{"id":189023,"date":"2023-02-18T07:57:42","date_gmt":"2023-02-18T06:57:42","guid":{"rendered":"https:\/\/sdk.mk\/?p=189023"},"modified":"2023-02-18T07:57:42","modified_gmt":"2023-02-18T06:57:42","slug":"ju-njoftojme-me-semundjet-e-rralla-artriti-reumatoid-i-te-miturve","status":"publish","type":"post","link":"https:\/\/sdk.mk\/index.php\/maqedonia\/ju-njoftojme-me-semundjet-e-rralla-artriti-reumatoid-i-te-miturve\/","title":{"rendered":"JU NJOFTOJM\u00cb ME S\u00cbMUNDJET E RRALLA: ARTRITI REUMATOID I T\u00cb MITURVE"},"content":{"rendered":"<div class=\"f52428582a4b906b2d2e2a7d733c7d27\" data-index=\"7\" style=\"float: none; margin:10px 0 10px 0; text-align:center;\">\n<!-- MSP Ads Asynchronous JS Tag - Generated with Revive Adserver v5.4.1 -->\r\n<ins data-revive-zoneid=\"167\" data-revive-id=\"060fdb01f6430ec164d3519234aa4967\"><\/ins>\r\n<script async src=\"\/\/panel.ads.com.mk\/www\/delivery\/asyncjs.php\"><\/script>\n<\/div>\n<p lang=\"mk-MK\"><em><strong><span style=\"font-size: medium;\">Artriti reumatoid (idiopatik) i t\u00eb miturve<\/span><\/strong><\/em><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">ICD M08.0 M08.1 M08.2 M08.3 M08.4 M08.8 M08.9<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Prevalenca 1-5\/10.000<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Artriti idiopatik i t\u00eb miturve (JIA) \u00ebsht\u00eb s\u00ebmundja reumatike m\u00eb e zakonshme tek f\u00ebmij\u00ebt dhe nj\u00eb nga s\u00ebmundjet kronike m\u00eb t\u00eb zakonshme q\u00eb shkakton paaft\u00ebsi afatshkurt\u00ebr ose afatgjat\u00eb. Vet\u00eb emri p\u00ebrcakton karakteristikat themelore t\u00eb k\u00ebsaj s\u00ebmundjeje, q\u00eb \u00ebsht\u00eb inflamacioni i nj\u00eb ose m\u00eb shum\u00eb nyjeve me etiologji t\u00eb panjohur, i cili shfaqet para mosh\u00ebs 16 vje\u00e7 dhe zgjat t\u00eb pakt\u00ebn 6 jav\u00eb. Ndodh rrall\u00eb para muajit t\u00eb gjasht\u00eb t\u00eb jet\u00ebs, dhe m\u00eb s\u00eb shpeshti shfaqet n\u00eb mosh\u00ebn parashkollore midis vitit t\u00eb par\u00eb dhe t\u00eb tret\u00eb t\u00eb jet\u00ebs.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">P\u00ebr her\u00eb t\u00eb par\u00eb s\u00ebmundja u p\u00ebrshkrua n\u00eb vitin 1896 nga pediatri britanik Sir George Frederick Steele i cili paraqiti 22 raste kryesisht nga Spitali i F\u00ebmij\u00ebve, Great Ormond Street me zgjerim kronik elastik fusiform t\u00eb ky\u00e7eve, splenomegali (zgjerim i shpretk\u00ebs) dhe zmadhim. t\u00eb gj\u00ebndrave n\u00eb lindje.me titull \u201cNj\u00eb form\u00eb e s\u00ebmundjes kronike t\u00eb ky\u00e7eve tek f\u00ebmij\u00ebt\u201d.<\/span><\/p>\n<p lang=\"mk-MK\"><strong><span style=\"font-size: medium;\">Zhvillimi i s\u00ebmundjes:<\/span><\/strong><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Disa faktor\u00eb gjenetik\u00eb dhe s\u00ebmundjet m\u00eb t\u00eb zakonshme virale infektive t\u00eb m\u00ebparshme e predispozojn\u00eb f\u00ebmij\u00ebn t\u00eb zhvilloj\u00eb artrit.