{"id":450,"date":"2025-03-15T20:39:55","date_gmt":"2025-03-15T20:39:55","guid":{"rendered":"https:\/\/rheumanext.pl\/?page_id=450"},"modified":"2026-03-15T00:41:11","modified_gmt":"2026-03-15T00:41:11","slug":"leki-innowacyjne-inhibitory-kinaz-janusowych-jak-tofacytynib-barycytynib-upadacytynib-filgotynib","status":"publish","type":"page","link":"https:\/\/rheumanext.pl\/pl\/leki-innowacyjne-inhibitory-kinaz-janusowych-jak-tofacytynib-barycytynib-upadacytynib-filgotynib\/","title":{"rendered":"Leki innowacyjne (inhibitory kinaz janusowych\/JAK: Tofacytynib, Barycytynib, Upadacytynib, Filgotynib)"},"content":{"rendered":"\n<section id=\"rx-jak-monitoring-calculator\" style=\"max-width:960px;margin:0 auto;font:16px\/1.55 Inter,ui-sans-serif,system-ui,-apple-system,BlinkMacSystemFont,'Segoe UI',sans-serif;color:#0f172a;\">\n  <div style=\"background:linear-gradient(180deg,#ffffff 0%,#fbfdff 100%);border:1px solid #e2e8f0;border-radius:24px;box-shadow:0 12px 30px rgba(15,23,42,.06);overflow:hidden;\">\n    <div style=\"padding:28px 28px 20px;border-bottom:1px solid #e2e8f0;background:radial-gradient(circle at top right, rgba(15,118,110,.08), transparent 32%), linear-gradient(180deg,#ffffff 0%,#f8fafc 100%);\">\n      <div style=\"display:inline-block;padding:6px 12px;border-radius:999px;background:rgba(15,118,110,.10);color:#0f766e;font-size:12px;font-weight:700;letter-spacing:.02em;text-transform:uppercase;margin-bottom:14px;\">Monitorowanie leczenia innowacyjnego<\/div>\n      <h2 style=\"margin:0 0 10px;font-size:clamp(24px,3vw,32px);line-height:1.15;letter-spacing:-.02em;\">Celowane leki innowacyjne (inhibitory kinaz janusowych \/ JAK) \u2014 Tofacytynib, Barycytynib, Upadacytynib, Filgotynib<\/h2>\n      <p style=\"margin:0;color:#475569;max-width:76ch;\">Interaktywny modu\u0142 do oceny bezpiecze\u0144stwa rozpocz\u0119cia lub kontynuacji leczenia inhibitorami JAK w reumatologii. Uwzgl\u0119dnia morfologi\u0119, nerki, w\u0105trob\u0119, lipidy, TB, HBV, infekcje, p\u00f3\u0142pasiec, ryzyko zakrzepowo-zatorowe i sercowo-naczyniowe.<\/p>\n    <\/div>\n\n    <div style=\"padding:28px;display:grid;gap:20px;\">\n\n      <div style=\"background:#fff;border:1px solid #e2e8f0;border-radius:20px;padding:20px;\">\n        <h3 style=\"margin:0 0 6px;font-size:18px;\">1. Etap terapii i lek<\/h3>\n        <p style=\"margin:0 0 16px;color:#475569;font-size:14px;\">Wybierz lek oraz moment oceny bezpiecze\u0144stwa.<\/p>\n\n        <div style=\"display:grid;grid-template-columns:repeat(2,minmax(0,1fr));gap:12px;margin-bottom:14px;\">\n          <div>\n            <label for=\"rx-jak-drug\" style=\"display:block;margin:0 0 8px;font-weight:700;\">Lek<\/label>\n            <select id=\"rx-jak-drug\" style=\"width:100%;box-sizing:border-box;padding:14px 16px;border:1px solid #cbd5e1;border-radius:14px;font:inherit;background:#fff;\">\n              <option value=\"tofacitinib\">Tofacytynib<\/option>\n              <option value=\"baricitinib\">Barycytynib<\/option>\n              <option value=\"upadacitinib\">Upadacytynib<\/option>\n              <option value=\"filgotinib\">Filgotynib<\/option>\n            <\/select>\n          <\/div>\n\n          <div>\n            <label for=\"rx-jak-lastreview\" style=\"display:block;margin:0 0 8px;font-weight:700;\">Ile dni min\u0119\u0142o od ostatniej kontroli \/ wizyty?