{"id":29236,"date":"2017-10-06T16:42:24","date_gmt":"2017-10-06T14:42:24","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=29236"},"modified":"2017-10-06T16:42:24","modified_gmt":"2017-10-06T14:42:24","slug":"vcasna-diagnoza-revmatoidni-artritidy-muze-vyrazne-zmirnit-priznaky-nemoci-nebo-vest-az-k-remisi-onemocneni","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=29236","title":{"rendered":"V\u010dasn\u00e1 diagn\u00f3za revmatoidn\u00ed artritidy m\u016f\u017ee v\u00fdrazn\u011b zm\u00edrnit p\u0159\u00edznaky nemoci nebo v\u00e9st a\u017e k remisi onemocn\u011bn\u00ed"},"content":{"rendered":"

V Evrop\u011b postihuj\u00ed revmatick\u00e1 onemocn\u011bn\u00ed v\u00edce ne\u017e 120 mili\u00f3n\u016f lid\u00ed \u2013 v\u00edce lid\u00ed ne\u017e kter\u00e1koli jin\u00e1 skupina onemocn\u011bn\u00ed. Revmatick\u00e1 onemocn\u011bn\u00ed se proto \u0159ad\u00ed na prvn\u00ed p\u0159\u00ed\u010dky d\u016fvod\u016f pracovn\u00ed neschopnosti.<\/strong>
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\nJejich p\u0159\u00ed\u010dinou mohou b\u00fdt metabolick\u00e9 \u010di hormon\u00e1ln\u00ed zm\u011bny v organismu, degenerativn\u00ed procesy nebo genetick\u00e9 abnormality. \u010cast\u00fdm typem revmatick\u00fdch onemocn\u011bn\u00ed jsou i z\u00e1n\u011btliv\u00e1 onemocn\u011bn\u00ed: nap\u0159\u00edklad revmatoidn\u00ed artritida, psoriatick\u00e1 artritida nebo Becht\u011brevova choroba.<\/p>\n

Prvn\u00edm krokem pro \u0159e\u0161en\u00ed jak\u00e9koli nemoci je schopnost rozpozn\u00e1n\u00ed symptom\u016f. \u201eNej\u010dast\u011bji se m\u016f\u017ee revmatick\u00e9 onemocn\u011bn\u00ed hl\u00e1sit bolest\u00ed a otokem alespo\u0148 jednoho kloubu, v\u00fdraznou rann\u00ed ztuhlost\u00ed kloub\u016f a zv\u00fd\u0161enou \u00fanavou. V p\u0159\u00edpad\u011b podez\u0159en\u00ed na revmatick\u00e9 onemocn\u011bn\u00ed odes\u00edl\u00e1 praktick\u00fd l\u00e9ka\u0159 pacienta k revmatologovi. V\u010dasn\u00e1 diagn\u00f3za revmatick\u00e9ho onemocn\u011bn\u00ed a v\u010dasn\u00e9 nasazen\u00ed \u00fa\u010dinn\u00e9 l\u00e9\u010dby jsou z\u00e1sadn\u00ed pro zabr\u00e1n\u011bn\u00ed postupn\u00e9 destrukci kloub\u016f a omezen\u00ed hybnosti kloub\u016f,\u201c \u0159\u00edk\u00e1 MUDr. Hana Cifersk\u00e1, Ph.D., Revmatologick\u00e1 klinika, 1. l\u00e9ka\u0159sk\u00e1 fakulta, Univerzita Karlova a Revmatologick\u00fd \u00fastav.<\/p>\n

V obecn\u00e9m pov\u011bdom\u00ed jsou revmatick\u00e1 onemocn\u011bn\u00ed spojov\u00e1na s vy\u0161\u0161\u00edm v\u011bkem. Ve skute\u010dnosti v\u0161ak postihuj\u00ed v\u0161echny v\u011bkov\u00e9 kategorie, v\u00fdjimkou nejsou ani d\u011bti. Pokud nejsou revmatick\u00e1 onemocn\u011bn\u00ed spr\u00e1vn\u011b l\u00e9\u010dena, m\u016f\u017ee doj\u00edt k ohro\u017een\u00ed kvality \u017eivota, omezen\u00ed fyzick\u00fdch schopnost\u00ed a znemo\u017en\u011bn\u00ed ka\u017edodenn\u00edch aktivit pacient\u016f, jako ch\u016fze, ch\u016fze do schod\u016f, osobn\u00ed hygiena nebo schopnost pracovat.<\/p>\n