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Besohet se baza e artritit tek f\u00ebmij\u00ebt ose e artritit idiopatik t\u00eb t\u00eb miturve (JIA) \u00ebsht\u00eb nj\u00eb mekaniz\u00ebm autoimun, por deri m\u00eb tani jo t\u00eb gjitha proceset patofiziologjike jan\u00eb vendosur plot\u00ebsisht, d.m.th. Shkaqet q\u00eb \u00e7ojn\u00eb n\u00eb s\u00ebmundje. Nuk ka dyshim se b\u00ebhet fjal\u00eb p\u00ebr aktivizimin e sistemit imunitar t\u00eb pacientit n\u00eb at\u00eb m\u00ebnyr\u00eb q\u00eb indet e tyre t\u00eb fillojn\u00eb t\u00eb njihen si t\u00eb huaja, gj\u00eb q\u00eb n\u00eb fund t\u00eb fundit \u00e7on n\u00eb inflamacion dhe d\u00ebmtim t\u00eb tyre.<\/span><\/p>\n<p lang=\"mk-MK\"><strong><span style=\"font-size: medium;\">Pamja klinike:<\/span><\/strong><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Nj\u00eb ky\u00e7 i p\u00ebrflakur \u00ebsht\u00eb i dhimbsh\u00ebm dhe i fryr\u00eb dhe shpesh v\u00ebrehet skuqje e l\u00ebkur\u00ebs mbi nyje. K\u00ebto \u00e7rregullime shoq\u00ebrohen me l\u00ebvizje t\u00eb kufizuar t\u00eb ky\u00e7eve dhe f\u00ebmij\u00ebt shmangin p\u00ebrdorimin e gjymtyr\u00ebs s\u00eb prekur p\u00ebr shkak t\u00eb dhimbjes, shpesh duke \u00e7aluar ose duke refuzuar t\u00eb ecin. N\u00eb m\u00ebngjes pas zgjimit pas nj\u00eb pushimi t\u00eb nat\u00ebs ose pas nj\u00eb pushimi t\u00eb gjat\u00eb, simptomat jan\u00eb m\u00eb t\u00eb theksuara.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Artriti mund t\u00eb zhvillohet gradualisht ose papritur dhe t\u00eb prek\u00eb nj\u00eb ose m\u00eb shum\u00eb nyje. N\u00eb fillim t\u00eb s\u00ebmundjes, t\u00eb ashtuquajturat nyje t\u00eb m\u00ebdha t\u00eb ekstremiteteve (gju, b\u00ebrryl, ky\u00e7et dhe ky\u00e7et e duarve) dhe shpesh \u00ebsht\u00eb simetrik n\u00eb shp\u00ebrndarje. N\u00eb rrjedh\u00ebn e m\u00ebvonshme t\u00eb s\u00ebmundjes, inflamacioni mund t\u00eb p\u00ebrfshij\u00eb edhe nyje m\u00eb t\u00eb vogla (nyjet e gishtave, gishtit t\u00eb madh).<\/span><\/p>\n<p lang=\"mk-MK\"><strong><span style=\"font-size: medium;\">Prevalenca dhe diagnoza:<\/span><\/strong><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Mosha tipike e shfaqjes s\u00eb simptomave t\u00eb para \u00ebsht\u00eb periudha parashkollore midis vitit t\u00eb par\u00eb dhe t\u00eb tret\u00eb t\u00eb jet\u00ebs, dy her\u00eb m\u00eb e zakonshme tek vajzat.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Artriti tek f\u00ebmij\u00ebt \u00ebsht\u00eb nj\u00eb s\u00ebmundje relativisht e zakonshme, por nuk \u00ebsht\u00eb v\u00ebrtetuar nj\u00eb incidenc\u00eb e qart\u00eb. Incidenca e vler\u00ebsuar \u00ebsht\u00eb midis 5-20 pacient\u00eb p\u00ebr 100,000 f\u00ebmij\u00eb. Mosha tipike e shfaqjes s\u00eb simptomave t\u00eb para \u00ebsht\u00eb periudha parashkollore midis vitit t\u00eb par\u00eb dhe t\u00eb tret\u00eb t\u00eb jet\u00ebs, dy her\u00eb m\u00eb e zakonshme tek vajzat.