<\/label>\n            <input id=\"rx-jak-lastreview\" type=\"number\" min=\"0\" max=\"365\" step=\"1\" value=\"30\" style=\"width:100%;box-sizing:border-box;padding:14px 16px;border:1px solid #cbd5e1;border-radius:14px;font:inherit;\">\n          <\/div>\n        <\/div>\n\n        <div style=\"display:grid;gap:12px;\">\n          <label style=\"display:flex;align-items:flex-start;gap:10px;padding:14px;border:1px solid #e2e8f0;border-radius:16px;background:#fff;cursor:pointer;\">\n            <input type=\"radio\" name=\"rx-jak-phase\" id=\"rx-jak-phase-start\" value=\"start\" checked style=\"margin-top:3px;accent-color:#0f766e;\">\n            <span><strong>Przed rozpocz\u0119ciem leczenia<\/strong><br><span style=\"color:#475569;font-size:13px;\">Najwa\u017cniejsze: TB, HBV, brak aktywnej infekcji, morfologia, nerki, w\u0105troba, ryzyko VTE\/MACE<\/span><\/span>\n          <\/label>\n\n          <label style=\"display:flex;align-items:flex-start;gap:10px;padding:14px;border:1px solid #e2e8f0;border-radius:16px;background:#fff;cursor:pointer;\">\n            <input type=\"radio\" name=\"rx-jak-phase\" id=\"rx-jak-phase-ongoing\" value=\"ongoing\" style=\"margin-top:3px;accent-color:#0f766e;\">\n            <span><strong>Kontynuacja leczenia \/ kolejna recepta<\/strong><br><span style=\"color:#475569;font-size:13px;\">Najwa\u017cniejsze: infekcje, HZ, morfologia, lipidy, VTE\/MACE, objawy w\u0105trobowe i zakrzepowe<\/span><\/span>\n          <\/label>\n        <\/div>\n      <\/div>\n\n      <div style=\"background:#fff;border:1px solid #e2e8f0;border-radius:20px;padding:20px;\">\n        <h3 style=\"margin:0 0 6px;font-size:18px;\">2. Wyniki bada\u0144 i screening<\/h3>\n        <p style=\"margin:0 0 16px;color:#475569;font-size:14px;\">Wpisz najbardziej aktualne wyniki.<\/p>\n\n        <div style=\"display:grid;grid-template-columns:repeat(2,minmax(0,1fr));gap:12px;\">\n          <div>\n            <label for=\"rx-jak-anc\" style=\"display:block;margin:0 0 8px;font-weight:700;\">ANC \/ neutrofile (\u00d710\u2079\/L)<\/label>\n            <input id=\"rx-jak-anc\" type=\"number\" min=\"0\" max=\"20\" step=\"0.1\" value=\"2.8\" style=\"width:100%;box-sizing:border-box;padding:14px 16px;border:1px solid #cbd5e1;border-radius:14px;font:inherit;\">\n          <\/div>\n\n          <div>\n            <label for=\"rx-jak-alc\" style=\"display:block;margin:0 0 8px;font-weight:700;\">ALC \/ limfocyty (\u00d710\u2079\/L)<\/label>\n            <input id=\"rx-jak-alc\" type=\"number\" min=\"0\" max=\"10\" step=\"0.1\" value=\"1.4\" style=\"width:100%;box-sizing:border-box;padding:14px 16px;border:1px solid #cbd5e1;border-radius:14px;font:inherit;\">\n          <\/div>\n\n          <div>\n            <label for=\"rx-jak-hb\" style=\"display:block;margin:0 0 8px;font-weight:700;\">Hemoglobina (g\/dL)<\/label>\n            <input id=\"rx-jak-hb\" type=\"number\" min=\"0\" max=\"20\" step=\"0.1\" value=\"13.2\" style=\"width:100%;box-sizing:border-box;padding:14px 16px;border:1px solid #cbd5e1;border-radius:14px;font:inherit;\">\n          <\/div>\n\n          <div>\n            <label for=\"rx-jak-egfr\" style=\"display:block;margin:0 0 8px;font-weight:700;\">eGFR (ml\/min\/1,73 m\u00b2)<\/label>\n            <input id=\"rx-jak-egfr\" type=\"number\" min=\"0\" max=\"150\" step=\"1\" value=\"90\" style=\"width:100%;box-sizing:border-box;padding:14px 16px;border:1px solid #cbd5e1;border-radius:14px;font:inherit;\">\n          <\/div>\n\n          <div>\n            <label for=\"rx-jak-altast\" style=\"display:block;margin:0 0 8px;font-weight:700;\">ALT \/ AST \u2014 wy\u017csza warto\u015b\u0107 (\u00d7 ULN)<\/label>\n            <input id=\"rx-jak-altast\" type=\"number\" min=\"0\" max=\"20\" step=\"0.1\" value=\"0.9\" style=\"width:100%;box-sizing:border-box;padding:14px 16px;border:1px solid #cbd5e1;border-radius:14px;font:inherit;\">\n          <\/div>\n\n          <div>\n            <label for=\"rx-jak-ldl\" style=\"display:block;margin:0 0 8px;font-weight:700;\">LDL (mg\/dL)<\/label>\n            <input id=\"rx-jak-ldl\" type=\"number\" min=\"0\" max=\"400\" step=\"1\" value=\"115\" style=\"width:100%;box-sizing:border-box;padding:14px 16px;border:1px solid #cbd5e1;border-radius:14px;font:inherit;\">\n          <\/div>\n\n          <div>\n            <label for=\"rx-jak-lastcbc\" style=\"display:block;margin:0 0 8px;font-weight:700;\">Ile dni min\u0119\u0142o od ostatniej morfologii?<\/label>\n            <input id=\"rx-jak-lastcbc\" type=\"number\" min=\"0\" max=\"365\" step=\"1\" value=\"30\" style=\"width:100%;box-sizing:border-box;padding:14px 16px;border:1px solid #cbd5e1;border-radius:14px;font:inherit;\">\n          <\/div>\n\n          <div>\n            <label for=\"rx-jak-lastlft\" style=\"display:block;margin:0 0 8px;font-weight:700;\">Ile dni min\u0119\u0142o od ostatnich ALT\/AST?<\/label>\n            <input id=\"rx-jak-lastlft\" type=\"number\" min=\"0\" max=\"365\" step=\"1\" value=\"30\" style=\"width:100%;box-sizing:border-box;padding:14px 16px;border:1px solid #cbd5e1;border-radius:14px;font:inherit;\">\n          <\/div>\n\n          <div>\n            <label for=\"rx-jak-lastlipids\" style=\"display:block;margin:0 0 8px;font-weight:700;\">Ile dni min\u0119\u0142o od ostatnich lipid\u00f3w?<\/label>\n            <input id=\"rx-jak-lastlipids\" type=\"number\" min=\"0\" max=\"365\" step=\"1\" value=\"60\" style=\"width:100%;box-sizing:border-box;padding:14px 16px;border:1px solid #cbd5e1;border-radius:14px;font:inherit;\">\n          <\/div>\n\n          <div>\n            <label for=\"rx-jak-tb\" style=\"display:block;margin:0 0 8px;font-weight:700;\">Gru\u017alica (TB) \u2014 screening<\/label>\n            <select id=\"rx-jak-tb\" style=\"width:100%;box-sizing:border-box;padding:14px 16px;border:1px solid #cbd5e1;border-radius:14px;font:inherit;background:#fff;\">\n              <option value=\"done-negative\">Wykonano \u2014 brak aktywnej \/ latentnej TB wymagaj\u0105cej odroczenia<\/option>\n              <option value=\"pending\">W trakcie \/ brak pe\u0142nego screeningu<\/option>\n              <option value=\"positive\">Dodatni \/ podejrzenie TB \/ wymaga dalszego post\u0119powania<\/option>\n            <\/select>\n          <\/div>\n\n          <div>\n            <label for=\"rx-jak-hbv\" style=\"display:block;margin:0 0 8px;font-weight:700;\">HBV \u2014 status<\/label>\n            <select id=\"rx-jak-hbv\" style=\"width:100%;box-sizing:border-box;padding:14px 16px;border:1px solid #cbd5e1;border-radius:14px;font:inherit;background:#fff;\">\n              <option value=\"done-low\">Status znany \u2014 brak niezaadresowanego problemu<\/option>\n              <option value=\"pending\">Status niepe\u0142ny \/ niejasny<\/option>\n              <option value=\"risk\">Ryzyko reaktywacji \/ dodatnia serologia \u2014 wymaga planu monitorowania<\/option>\n            <\/select>\n          <\/div>\n\n          <div style=\"grid-column:1\/-1;\">\n            <label for=\"rx-jak-vax\" style=\"display:block;margin:0 0 8px;font-weight:700;\">Szczepienia i plan immunizacji<\/label>\n            <select id=\"rx-jak-vax\" style=\"width:100%;box-sizing:border-box;padding:14px 16px;border:1px solid #cbd5e1;border-radius:14px;font:inherit;background:#fff;\">\n              <option value=\"up-to-date\">Plan szczepie\u0144 jest aktualny \/ om\u00f3wiony<\/option>\n              <option value=\"partial\">Cz\u0119\u015bciowo uzupe\u0142niony \/ wymaga doplanowania<\/option>\n              <option value=\"unknown\">Niezweryfikowany<\/option>\n            <\/select>\n          <\/div>\n        <\/div>\n      <\/div>\n\n      <div style=\"background:#fff;border:1px solid #e2e8f0;border-radius:20px;padding:20px;\">\n        <h3 style=\"margin:0 0 6px;font-size:18px;\">3. Czynniki ryzyka i czerwone flagi<\/h3>\n        <p style=\"margin:0 0 16px;color:#475569;font-size:14px;\">Zaznacz obecne objawy lub istotne obci\u0105\u017cenia.