Revmatoidn\u00ed artritida<\/p>\n

Nej\u010dast\u011bj\u0161\u00ed ze skupiny revmatick\u00fdch z\u00e1n\u011btliv\u00fdch onemocn\u011bn\u00ed je revmatoidn\u00ed artritida. T\u00edmto chronick\u00fdm onemocn\u011bn\u00edm trp\u00ed p\u0159ibli\u017en\u011b 0,5-1 % obyvatel, v \u010cesk\u00e9 republice tedy p\u0159ibli\u017en\u011b a\u017e 85 000 osob. Ro\u010dn\u011b p\u0159ib\u00fdv\u00e1 zhruba 4 000 nov\u00fdch pacient\u016f. Revmatoidn\u00ed artritida zna\u010dn\u011b sni\u017euje funk\u010dn\u00ed schopnosti a kvalitu \u017eivota a zkracuje \u017eivot nemocn\u00fdch v pr\u016fm\u011bru o 5-10 let.<\/p>\n

Spr\u00e1vn\u011b nasazen\u00e1 l\u00e9\u010dba a \u00faprava l\u00e9\u010debn\u00e9ho postupu podle aktu\u00e1ln\u00edho stavu pacienta je ozna\u010dov\u00e1na jako \u201el\u00e9\u010dba k c\u00edli\u201c. C\u00edlem je dostat onemocn\u011bn\u00ed do st\u00e1dia remise (vymizen\u00ed p\u0159\u00edznak\u016f) nebo alespo\u0148 n\u00edzk\u00e9 klinick\u00e9 aktivity, a to v co nejkrat\u0161\u00edm \u010dasov\u00e9m rozmez\u00ed. Pokud je adekv\u00e1tn\u00ed l\u00e9\u010dba zah\u00e1jena v pr\u016fb\u011bhu 12 t\u00fddn\u016f od objeven\u00ed p\u0159\u00edznak\u016f, \u0161ance na minimalizaci \u00farovn\u011b posti\u017een\u00ed kloubu, zm\u00edrn\u011bn\u00ed dlouhodob\u00e9ho pr\u016fb\u011bhu onemocn\u011bn\u00ed a \u0161ance na remisi se zna\u010dn\u011b zvy\u0161uj\u00ed.<\/p>\n

Biologick\u00e1 l\u00e9\u010dba<\/p>\n

Jedn\u00edm z p\u0159\u00edstup\u016f k l\u00e9\u010db\u011b revmatoidn\u00ed artritidy je biologick\u00e1 l\u00e9\u010dba. Biologick\u00e9 l\u00e9ky c\u00edlen\u011b ovliv\u0148uj\u00ed slo\u017eky imunitn\u00edho syst\u00e9mu, kter\u00e9 jsou zodpov\u011bdn\u00e9 za vznik a udr\u017eov\u00e1n\u00ed chronick\u00e9ho z\u00e1n\u011btu. Biologick\u00e1 l\u00e9\u010dba v posledn\u00edch letech v\u00fdrazn\u011b p\u0159isp\u011bla ke zlep\u0161en\u00ed v\u00fdsledk\u016f l\u00e9\u010dby a v\u00fdrazn\u011b zv\u00fd\u0161ila kvalitu \u017eivota mnoha lidem s revmatick\u00fdm onemocn\u011bn\u00edm.<\/p>\n

