Non-alcoholic fatty liver disease(NAFLD)is the most common and emerging form of chronic liver disease worldwide.It includes a wide spectrum of liver diseases ranging from simple fatty liver to steatohepatitis,which ma...Non-alcoholic fatty liver disease(NAFLD)is the most common and emerging form of chronic liver disease worldwide.It includes a wide spectrum of liver diseases ranging from simple fatty liver to steatohepatitis,which may progress to cirrhosis,liver cancer,and liver mortality.Common metabolic diseases,which are well established cardiovascular risk factors,have been associated to NAFLD and cardiovascular disease is the single most important cause of morbidity and mortality in this patient population.The pathogenesis of NAFLD appears multifactorial and many mechanisms have been proposed as possible causes of fatty liver infiltration.Management of fatty liver has become a major challenge to healthcare systems as the consequence of the increasing rates of obesity worldwide.First-line management focuses on lifestyle modifications.Moderate weight reduction either by dietary restriction or by increased habitual physical activity is safe and highly recommended.Several therapeutic interventions have been proposed.These include insulin sensitizer agents,lipid lowering drugs,antioxidants such as vitamin E and supplementation of vitamin D3.However,therapeutic strategies have been largely empirical so far,and experimental trials have mostly been carried out in uncontrolled settings with small sample sizes.Metabolic conditions such as diabetes mellitus,obesity,hypertension and hyperlipidemia,should be strongly considered and a multidisciplinary approach should be personalized for individual patients.Treatment of co-morbidities should be regarded as of paramount importance in the management of these patients.The purpose of this review is to examine different approaches for the clinical management of non-alcoholic fatty liver disease.展开更多
Nowadays it is worldwide accepted that early diagnosis and early treatment of Rheumatoid Arthritis (RA) can improve the prognosis in most of patients. In this way, the 2010 ACR/EULAR Rheumatoid Arthritis classificatio...Nowadays it is worldwide accepted that early diagnosis and early treatment of Rheumatoid Arthritis (RA) can improve the prognosis in most of patients. In this way, the 2010 ACR/EULAR Rheumatoid Arthritis classification criteria have shown to be more sensitive than the ACR 1987 criteria and include better patients with early RA. Other important point to focus on is to identify predictive factors for outcome, in order to propose a more aggressive treatment for early RA patients who could develop a persistent and/or erosive disease. The presence of Rheumatoid Factors (RF) and Anti- citrullinated peptides antibobies (ACPA), as well as the duration of the disease at the time of diagnosis, are independent risk factors for the development of erosive RA. As for imaging, both traditional X-ray and Magnetic Resonance Imaging (MRI) highlight respectively the Rapid Radiological Progression (RRP) and the presence of bone edema which are associated to a more aggressive disease. In the last years, the musculoskeletal ultrasonography (MSUS) has emerged as a useful imaging technique since it allows to identify synovitis and bone alteration earlier than the radiological examination. Interating clinical, serological and imaging data the clinician can define the effective disease activity of each patient.展开更多
文摘Non-alcoholic fatty liver disease(NAFLD)is the most common and emerging form of chronic liver disease worldwide.It includes a wide spectrum of liver diseases ranging from simple fatty liver to steatohepatitis,which may progress to cirrhosis,liver cancer,and liver mortality.Common metabolic diseases,which are well established cardiovascular risk factors,have been associated to NAFLD and cardiovascular disease is the single most important cause of morbidity and mortality in this patient population.The pathogenesis of NAFLD appears multifactorial and many mechanisms have been proposed as possible causes of fatty liver infiltration.Management of fatty liver has become a major challenge to healthcare systems as the consequence of the increasing rates of obesity worldwide.First-line management focuses on lifestyle modifications.Moderate weight reduction either by dietary restriction or by increased habitual physical activity is safe and highly recommended.Several therapeutic interventions have been proposed.These include insulin sensitizer agents,lipid lowering drugs,antioxidants such as vitamin E and supplementation of vitamin D3.However,therapeutic strategies have been largely empirical so far,and experimental trials have mostly been carried out in uncontrolled settings with small sample sizes.Metabolic conditions such as diabetes mellitus,obesity,hypertension and hyperlipidemia,should be strongly considered and a multidisciplinary approach should be personalized for individual patients.Treatment of co-morbidities should be regarded as of paramount importance in the management of these patients.The purpose of this review is to examine different approaches for the clinical management of non-alcoholic fatty liver disease.
文摘Nowadays it is worldwide accepted that early diagnosis and early treatment of Rheumatoid Arthritis (RA) can improve the prognosis in most of patients. In this way, the 2010 ACR/EULAR Rheumatoid Arthritis classification criteria have shown to be more sensitive than the ACR 1987 criteria and include better patients with early RA. Other important point to focus on is to identify predictive factors for outcome, in order to propose a more aggressive treatment for early RA patients who could develop a persistent and/or erosive disease. The presence of Rheumatoid Factors (RF) and Anti- citrullinated peptides antibobies (ACPA), as well as the duration of the disease at the time of diagnosis, are independent risk factors for the development of erosive RA. As for imaging, both traditional X-ray and Magnetic Resonance Imaging (MRI) highlight respectively the Rapid Radiological Progression (RRP) and the presence of bone edema which are associated to a more aggressive disease. In the last years, the musculoskeletal ultrasonography (MSUS) has emerged as a useful imaging technique since it allows to identify synovitis and bone alteration earlier than the radiological examination. Interating clinical, serological and imaging data the clinician can define the effective disease activity of each patient.