<\/p>\n\n        <div style=\"display:grid;grid-template-columns:repeat(2,minmax(0,1fr));gap:12px;\">\n          <label style=\"display:flex;align-items:flex-start;gap:10px;padding:14px;border:1px solid #e2e8f0;border-radius:16px;background:#fff;cursor:pointer;\">\n            <input type=\"checkbox\" id=\"rx-jak-livevax\" style=\"margin-top:3px;accent-color:#0f766e;\">\n            <span><strong>Planowana lub niedawno podana \u017cywa szczepionka<\/strong><\/span>\n          <\/label>\n\n          <label style=\"display:flex;align-items:flex-start;gap:10px;padding:14px;border:1px solid #e2e8f0;border-radius:16px;background:#fff;cursor:pointer;\">\n            <input type=\"checkbox\" id=\"rx-jak-infection\" style=\"margin-top:3px;accent-color:#0f766e;\">\n            <span><strong>Aktywna klinicznie istotna infekcja \/ gor\u0105czka<\/strong><\/span>\n          <\/label>\n\n          <label style=\"display:flex;align-items:flex-start;gap:10px;padding:14px;border:1px solid #e2e8f0;border-radius:16px;background:#fff;cursor:pointer;\">\n            <input type=\"checkbox\" id=\"rx-jak-tbexposure\" style=\"margin-top:3px;accent-color:#0f766e;\">\n            <span><strong>Ekspozycja na TB \/ objawy sugeruj\u0105ce TB<\/strong><\/span>\n          <\/label>\n\n          <label style=\"display:flex;align-items:flex-start;gap:10px;padding:14px;border:1px solid #e2e8f0;border-radius:16px;background:#fff;cursor:pointer;\">\n            <input type=\"checkbox\" id=\"rx-jak-zoster\" style=\"margin-top:3px;accent-color:#0f766e;\">\n            <span><strong>Aktywny lub \u015bwie\u017cy p\u00f3\u0142pasiec<\/strong><\/span>\n          <\/label>\n\n          <label style=\"display:flex;align-items:flex-start;gap:10px;padding:14px;border:1px solid #e2e8f0;border-radius:16px;background:#fff;cursor:pointer;\">\n            <input type=\"checkbox\" id=\"rx-jak-vte\" style=\"margin-top:3px;accent-color:#0f766e;\">\n            <span><strong>Przebyta VTE \/ aktualne objawy zakrzepicy lub zatorowo\u015bci<\/strong><\/span>\n          <\/label>\n\n          <label style=\"display:flex;align-items:flex-start;gap:10px;padding:14px;border:1px solid #e2e8f0;border-radius:16px;background:#fff;cursor:pointer;\">\n            <input type=\"checkbox\" id=\"rx-jak-mace\" style=\"margin-top:3px;accent-color:#0f766e;\">\n            <span><strong>Wysokie ryzyko sercowo-naczyniowe \/ przebyty MACE<\/strong><\/span>\n          <\/label>\n\n          <label style=\"display:flex;align-items:flex-start;gap:10px;padding:14px;border:1px solid #e2e8f0;border-radius:16px;background:#fff;cursor:pointer;\">\n            <input type=\"checkbox\" id=\"rx-jak-cancer\" style=\"margin-top:3px;accent-color:#0f766e;\">\n            <span><strong>Nowotw\u00f3r aktywny \/ \u015bwie\u017cy \/ istotny wywiad onkologiczny<\/strong><\/span>\n          <\/label>\n\n          <label style=\"display:flex;align-items:flex-start;gap:10px;padding:14px;border:1px solid #e2e8f0;border-radius:16px;background:#fff;cursor:pointer;\">\n            <input type=\"checkbox\" id=\"rx-jak-hepatic\" style=\"margin-top:3px;accent-color:#0f766e;\">\n            <span><strong>Objawy zaostrzenia choroby