A\u010dkoli biologick\u00e9 l\u00e9ky prokazateln\u011b v\u00fdrazn\u011b zlep\u0161uj\u00ed l\u00e9\u010dbu autoimunitn\u00edch onemocn\u011bn\u00ed u vhodn\u00fdch pacient\u016f, jejich n\u00e1kladnost p\u0159edstavuje p\u0159ek\u00e1\u017eku jejich \u0161irok\u00e9mu uplatn\u011bn\u00ed. \u201eV \u010cR \u010din\u00ed n\u00e1klady na l\u00e9\u010dbu pacienta p\u0159ibli\u017en\u011b 200-300 000 K\u010d ro\u010dn\u011b. N\u00e1klady na biologickou l\u00e9\u010dbu je ale t\u0159eba vn\u00edmat v kontextu p\u0159\u00edm\u00fdch a nep\u0159\u00edm\u00fdch n\u00e1klad\u016f, tedy z perspektivy jak zdravotn\u00edho, tak soci\u00e1ln\u00edho syst\u00e9mu. P\u0159\u00edm\u00e9 \u00faspory vzniknou v p\u0159\u00edpad\u011b udr\u017een\u00ed pacienta d\u00e9le bez pot\u0159eby dal\u0161\u00ed zdravotn\u00ed p\u00e9\u010de (nap\u0159\u00edklad operac\u00ed, hospitalizac\u00ed), nep\u0159\u00edm\u00e9 \u00faspory vznikaj\u00ed v r\u00e1mci soci\u00e1ln\u00edho syst\u00e9mu t\u00edm, \u017ee udr\u017e\u00ed pacienta d\u00e9le pr\u00e1ceschopn\u00e9ho,\u201c vysv\u011btluje MUDr. Tom\u00e1\u0161 Dole\u017eal, Ph.D., Institut pro zdravotn\u00ed ekonomiku a technology assessment.<\/p>\n

\u010cesk\u00e1 revmatologick\u00e1 spole\u010dnost stejn\u011b jako evropsk\u00e1 EULAR doporu\u010duje l\u00e9\u010dit vhodn\u00e9 pacienty biologickou l\u00e9\u010dbou p\u0159i st\u0159edn\u00ed a vysok\u00e9 aktivit\u011b onemocn\u011bn\u00ed (DAS28 v\u011bt\u0161\u00edm ne\u017e 3,2), biologick\u00e1 l\u00e9\u010dba je ale v sou\u010dasnosti hrazena pouze pro pacienty s vysokou aktivitou onemocn\u011bn\u00ed, v nejt\u011b\u017e\u0161\u00edm stadiu onemocn\u011bn\u00ed. Tento rozpor mezi doporu\u010den\u00edmi odborn\u00edk\u016f a podm\u00ednkami \u00fahrady zp\u016fsobuje nedostate\u010dn\u00fd p\u0159\u00edstup k l\u00e9\u010db\u011b t\u011bm pacient\u016fm, kte\u0159\u00ed terapeuticky neprosp\u00edvaj\u00ed na l\u00e9\u010db\u011b syntetick\u00fdmi chorobu modifikuj\u00edc\u00edmi l\u00e9ky, av\u0161ak doposud nedos\u00e1hli nejt\u011b\u017e\u0161\u00edho stupn\u011b onemocn\u011bn\u00ed. \u201eTakov\u00ed pacienti bohu\u017eel mus\u00ed v podstat\u011b \u010dekat na zhor\u0161en\u00ed sv\u00e9ho onemocn\u011bn\u00ed, rovnaj\u00edc\u00ed se sk\u00f3re DAS 28 v\u011bt\u0161\u00edm ne\u017e 5,1. Tento p\u0159\u00edstup pova\u017euje Revma Liga \u010cR za zastaral\u00fd a neetick\u00fd v\u016f\u010di pacient\u016fm,\u201c \u0159\u00edk\u00e1 Edita M\u00fcllerov\u00e1, p\u0159edsedkyn\u011b spolku Revma Liga \u010cR.<\/p>\n

12. \u0159\u00edjna \u2013 Sv\u011btov\u00fd den artritidy<\/p>\n

K p\u0159\u00edle\u017eitosti Sv\u011btov\u00e9ho dne artritidy, kter\u00fd ka\u017edoro\u010dn\u011b p\u0159ipad\u00e1 na 12. \u0159\u00edjna, p\u0159ipravila Revma Liga \u010cR dal\u0161\u00ed pokra\u010dov\u00e1n\u00ed informa\u010dn\u00ed kampan\u011b pro ve\u0159ejnost s n\u00e1zvem Revma v\u00fdzva. Hlavn\u00ed tv\u00e1\u0159\u00ed kampan\u011b je op\u011bt herec Jakub \u017d\u00e1\u010dek, kter\u00fd vyzval kajak\u00e1\u0159e Ji\u0159\u00edho Prskavce a atletky Barboru a Kate\u0159inu Dvo\u0159\u00e1kovy, aby si obl\u00e9kli speci\u00e1ln\u00ed oblek a rukavice p\u0159ibli\u017euj\u00edc\u00ed pohybov\u00e9 omezen\u00ed revmatik\u016f. \u201eNa\u0161\u00ed snahou je zv\u00fd\u0161it pov\u011bdom\u00ed o tom, s jak\u00fdmi t\u011b\u017ekostmi se mus\u00ed pot\u00fdkat nemocn\u00ed s revmatoidn\u00ed artritidou a jak negativn\u011b nemoc zasahuje do jejich \u017eivota,\u201c objas\u0148uje Edita M\u00fcllerov\u00e1.<\/p>\n