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Diagnoza vendoset kryesisht n\u00eb baz\u00eb t\u00eb pasqyr\u00ebs klinike dhe koh\u00ebzgjatjes (minimumi 6 jav\u00eb) t\u00eb shenjave dhe simptomave t\u00eb s\u00ebmundjes. Gjetjet laboratorike (num\u00ebrimi i gjakut, reaktant\u00ebt inflamator\u00eb: proteina C-reaktive, sedimentimi) jan\u00eb zakonisht normale ose vet\u00ebm pak mbi vler\u00ebn e referenc\u00ebs p\u00ebr mosh\u00ebn e f\u00ebmij\u00ebs dhe p\u00ebr k\u00ebt\u00eb arsye nuk jan\u00eb vendimtare n\u00eb diagnoz\u00ebn, por ndihmojn\u00eb n\u00eb monitorimin e p\u00ebrparimit t\u00eb s\u00ebmundjes dhe p\u00ebrgjigjen ndaj trajtimit.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Testet imunologjike \u2013 faktori reumatoid (RF) dhe antitrupat antinuklear (ANA) zbulojn\u00eb ekzistenc\u00ebn e antitrupave dhe pozitiviteti i tyre ndihmon n\u00eb klasifikimin dhe prognoz\u00ebn e artritit idiopatik juvenil. Pacient\u00ebt me ANA-artrit pozitiv kan\u00eb nj\u00eb rrezik m\u00eb t\u00eb lart\u00eb t\u00eb zhvillimit t\u00eb iridociklitit kronik (inflamacion i irisit t\u00eb syrit).<\/span><\/p>\n<p lang=\"mk-MK\"><strong><span style=\"font-size: medium;\">Format e s\u00ebmundjes \/ Artriti idiopatik i t\u00eb miturve ndahet n\u00eb disa n\u00ebntipe:<\/span><\/strong><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">1. Forma oligoartikulare &#8211; \u00ebsht\u00eb m\u00eb e shpeshta nga t\u00eb gjitha format e artritit tek f\u00ebmij\u00ebt, n\u00eb 6 muajt e par\u00eb t\u00eb s\u00ebmundjes preken maksimumi kat\u00ebr ky\u00e7e. Zakonisht shfaqet deri n\u00eb mosh\u00ebn 6 vje\u00e7are dhe \u00ebsht\u00eb m\u00eb e zakonshme tek vajzat. Ecuria e s\u00ebmundjes \u00ebsht\u00eb e ndryshueshme, prognoza \u00ebsht\u00eb e mir\u00eb n\u00ebse poliartriti nuk zhvillohet.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">2. Forma poliartikulare &#8211; prek rreth nj\u00eb t\u00eb kat\u00ebrt\u00ebn e pacient\u00ebve, karakterizohet me inflamacion t\u00eb pes\u00eb ose m\u00eb shum\u00eb ky\u00e7eve n\u00eb 6 muajt e par\u00eb dhe n\u00eb baz\u00eb t\u00eb RF-s\u00eb e ndajm\u00eb n\u00eb dy n\u00ebntipe: RF-negative dhe RF-pozitive. E dyta \u00ebsht\u00eb nj\u00eb form\u00eb mjaft e rrall\u00eb e artritit, e cila prek m\u00eb s\u00eb shumti vajzat mbi 10 vje\u00e7 me inflamacion t\u00eb ky\u00e7eve t\u00eb vogla t\u00eb gjymtyr\u00ebve dhe me prognoz\u00eb m\u00eb t\u00eb keqe.