w\u0105troby \/ WZW<\/strong><\/span>\n          <\/label>\n\n          <label style=\"display:flex;align-items:flex-start;gap:10px;padding:14px;border:1px solid #e2e8f0;border-radius:16px;background:#fff;cursor:pointer;\">\n            <input type=\"checkbox\" id=\"rx-jak-pregnancy\" style=\"margin-top:3px;accent-color:#0f766e;\">\n            <span><strong>Ci\u0105\u017ca \/ planowanie ci\u0105\u017cy<\/strong><\/span>\n          <\/label>\n\n          <label style=\"display:flex;align-items:flex-start;gap:10px;padding:14px;border:1px solid #e2e8f0;border-radius:16px;background:#fff;cursor:pointer;\">\n            <input type=\"checkbox\" id=\"rx-jak-recurrentinf\" style=\"margin-top:3px;accent-color:#0f766e;\">\n            <span><strong>Wywiad nawracaj\u0105cych ci\u0119\u017ckich infekcji<\/strong><\/span>\n          <\/label>\n        <\/div>\n      <\/div>\n\n      <div style=\"display:flex;flex-wrap:wrap;gap:12px;margin-top:2px;\">\n        <button\n          type=\"button\"\n          id=\"rx-jak-calc-btn\"\n          style=\"appearance:none;border:0;border-radius:16px;padding:14px 18px;background:linear-gradient(180deg,#0f766e 0%,#115e59 100%);color:#fff;font:inherit;font-weight:700;cursor:pointer;box-shadow:0 12px 24px rgba(15,118,110,.22);display:inline-flex;align-items:center;justify-content:center;min-width:180px;\"\n        >Oblicz wynik<\/button>\n\n        <button\n          type=\"button\"\n          id=\"rx-jak-clear-btn\"\n          style=\"appearance:none;border:1px solid #cbd5e1;border-radius:16px;padding:14px 18px;background:#fff;color:#0f172a;font:inherit;font-weight:700;cursor:pointer;display:inline-flex;align-items:center;justify-content:center;\"\n        >Wyczy\u015b\u0107<\/button>\n      <\/div>\n\n      <div id=\"rx-jak-result\" style=\"display:block;border-radius:20px;padding:20px;border:1px solid #e2e8f0;background:#f8fafc;\">\n        <p id=\"rx-jak-result-title\" style=\"margin:0 0 8px;font-size:18px;line-height:1.3;font-weight:800;color:#0f172a;\">Wynik pojawi si\u0119 tutaj<\/p>\n        <p id=\"rx-jak-result-text\" style=\"margin:0 0 8px;\">Uzupe\u0142nij wyniki, screening i czerwone flagi, a nast\u0119pnie kliknij \u201eOblicz wynik\u201d.<\/p>\n        <p id=\"rx-jak-result-note\" style=\"margin:0;color:#475569;font-size:14px;\">Modu\u0142 bezpiecze\u0144stwa monitorowania inhibitor\u00f3w JAK: pokazuje brak oczywistych czerwonych flag, potrzeb\u0119 weryfikacji lub piln\u0105 flag\u0119 bezpiecze\u0144stwa.<\/p>\n      <\/div>\n\n      <div style=\"border:1px solid #e2e8f0;background:linear-gradient(180deg,#ffffff 0%,#f8fafc 100%);border-radius:18px;padding:16px 18px;color:#475569;font-size:14px;\">\n        <strong style=\"color:#0f172a;\">Uwaga:<\/strong> to narz\u0119dzie wspiera monitorowanie bezpiecze\u0144stwa leczenia inhibitorami JAK i nie zast\u0119puje decyzji klinicznej. W praktyce kluczowe s\u0105: infekcje, TB, p\u00f3\u0142pasiec, morfologia, w\u0105troba, lipidy, nerki oraz ryzyko VTE\/MACE\/nowotwor\u00f3w.\n      <\/div>\n    <\/div>\n  <\/div>\n<\/section>\n\n<script>\n(function () {\n  var calcBtn = document.getElementById('rx-jak-calc-btn');\n  var clearBtn = document.getElementById('rx-jak-clear-btn');\n\n  if (!calcBtn || !clearBtn) return;\n\n  function readValue(id, min, max, fallback) {\n    var v = parseFloat(document.getElementById(id).value);\n    if (isNaN(v)) v = fallback;\n    if (v < min) v = min;\n    if (v > max) v = max;\n    return v;\n  }\n\n  function getDrug() {\n    return document.getElementById('rx-jak-drug').value;\n  }\n\n  function isStart() {\n    return document.getElementById('rx-jak-phase-start').checked;\n  }\n\n  function expectedReviewDays() { return isStart() ? 