Revmatoidn\u00ed artritida (RA)<\/p>\n

Revmatoidn\u00ed artritida je z\u00e1n\u011btliv\u00e9 onemocn\u011bn\u00ed kloub\u016f projevuj\u00edc\u00ed se bolestmi kloub\u016f a jejich otokem s nebezpe\u010d\u00edm pozd\u011bj\u0161\u00edho vzniku deformit. Revmatoidn\u00ed artritida pat\u0159\u00ed do skupiny autoimunitn\u00edch onemocn\u011bn\u00ed, jej\u00ed z\u00e1kladn\u00ed p\u0159\u00ed\u010dinou je naru\u0161en\u00fd imunitn\u00ed syst\u00e9m, kter\u00fd reaguje proti tk\u00e1n\u00edm vlastn\u00edho t\u011bla a po\u0161kozuje je tak, \u017ee v nich vyvol\u00e1v\u00e1 chronicky prob\u00edhaj\u00edc\u00ed z\u00e1n\u011bt. Revmatoidn\u00ed artritida \u010dlov\u011bka postupn\u011b omezuje v pohybu a br\u00e1n\u00ed mu vykon\u00e1vat b\u011b\u017en\u00e9 ka\u017edodenn\u00ed aktivity a \u017e\u00edt samostatn\u00fd a nez\u00e1visl\u00fd \u017eivot. P\u0159esto\u017ee pro revmatoidn\u00ed artritidu je nejtypi\u010dt\u011bj\u0161\u00ed onemocn\u011bn\u00ed kloub\u016f, m\u016f\u017ee nemoc postihnout tak\u00e9 kter\u00fdkoli jin\u00fd org\u00e1n v t\u011ble. Roz\u0161\u00ed\u0159en\u00ed onemocn\u011bn\u00ed se ud\u00e1v\u00e1 v rozmez\u00ed 0,5-1 % dosp\u011bl\u00e9 populace, v \u010cR lze tedy p\u0159edpokl\u00e1dat v\u00fdskyt 80 000 \u2013 90 000 nemocn\u00fdch. Nejv\u00edce (a\u017e 80 %) nemocn\u00fdch je mezi 35. a 50. rokem (35 000 \u2013 70 000 osob), tedy v produktivn\u00edm v\u011bku. Nemoc v\u0161ak postihuje v\u0161echny generace.<\/p>\n

P\u0159i diagnostice a dal\u0161\u00ed p\u00e9\u010di o pacienta l\u00e9ka\u0159 hodnot\u00ed pr\u016fb\u011bh a z\u00e1va\u017enost revmatoidn\u00ed artritidy dle r\u016fzn\u00fdch parametr\u016f. Pro stanoven\u00ed aktivity RA se ur\u010duje tzv. sk\u00f3re DAS 28 (z anglick\u00e9ho Disease Activity Score), kter\u00e9 se stanov\u00ed dle v\u00fdsledk\u016f krevn\u00edch test\u016f a posouzen\u00ed po\u010dtu otekl\u00fdch kloub\u016f \u2013 posuzuje se 28 kloub\u016f. Sk\u00f3re DAS 28 rozd\u011bluje aktivitu RA do 3 st\u00e1di\u00ed \u2013 n\u00edzk\u00e1 aktivita, st\u0159edn\u00ed aktivita, vysok\u00e1 aktivita (DAS 28 do 2,6 n\u00edzk\u00e1 aktivita onemocn\u011bn\u00ed; 3,2 \u2013 5,1 st\u0159edn\u00ed aktivita; nad 5,1 vysok\u00e1 aktivita). Vedle \u0161k\u00e1ly DAS 28 jsou pou\u017e\u00edvan\u00e9 i dal\u0161\u00ed \u0161k\u00e1ly (SDAI, CDAI).<\/p>\n