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">3. Forma sistemike (s\u00ebmundja e Stilit) &#8211; p\u00ebrve\u00e7 sistemit lokomotor preken edhe sistemet e tjera t\u00eb organeve. Ajo prek si djemt\u00eb ashtu edhe vajzat e \u00e7do moshe. Karakterizohet nga ethe, nj\u00eb skuqje e vog\u00ebl roz\u00eb zakonisht gjat\u00eb nat\u00ebs, zmadhimi i shpretk\u00ebs dhe m\u00ebl\u00e7is\u00eb, zmadhimi i nyjeve limfatike, inflamacioni i mushk\u00ebrive (pleurit) ose i zemr\u00ebs (perikardit). Shenjat e prekjes s\u00eb ky\u00e7eve zakonisht shfaqen t\u00eb fundit, por mund t\u00eb shfaqen edhe n\u00eb fillim t\u00eb s\u00ebmundjes.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">4. Artriti psoriatik &#8211; te artriti ka ndryshime t\u00eb l\u00ebkur\u00ebs karakteristike p\u00ebr psoriasis: vatra n\u00eb b\u00ebrryla dhe gjunj\u00eb n\u00eb form\u00eb t\u00eb depozitave me luspa t\u00eb kuqe.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">5. Enteziti i shoq\u00ebruar me artrit &#8211; kjo form\u00eb karakterizohet me artrit t\u00eb ky\u00e7eve t\u00eb m\u00ebdha t\u00eb gjymtyr\u00ebve t\u00eb poshtme, i shoq\u00ebruar me inflamacion t\u00eb ngjitjeve t\u00eb tendinit n\u00eb kock\u00eb. Shumica e pacient\u00ebve jan\u00eb pozitiv\u00eb p\u00ebr markerin e qelizave HLA B27. M\u00eb s\u00eb shumti prek djemt\u00eb pas mosh\u00ebs 6 vje\u00e7are. Ecuria e s\u00ebmundjes \u00ebsht\u00eb e ndryshueshme; nga zgjidhja e plot\u00eb e shqet\u00ebsimit deri n\u00eb p\u00ebrparimin e nyjeve t\u00eb vogla t\u00eb shtyll\u00ebs kurrizore, legenit dhe nyjeve sakroiliake.<\/span><\/p>\n<p lang=\"mk-MK\"><strong><span style=\"font-size: medium;\">Qasja terapeutike:<\/span><\/strong><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Administrimi intra-artikular i kortikosteroideve \u00ebsht\u00eb treguar jasht\u00ebzakonisht efektiv n\u00eb trajtimin e artritit tek f\u00ebmij\u00ebt, me nj\u00eb p\u00ebrthithje sistematike t\u00eb pap\u00ebrfillshme t\u00eb barit.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Q\u00ebllimi i trajtimit \u00ebsht\u00eb t\u00eb shtyp\u00eb dhimbjen, t\u00eb ndaloj\u00eb inflamacionin p\u00ebr t\u00eb parandaluar d\u00ebmtimin e p\u00ebrhersh\u00ebm t\u00eb ky\u00e7eve, humbjen e funksionit dhe paaft\u00ebsin\u00eb dhe arritjen e nj\u00eb faljeje t\u00eb q\u00ebndrueshme t\u00eb s\u00ebmundjes.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Duke qen\u00eb se kjo \u00ebsht\u00eb nj\u00eb s\u00ebmundje kronike me ecuri dhe rezultat t\u00eb paparashikuesh\u00ebm, edukimi i prind\u00ebrve dhe mb\u00ebshtetja psikologjike si p\u00ebr pacient\u00ebt ashtu edhe p\u00ebr an\u00ebtar\u00ebt e ngusht\u00eb t\u00eb familjes \u00ebsht\u00eb shum\u00eb i r\u00ebnd\u00ebsish\u00ebm. Pas futjes s\u00eb terapis\u00eb biologjike n\u00eb algoritmet e trajtimit pediatrik, numri i pacient\u00ebve me d\u00ebmtim t\u00eb p\u00ebrhersh\u00ebm funksional dhe ndryshime t\u00eb dukshme radiografike n\u00eb ky\u00e7e \u00ebsht\u00eb shum\u00eb i vog\u00ebl.