30 : 90; }\n  function expectedCBCDays() { return 90; }\n  function expectedLFTDays() { return 90; }\n  function expectedLipidsDays() { return 90; }\n\n  calcBtn.addEventListener('click', function () {\n    var drug = getDrug();\n    var lastReview = readValue('rx-jak-lastreview', 0, 365, 30);\n    var anc = readValue('rx-jak-anc', 0, 20, 2.8);\n    var alc = readValue('rx-jak-alc', 0, 10, 1.4);\n    var hb = readValue('rx-jak-hb', 0, 20, 13.2);\n    var egfr = readValue('rx-jak-egfr', 0, 150, 90);\n    var altast = readValue('rx-jak-altast', 0, 20, 0.9);\n    var ldl = readValue('rx-jak-ldl', 0, 400, 115);\n    var lastCBC = readValue('rx-jak-lastcbc', 0, 365, 30);\n    var lastLFT = readValue('rx-jak-lastlft', 0, 365, 30);\n    var lastLipids = readValue('rx-jak-lastlipids', 0, 365, 60);\n\n    var tb = document.getElementById('rx-jak-tb').value;\n    var hbv = document.getElementById('rx-jak-hbv').value;\n    var vax = document.getElementById('rx-jak-vax').value;\n\n    var liveVax = document.getElementById('rx-jak-livevax').checked;\n    var infection = document.getElementById('rx-jak-infection').checked;\n    var tbExposure = document.getElementById('rx-jak-tbexposure').checked;\n    var zoster = document.getElementById('rx-jak-zoster').checked;\n    var vte = document.getElementById('rx-jak-vte').checked;\n    var mace = document.getElementById('rx-jak-mace').checked;\n    var cancer = document.getElementById('rx-jak-cancer').checked;\n    var hepatic = document.getElementById('rx-jak-hepatic').checked;\n    var pregnancy = document.getElementById('rx-jak-pregnancy').checked;\n    var recurrentInf = document.getElementById('rx-jak-recurrentinf').checked;\n\n    var redFlags = [];\n    var yellowFlags = [];\n\n    if (tb === 'positive') redFlags.push('dodatni \/ niezamkni\u0119ty problem TB');\n    if (liveVax) redFlags.push('\u017cywa szczepionka w nieprawid\u0142owym oknie czasowym');\n    if (infection) redFlags.push('aktywna klinicznie istotna infekcja \/ gor\u0105czka');\n    if (tbExposure) redFlags.push('ekspozycja na TB lub objawy sugeruj\u0105ce TB');\n    if (zoster) redFlags.push('aktywny lub \u015bwie\u017cy p\u00f3\u0142pasiec');\n    if (vte) redFlags.push('przebyta VTE lub aktualne objawy zakrzepicy \/ zatorowo\u015bci wymagaj\u0105 pilnej oceny');\n    if (hepatic) redFlags.push('objawy zaostrzenia choroby w\u0105troby \/ WZW');\n\n    if (drug === 'tofacitinib') {\n      if (alc < 0.75) redFlags.push('tofacytynib: ALC < 0,75 \u00d710\u2079\/L');\n      if (anc < 1.0) redFlags.push('tofacytynib: ANC < 1,0 \u00d710\u2079\/L');\n      if (hb < 9) redFlags.push('tofacytynib: Hb < 9 g\/dL');\n      if (altast > 5) redFlags.push('tofacytynib: ALT\/AST > 5 \u00d7 ULN');\n    }\n\n    if (drug === 'baricitinib') {\n      if (alc < 0.5) redFlags.push('barycytynib: ALC < 0,5 \u00d710\u2079\/L');\n      if (anc < 1.0) redFlags.push('barycytynib: ANC < 1,0 \u00d710\u2079\/L');\n      if (hb < 8) redFlags.push('barycytynib: Hb < 8 g\/dL');\n      if (egfr < 15) redFlags.push('barycytynib: bardzo ci\u0119\u017ckie upo\u015bledzenie nerek \/ schy\u0142kowa niewydolno\u015b\u0107');\n      if (altast > 5) redFlags.push('barycytynib: ALT\/AST > 5 \u00d7 ULN');\n    }\n\n    if (drug === 'upadacitinib') {\n      if (alc < 0.5) redFlags.push('upadacytynib: ALC < 0,5 \u00d710\u2079\/L');\n      if (anc < 1.0) redFlags.push('upadacytynib: ANC < 1,0 \u00d710\u2079\/L');\n      if (hb < 8) redFlags.push('upadacytynib: Hb < 8 g\/dL');\n      if (altast > 5) redFlags.push('upadacytynib: