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Tumoral Calcinosis 1. กก 2. ก 3. กกก ก ก .. ก ก .. .. ก .. ก .. ก ก 9 2 ก 10310 0-2716-6524, 0-2716-6661-4 9002 0-2716-6525 E-mail [email protected] ก 15/125 ก ก ก 10240 ก iii CalcinOsis in RhEumatic DisEasEs 42 EndOthElin REcEptOr AntagOnists in SystEmic RhEumatic DisEasE 59 ก 2551 ก CalcinOsis in RhEumatic DisEasEs .. ก EndOthElin REcEptOr AntagOnists in SystEmic RhEumatic DisEasE .. ก กกกก ก กกกกก ก ก Calcinosis in Rheumatic Diseases ก * ** ก *** **** CalcinOsis ก ก กก ก (systEmic sclerOsis, SSc) กก (dErmatOmyOsitis/pOlymyOsitis, DM/PM) (systEmic lupus ErythEmatOsus, SLE) กกก กก ก กก ก ก ก ก กกก กกกก1 กกกก ก กกกกกก ก กก กก กก ก กกก กก ก ก CalcinOsis 2 กก (pathOlOgical calcificatiOn) กกกกกก ก กก ก ก กก ก ก 2 ก *.. กก กก **.. ก กก กก ***.. ก กก กก ****.. กก กก ก mEtastatic calcificatiOn calcinOsis กก กก dystrOphic calcificatiOn ก กกกก ก 3 กก soft tissue calcifications กกกก ก 4-11 ก ก (idiopathic) กกก (mEtabOlic disOrdEr) กกก ก - 1975 GrEEnfEld GB. 4 ก 3 ก ก mEtastatic calcification, gEnEralizEd calcinOsis idiopathic tumOral calcinOsis - 1985 Black Kanat 5 3 ก ก mEtastatic calcificatiOn, dystrOphic calcification calcinOsis - 1999 MarzanO 6 4 ก ก dystrOphic calcificatiOn, idiOpathic calcification, tumOral calcinOsis mEtastatic calcification - 2002 WilmEr 7 กก 1 ก ก calciphylaxis - 2005 BOulman 1 5 ก ก mEtastatic calcificatiOn, dystrOphic calcification, tumOral calcinOsis, idiOpathic calcificatiOn calciphylaxis Metastatic calcification MEtastatic calcificatiOn กก ก ก/กก ก 5 ก กก ก 1 1. mEtastatic calcification 3 Metastatic calcification • HypErphOsphatEmia statEs ChrOnic rEnal failurE, hypOparathyriodism, psEudOhypOparathyrOidism • HypErcalcEmia statEs Primary hypErparathyrOidism, hypErvitaminOsis D, Milk-alkali syndrOmE, nEOplasm, sarcOidOsis ก/ก กก ก phOsphatE bindEr กก vEry low calcium dialysatE Tumoral calcinosis TumOral calcinOsis กก ก ก กก กก8 ( 1) 1. TumOral calcinOsis กกก TumOral calcinOsis ก ก กก กก กก กก กก 12 ก tumOral calcinOsis mEtastatic calcification กก กก ก ก ก ก ก ก กก alkalinE phOsphatasE (ALP) ก ก ก 13 ก กกก กกก กก กกก กกก กกก ก กก กกกก ก 14 Idiopathic calcification Idiopathic calcificatiOn กก กก ก กก 3-11 ก กก15 กกก 2 กก กก (calcified swEat gland harmatOma) 16 idiOpathic calcification ก 4 ก 17 ก - SubEpidErmal calcifiEd nOdulE - Idiopathic calcification Of scrOtum - PrOgrEssivE OssEOus hEtErOplasia - Milia-likE idiopathic calcinOsis cutis in DOwn syndrOmE Calciphylaxis Calciphylaxis กก (mEdia) กกก (EndOthElium) กก 7 (violacEOus plaguE) ก sEcOndary hypErparathyrOidism ก กก ( 2) Dystrophic calcification DystrOphic calcificatiOn กก กก ก ก ก 2 กก ก ก calcinOsis circumscripta ก ก calcinOsis univEralis 17 กก 2 dystrOphic calcificatiOn ก 2. Calciphylaxis ก 2. dystrOphic calcificatiOn 3 Dystrophic calcification • Primary cOnnEctivE tissuE disEasEs SclerOdErma (diffusE Or limitEd fOrm), dErmatOmyOsitis, pOlymyOsitis, Ehlers-DanlOs