Ankylozuji\u0301ci\u0301 spondylitida (Becht\u011brevova choroba)<\/p>\n

Becht\u011brevova choroba je chronick\u00e9 z\u00e1n\u011btliv\u00e9 onemocn\u011bn\u00ed, kter\u00e9 postihuje p\u0159edev\u0161\u00edm p\u00e1te\u0159n\u00ed sklouben\u00ed a vazy. S postupuj\u00edc\u00edm onemocn\u011bn\u00edm vyr\u016fstaj\u00ed po obou stran\u00e1ch p\u00e1te\u0159e kostn\u00ed v\u00fdr\u016fstky, a jakmile tyto v\u00fdr\u016fstky spoj\u00ed dva obratle (p\u0159emost\u00ed je), dojde ke znehybn\u011bn\u00ed posti\u017een\u00e9ho \u00faseku p\u00e1te\u0159e. Vlivem postupn\u00e9ho tuhnut\u00ed p\u00e1te\u0159e je zna\u010dn\u011b omezen\u00e1 hybnost pacienta.<\/p>\n

Psoriatick\u00e1 artritida<\/p>\n

Psoriatick\u00e1 artritida se \u010dast\u011bji vyskytuje u pacient\u016f s t\u011b\u017ekou formou lup\u00e9nky. Vyzna\u010duje se sou\u010dasnou p\u0159\u00edtomnost\u00ed kloubn\u00edho z\u00e1n\u011btliv\u00e9ho onemocn\u011bn\u00ed a psori\u00e1zy (lup\u00e9nky). Posti\u017een\u00ed kloub\u016f v\u011bt\u0161inou p\u0159ich\u00e1z\u00ed pozd\u011bji, \u010dasto a\u017e po deseti letech trv\u00e1n\u00ed ko\u017en\u00edch projev\u016f. Kloubn\u00ed z\u00e1n\u011btliv\u00e9 projevy obvykle postihnou jen n\u011bkolik m\u00e1lo kloub\u016f, p\u0159ev\u00e1\u017en\u011b na doln\u00edch kon\u010detin\u00e1ch. Krom\u011b nich b\u00fdv\u00e1 posti\u017eena tak\u00e9 p\u00e1te\u0159, p\u0159edev\u0161\u00edm v k\u0159\u00ed\u017eov\u00e9 oblasti.<\/p>\n

Juveniln\u00ed idiopatick\u00e1 artritida (JIA)<\/p>\n

Juveniln\u00ed idiopatick\u00e1 artritida postihuje d\u011bti do \u0161estn\u00e1cti let. Trp\u00ed j\u00ed p\u0159ibli\u017en\u011b 30\u2013150 na 100 000 d\u011bt\u00ed. JIA je velmi agresivn\u00ed nemoc\u00ed, u n\u00ed\u017e doch\u00e1z\u00ed k po\u0161kozen\u00ed kloub\u016f. Z\u00e1rove\u0148 m\u016f\u017ee m\u00edt tato nemoc v\u00e1\u017en\u00fd dopad na r\u016fst a v\u00fdvoj kost\u00ed.<\/p>\n

Koncept l\u00e9\u010dby k c\u00edli<\/p>\n

L\u00e9\u010dba k c\u00edli je zalo\u017eena na strategii stanoven\u00ed c\u00edle (=dosa\u017een\u00ed remise nebo n\u00edzk\u00e9 klinick\u00e9 aktivity nemoci) a n\u00e1sledn\u00e9ho \u010dast\u00e9ho sledov\u00e1n\u00ed aktivity onemocn\u011bn\u00ed a hodnocen\u00ed efektivity l\u00e9\u010dby. Pro hodnocen\u00ed klinick\u00e9 aktivity onemocn\u011bn\u00ed se pou\u017e\u00edvaj\u00ed takzvan\u00e9 kompozitn\u00ed indexy, kter\u00e9 v\u011bt\u0161inou zahrnuj\u00ed po\u010det otekl\u00fdch nebo citliv\u00fdch kloub\u016f, CRP sedimentaci a glob\u00e1ln\u00ed hodnocen\u00ed pacientem. Nejpou\u017e\u00edvan\u011bj\u0161\u00ed index se jmenuje DAS 28.<\/p>\n

Remise<\/p>\n

Remise ozna\u010duje n\u00e1vrat ke stavu p\u0159ed vypuknut\u00edm nemoci, vymizen\u00ed p\u0159\u00edznak\u016f a projev\u016f nemoci.<\/p>\n