ALT\/AST > 5 \u00d7 ULN');\n    }\n\n    if (drug === 'filgotinib') {\n      if (alc < 0.5) redFlags.push('filgotynib: ALC < 0,5 \u00d710\u2079\/L');\n      if (anc < 1.0) redFlags.push('filgotynib: ANC < 1,0 \u00d710\u2079\/L');\n      if (hb < 8) redFlags.push('filgotynib: Hb < 8 g\/dL');\n      if (egfr < 15) redFlags.push('filgotynib: bardzo ci\u0119\u017ckie upo\u015bledzenie nerek \/ schy\u0142kowa niewydolno\u015b\u0107');\n      if (altast > 5) redFlags.push('filgotynib: ALT\/AST > 5 \u00d7 ULN');\n    }\n\n    if (tb === 'pending') yellowFlags.push('brak pe\u0142nego screeningu TB');\n    if (hbv === 'pending') yellowFlags.push('niepe\u0142ny \/ niejasny status HBV');\n    if (hbv === 'risk') yellowFlags.push('HBV wymaga planu monitorowania \/ wsp\u00f3\u0142pracy specjalistycznej');\n    if (vax === 'partial') yellowFlags.push('plan szczepie\u0144 wymaga uzupe\u0142nienia');\n    if (vax === 'unknown') yellowFlags.push('status szczepie\u0144 niezweryfikowany');\n\n    if (mace) yellowFlags.push('wysokie ryzyko sercowo-naczyniowe \/ przebyty MACE wymaga ostro\u017cno\u015bci');\n    if (cancer) yellowFlags.push('aktywny \/ \u015bwie\u017cy nowotw\u00f3r lub istotny wywiad onkologiczny wymaga indywidualnej oceny');\n    if (pregnancy) yellowFlags.push('ci\u0105\u017ca \/ planowanie ci\u0105\u017cy wymaga om\u00f3wienia');\n    if (recurrentInf) yellowFlags.push('wywiad nawracaj\u0105cych ci\u0119\u017ckich infekcji');\n\n    if (altast > 1.5 && altast <= 5) yellowFlags.push('podwy\u017cszone ALT\/AST wymagaj\u0105 weryfikacji');\n\n    if (lastCBC > expectedCBCDays()) yellowFlags.push('morfologia by\u0142a wykonana p\u00f3\u017aniej ni\u017c typowy interwa\u0142');\n    if (lastLFT > expectedLFTDays()) yellowFlags.push('ALT\/AST by\u0142y wykonane p\u00f3\u017aniej ni\u017c typowy interwa\u0142');\n    if (lastLipids > expectedLipidsDays()) yellowFlags.push('lipidy by\u0142y wykonane p\u00f3\u017aniej ni\u017c typowy interwa\u0142');\n    if (lastReview > expectedReviewDays()) yellowFlags.push('kontrola by\u0142a p\u00f3\u017aniej ni\u017c typowy interwa\u0142 dla tego etapu leczenia');\n\n    if (ldl >= 190) {\n      yellowFlags.push('LDL \u2265 190 mg\/dL \u2014 wymaga pilnej korekty ryzyka sercowo-naczyniowego');\n    } else if (ldl >= 160) {\n      yellowFlags.push('LDL 160\u2013189 mg\/dL \u2014 wymaga intensyfikacji oceny i leczenia ryzyka sercowo-naczyniowego');\n    } else if (ldl >= 130 && mace) {\n      yellowFlags.push('LDL \u2265 130 mg\/dL przy wysokim ryzyku sercowo-naczyniowym \/ po MACE');\n    }\n\n    if (drug === 'baricitinib') {\n      if (egfr >= 15 && egfr < 30) yellowFlags.push('barycytynib: ci\u0119\u017ckie upo\u015bledzenie nerek zwykle wymaga redukcji dawki \/ ostro\u017cno\u015bci');\n    }\n    if (drug === 'filgotinib') {\n      if (egfr >= 15 && egfr < 60) yellowFlags.push('filgotynib: upo\u015bledzenie nerek wymaga dostosowania \/ ostro\u017cno\u015bci');\n    }\n    if (drug === 'tofacitinib') {\n      if (alc >= 0.75 && alc < 1.0) yellowFlags.push('tofacytynib: niskie limfocyty wymagaj\u0105 wzmo\u017conej kontroli');\n    }\n\n    var result = document.getElementById('rx-jak-result');\n    var title = document.getElementById('rx-jak-result-title');\n    var text = document.getElementById('rx-jak-result-text');\n    var note = document.getElementById('rx-jak-result-note');\n\n    result.style.display = 'block';\n\n    if (redFlags.length > 0) {\n      result.style.background = '#fef2f2';\n      result.style.border = '1px solid #fecaca';\n      title.style.color = '#991b1b';\n      title.innerHTML = 'Czerwona