciu temperatura ciała pacjentki wynosiła 38,4°C. Dziewczyna oraz jej rodzice wykazują deficyt wiedzy na temat choroby oraz postępowania w przypadku jej zaostrzenia. Wnioski. Bardzo ważnym aspektem w leczeniu choroby Leśniowskiego-Crohna u opisanej pacjentki jest stosowanie się do zaleceń żywieniowych oraz systematyczne przyjmowanie zleconych środków farmakologicznych. Całkowite wyleczenie choroby nie jest możliwe, lecz podjęte działania w walce z chorobą pozwalają na uzyskanie długiej remisji i zmniejszenie ryzyka wystąpienia jej poważnych powikłań.