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Qasja farmakologjike p\u00ebr trajtimin e JIA p\u00ebrb\u00ebhet nga disa hapa. N\u00eb radh\u00eb t\u00eb par\u00eb jan\u00eb antiinflamator\u00ebt josteroid\u00eb (NSAIDs), t\u00eb cil\u00ebt jan\u00eb linja e par\u00eb e terapis\u00eb dhe gjithashtu pjes\u00eb e pothuajse \u00e7do plani trajtimi. Ata kan\u00eb nj\u00eb efekt analgjezik dhe anti-inflamator. Nj\u00eb efekt an\u00ebsor i k\u00ebsaj terapie mund t\u00eb jet\u00eb acarimi i mukoz\u00ebs s\u00eb stomakut deri n\u00eb zhvillimin e gastritit dhe gjakderdhjes. Por f\u00ebmij\u00ebt n\u00eb p\u00ebrgjith\u00ebsi e tolerojn\u00eb mir\u00eb trajtimin me k\u00ebt\u00eb grup barnash. Inhibitor\u00ebt e pomp\u00ebs protonike mund t\u00eb shtohen sipas nevoj\u00ebs p\u00ebr t\u00eb parandaluar gastritin.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Ila\u00e7et antireumatike modifikuese t\u00eb s\u00ebmundjes (DMARDs) kan\u00eb nj\u00eb efekt anti-inflamator pas p\u00ebrdorimit afatgjat\u00eb. P\u00ebrfaq\u00ebsues tipik\u00eb t\u00eb k\u00ebtij grupi jan\u00eb metotreksati dhe sulfasalazina. Metotreksati administrohet m\u00eb s\u00eb shpeshti n\u00eb m\u00ebnyr\u00eb subkutane me administrim javor. Me futjen e terapis\u00eb, \u00ebsht\u00eb e nevojshme t\u00eb kontrollohen vlerat e transaminazave hepatike n\u00eb m\u00ebnyr\u00eb q\u00eb t\u00eb parandalohet menj\u00ebher\u00eb zhvillimi i mundsh\u00ebm i hepatitit toksik. Rekomandohet futja e acidit folik me metotreksat p\u00ebr t\u00eb minimizuar rrezikun e efekteve an\u00ebsore.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Kortikosteroidet jan\u00eb ila\u00e7e shum\u00eb t\u00eb fuqishme anti-inflamatore, por p\u00ebrdorimi i tyre sistematik i zgjatur shoq\u00ebrohet me nj\u00eb s\u00ebr\u00eb efektesh an\u00ebsore. Administrimi intra-artikular (administrimi i p\u00ebrbashk\u00ebt) \u00ebsht\u00eb treguar t\u00eb jet\u00eb jasht\u00ebzakonisht efektiv me absorbimin e ul\u00ebt sistemik t\u00eb barit.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Biologjik\u00ebt jan\u00eb p\u00ebrdorur gjithnj\u00eb e m\u00eb shum\u00eb n\u00eb trajtimin e s\u00ebmundjeve reumatizmale gjat\u00eb dhjet\u00eb viteve t\u00eb fundit, duke p\u00ebrfshir\u00eb edhe popullat\u00ebn pediatrike. Futja e tyre n\u00eb algoritmet terapeutike uli ndjesh\u00ebm numrin e pacient\u00ebve me d\u00ebmtim t\u00eb r\u00ebnd\u00eb funksional. Parimi i veprimit t\u00eb tyre, ndryshe nga grupet terapeutike t\u00eb p\u00ebrmendura m\u00eb par\u00eb, \u00ebsht\u00eb specifik dhe i drejtuar kund\u00ebr molekulave specifike ose sh\u00ebnuesve t\u00eb qelizave. Terapia p\u00ebrgjith\u00ebsisht tolerohet mir\u00eb, ve\u00e7an\u00ebrisht gjat\u00eb viteve t\u00eb para t\u00eb trajtimit.