syndrOmE, psEudOxanthOma Elasticum • MEtabOlic disEasEs GOut, diabEtEs mEllitus, alkaptOnuria (OchrOnOsis), pOrphyria cutanEa tada, psEudOpsEudOhypOparathyrOidism, WErnErs syndrOmE, prOgEria, myOsitis Ossificans prOgrEssiva • ParasitE infEstatiOn • NEurOlogic injury / paralytic para -articular calcification ก dystrophic calcification กกกก ก กกกกกก กกก กกกก กกกก กกกกกกกก กก (chOndrOcalcinOsis) กกก กก ก inOrganic pyrOphOsphatE-gEnErating EctOEnzymE PC- 1/nuclEOtidE pyrOphOsphatasE phOsphOdiEstErasE 1 pyrOphOsphatE ก กกก กกกก ก18 กกกกก ก กกกกก ก , , ก กก กกก กกกก กกกกกกก 17 กกกกกก calcinOsis cutis ALP ก กกกกก กก SSc calcinOsis cutis ก กกกกก ก 19 กก gamma carbOxyglutamic acid (GCGA) calcium binding aminO acid (CBAA) vitamin K ก กกกก 20-23 กกก ก กกกกก ก CBAA ก GCGA 24-29 กกกกก DM macrOphagE, intErleukin (IL)-6, IL-1β tumOr nEcrOtic factOr (TNF)-α กก IL-1β, IL-1 rEcEptOr antagOnist, sOlublE TNF-α, sOluble IL-2 rEcEptOr IL- 10 mOnOcytE, macrOphagE B cEll กกก DM 30 Chronic tissue inflammation hypovascularity Structeral defect Age related hypoxemia Macrophage activity changes Tissue damage Increased Increased Decreased renal P Muscle CBAA/GCAA Increased influx alteration apoptosis of Ca into cell clearance Calcinosis 1. ก dystrOphic calcinOsis (ก BOulman N. SEmin Arthritis RhEum. 2005;34:805-12) กกก Systemic sclerosis (SSc) ก calcinOsis ก diffusE SSc limitEd SSc (CREST syndrOmE) กกก 25 31 กกก ( 3) ก กก , , ก กกกก กก (calcinOsis circumscripta) ก calcinOsis 10-12 10 กกก ก กก กกก32 กก กกก33 กกก tumOral calcinOsis 34 กกก calcinOsis univErsalis 35 3. CalcinOsis cutis (dystrOphic calcification) กกก SSc กกก กก กกก กกก (radiculopathy) 36 ก CREST ก (cOnstrictivE pEricarditis) 37 Polymyositis and dermatomyositis (DM/PM) CalcinOsis DM/PM ก 38-41 44-70 กก 20 42 กกก กก 40 ก, ก ก กกกกก ก, , ก ก calcinOsis 2-3 กก 40 ก 4 กก ก 12 กก 43-45 กก 40 ก กก กกก กกก กก กก กกก กก ExOskElEtOn กกกกก ก กกกก ก ก ก 41 Systemic lupus erythematosus (SLE) CalcinOsis SLE ก SSc DM/PM ก ก 46-48 ก กก ก ก 48-51 Okada 52 calcinOsis ก 17 SLE กก SLE ก 53 Myositis (fibrodysplasia) ossifican progressiva ก ก (autOsOmal dOminant trait with irrEgular pEnEtrancE) กก กก (OssificatiOn) กก ก ก ก (micrOdactyly) ก กก กกกกกกก ก กกก กกก กก กกก กก ก กกกกกกกกก กก กกก กก (rEstrictivE pulmOnary disEasE) 54 กกก กกกกกกกกกกกก ( 4) กก calcinosis ก กกก calcinOsis กกกกก กก ก warfarin, cOlchicinE, prObEnEcid, bisphOsphOnatE, diltiazEm, minOcyclinE, aluinium hydrOxidE salicylatE กกกก CO 2 lasEr ก ก กกก กกกก 4. MyOsitis (fibrOdysplasia) Ossifican prOgrEssivE ก ก Tissue damage Increased Increased Decreased renal P Muscle CBAA/GCAA Increased influx alteration apoptosis of Ca into cell clearance Colchicine, Probenecid, Bisphosphonate aluminium hydroxide Warfarin, CO laser, salicylate Diltiazem, 2 Minocycline, excision Bisphosphonate Calcinosis 2. กกก calcinOsis (ก BOulman N. SEmin Arthritis RhEum.
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