Biologick\u00e9 l\u00e9ky<\/p>\n

Biologick\u00e9 l\u00e9ky jsou vyr\u00e1b\u011bn\u00e9 z bun\u011bk \u017eiv\u00fdch organism\u016f. Jsou zac\u00edlen\u00e9 na imunitn\u00ed syst\u00e9m a blokuj\u00ed \u010dinnost ur\u010dit\u00fdch bun\u011bk, kter\u00e9 zp\u016fsobuj\u00ed z\u00e1n\u011bt. D\u00edky tomu jsou velmi \u00fa\u010dinn\u00e9. V p\u0159\u00edpad\u011b revmatoidn\u00ed artritidy je biologick\u00e1 l\u00e9\u010dba pou\u017e\u00edv\u00e1na, pokud onemocn\u011bn\u00ed vykazuje nedostate\u010dnou odezvu na st\u00e1vaj\u00edc\u00ed terapii, nebo v p\u0159\u00edpad\u011b t\u011b\u017e\u0161\u00edho pr\u016fb\u011bhu nemoci. Biologick\u00e1 l\u00e9\u010dba revmatoidn\u00ed artritidy je pr\u016flomov\u00e1, proto\u017ee umo\u017e\u0148uje n\u00e1vrat pacient\u016f do b\u011b\u017en\u00e9ho \u017eivota. Poskytuje jim \u0161anci, kterou by je\u0161t\u011b p\u0159ed n\u011bkolika lety nem\u011bli. Dokud nebyly biologick\u00e9 l\u00e9ky k dispozici, pova\u017eovalo se za \u00fasp\u011bch, kdy\u017e se poda\u0159ilo chorobu zpomalit, kdy\u017e se poda\u0159ilo zredukovat po\u010det kloub\u016f, kde b\u011b\u017eel z\u00e1n\u011btliv\u00fd proces, t\u0159eba na polovinu. Dnes se pova\u017euje za \u00fasp\u011bch, kdy\u017e se choroba zastav\u00ed, kdy\u017e z\u00e1n\u011btliv\u00fd proces neprob\u00edh\u00e1 ani v jednom kloubu. To je mo\u017en\u00e9 jen d\u00edky biologick\u00e9 l\u00e9\u010db\u011b.<\/p>\n

Revma Liga \u010cR<\/p>\n

Revma Liga \u010cR je spole\u010dnost lid\u00ed s revmatismem, jejich rodinn\u00fdch p\u0159\u00edslu\u0161n\u00edk\u016f a p\u0159\u00e1tel. C\u00edlem spole\u010dnosti je zvy\u0161ov\u00e1n\u00ed pov\u011bdom\u00ed o revmatick\u00fdch chorob\u00e1ch. \u010clenov\u00e9 Revma Ligy \u010cR bojuj\u00ed za plnohodnotn\u00fd a rovnopr\u00e1vn\u00fd \u017eivot zdravotn\u011b posti\u017een\u00fdch a vytv\u00e1\u0159ej\u00ed pro n\u011b region\u00e1ln\u00ed kluby po cel\u00e9 \u010cesk\u00e9 republice. Revma Liga \u010cR spolupracuje s mezin\u00e1rodn\u00edmi organizacemi stejn\u00e9ho zam\u011b\u0159en\u00ed v zahrani\u010d\u00ed a jej\u00ed \u010dinnost podporuj\u00ed l\u00e9ka\u0159i a zdravotn\u00edci.<\/p>\n

Radka Lej\u010dkov\u00e1
\nTiskov\u00e1 zpr\u00e1va<\/p>\n","protected":false},"excerpt":{"rendered":"

V Evrop\u011b postihuj\u00ed revmatick\u00e1 onemocn\u011bn\u00ed v\u00edce ne\u017e 120 mili\u00f3n\u016f lid\u00ed \u2013 v\u00edce lid\u00ed ne\u017e kter\u00e1koli jin\u00e1 skupina onemocn\u011bn\u00ed. Revmatick\u00e1 onemocn\u011bn\u00ed se proto \u0159ad\u00ed na prvn\u00ed […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":5408,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,9],"tags":[],"class_list":["post-29236","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravi","category-zpravy"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/29236","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=29236"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/29236\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/5408"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=29236"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=29236"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=29236"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}