<\/span><\/p>\n<p lang=\"mk-MK\"><strong><span style=\"font-size: medium;\">Prognoza:<\/span><\/strong><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Disa forma t\u00eb artritit tek f\u00ebmij\u00ebt tregojn\u00eb nj\u00eb tendenc\u00eb m\u00eb t\u00eb madhe p\u00ebr zhvillimin e komplikimeve okulistike, prandaj rekomandohen ekzaminime t\u00eb rregullta nga okulist\u00eb edhe gjat\u00eb periudh\u00ebs s\u00eb s\u00ebmundjes pa artrit aktiv.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Koh\u00ebzgjatja e trajtimit nuk \u00ebsht\u00eb e p\u00ebrcaktuar qart\u00eb, sepse s\u00ebmundja ka nj\u00eb ecuri t\u00eb paparashikueshme n\u00eb t\u00eb cil\u00ebn periudhat e faljes dhe acarimeve mund t\u00eb alternohen. Nd\u00ebrprerja e plot\u00eb e trajtimit zakonisht mund t\u00eb konsiderohet vet\u00ebm pasi shenjat e artritit t\u00eb jen\u00eb zhdukur p\u00ebr nj\u00eb minimum prej 6-12 muajsh.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Disa forma t\u00eb artritit tek f\u00ebmij\u00ebt tregojn\u00eb nj\u00eb tendenc\u00eb m\u00eb t\u00eb madhe p\u00ebr zhvillimin e komplikimeve okulistike, prandaj rekomandohen ekzaminime t\u00eb rregullta nga okulist\u00eb edhe gjat\u00eb periudh\u00ebs s\u00eb s\u00ebmundjes pa artrit aktiv. Rezultati i artritit idiopatik juvenil \u00ebsht\u00eb i mir\u00eb n\u00eb terma afatgjat\u00eb, vler\u00ebsohet se rreth 40% e pacient\u00ebve nuk k\u00ebrkojn\u00eb trajtim aktiv pas 8-10 vjet\u00ebsh. Forma poliartikulare RF-pozitive e artritit tek f\u00ebmij\u00ebt shpesh ka nj\u00eb ecuri progresive.<\/span><\/p>\n<p lang=\"mk-MK\"><span style=\"font-size: medium;\">Duke qen\u00eb se \u00ebsht\u00eb s\u00ebmundje kronike, bashk\u00ebpunimi i mir\u00eb nd\u00ebrmjet imunolog\u00ebve\/reumatolog\u00ebve dhe prind\u00ebrve, edukimi i mir\u00eb dhe disponueshm\u00ebria e terapis\u00eb jan\u00eb jasht\u00ebzakonisht t\u00eb r\u00ebnd\u00ebsishme. F\u00ebmij\u00ebs duhet t&#8217;i lejohet frekuentimi i rregullt i shkoll\u00ebs, aktiviteti fizik adekuat dhe nj\u00eb f\u00ebmij\u00ebri me sa m\u00eb pak kufizime t\u00eb jet\u00eb e mundur.<\/span><\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Artriti reumatoid (idiopatik) i t\u00eb miturve ICD M08.0 M08.1 M08.2 M08.3 M08.4 M08.8 M08.9 Prevalenca 1-5\/10.000 Artriti idiopatik i t\u00eb [&hellip;]<\/p>\n","protected":false},"author":22,"featured_media":189024,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_mo_disable_npp":"no","inline_featured_image":false},"categories":[3087],"tags":[],"imageURL":"https:\/\/sdk.mk\/wp-content\/uploads\/2023\/02\/18-Juvenile-idiopathic-arthritis-1-650x366.png","thumbURL":"https:\/\/sdk.mk\/wp-content\/uploads\/2023\/02\/18-Juvenile-idiopathic-arthritis-1-250x141.png","categoryNames":["Maqedonia"],"feature_caption":"","subtitle":"","views":"735","source":"\u0421\u043a\u043e\u043f\u0458\u0435, (\u0421\u0410\u041a\u0410\u041c\u0414\u0410\u041a\u0410\u0416\u0410\u041c.\u041c\u041a)","yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v15.0 - 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