flaga bezpiecze\u0144stwa';\n      text.innerHTML = 'Ten modu\u0142 wykry\u0142 istotne nieprawid\u0142owo\u015bci wymagaj\u0105ce pilnej weryfikacji i zwykle odroczenia rozpocz\u0119cia leczenia lub kolejnej recepty \/ dawki do czasu kontaktu z lekarzem prowadz\u0105cym.';\n      note.innerHTML = 'Wykryte problemy: ' + redFlags.join('; ') + (yellowFlags.length ? '. Dodatkowo: ' + yellowFlags.join('; ') : '') + '.';\n    } else if (yellowFlags.length > 0) {\n      result.style.background = '#fffbeb';\n      result.style.border = '1px solid #fde68a';\n      title.style.color = '#92400e';\n      title.innerHTML = 'Wymaga weryfikacji';\n      text.innerHTML = 'Brak oczywistych czerwonych flag w podanych progach, ale s\u0105 elementy wymagaj\u0105ce kontroli klinicznej, organizacyjnej lub korekty monitorowania.';\n      note.innerHTML = 'Do weryfikacji: ' + yellowFlags.join('; ') + '.';\n    } else {\n      result.style.background = '#f0fdf4';\n      result.style.border = '1px solid #bbf7d0';\n      title.style.color = '#166534';\n      title.innerHTML = 'Brak oczywistych czerwonych flag w tym module';\n      text.innerHTML = 'W podanych danych nie wykryto najwa\u017cniejszych sygna\u0142\u00f3w alarmowych u\u017cytych w tym kwalifikatorze.';\n      note.innerHTML = 'Pami\u0119taj o monitorowaniu morfologii, w\u0105troby, lipid\u00f3w, nerek oraz o czujno\u015bci na infekcje, p\u00f3\u0142pasiec, TB i ryzyko zakrzepowo-zatorowe \/ sercowo-naczyniowe.';\n    }\n  });\n\n  clearBtn.addEventListener('click', function () {\n    document.getElementById('rx-jak-drug').value = 'tofacitinib';\n    document.getElementById('rx-jak-lastreview').value = 30;\n    document.getElementById('rx-jak-phase-start').checked = true;\n    document.getElementById('rx-jak-anc').value = 2.8;\n    document.getElementById('rx-jak-alc').value = 1.4;\n    document.getElementById('rx-jak-hb').value = 13.2;\n    document.getElementById('rx-jak-egfr').value = 90;\n    document.getElementById('rx-jak-altast').value = 0.9;\n    document.getElementById('rx-jak-ldl').value = 115;\n    document.getElementById('rx-jak-lastcbc').value = 30;\n    document.getElementById('rx-jak-lastlft').value = 30;\n    document.getElementById('rx-jak-lastlipids').value = 60;\n    document.getElementById('rx-jak-tb').value = 'done-negative';\n    document.getElementById('rx-jak-hbv').value = 'done-low';\n    document.getElementById('rx-jak-vax').value = 'up-to-date';\n    document.getElementById('rx-jak-livevax').checked = false;\n    document.getElementById('rx-jak-infection').checked = false;\n    document.getElementById('rx-jak-tbexposure').checked = false;\n    document.getElementById('rx-jak-zoster').checked = false;\n    document.getElementById('rx-jak-vte').checked = false;\n    document.getElementById('rx-jak-mace').checked = false;\n    document.getElementById('rx-jak-cancer').checked = false;\n    document.getElementById('rx-jak-hepatic').checked = false;\n    document.getElementById('rx-jak-pregnancy').checked = false;\n    document.getElementById('rx-jak-recurrentinf').checked = false;\n\n    document.getElementById('rx-jak-result').style.display = 'block';\n    document.getElementById('rx-jak-result').style.background = '#f8fafc';\n    document.getElementById('rx-jak-result').style.border = '1px solid #e2e8f0';\n    document.getElementById('rx-jak-result-title').style.color = '#0f172a';\n    document.getElementById('rx-jak-result-title').innerHTML = 'Wynik pojawi si\u0119 tutaj';\n    document.getElementById('rx-jak-result-text').innerHTML = 'Uzupe\u0142nij wyniki, screening i czerwone flagi, a nast\u0119pnie kliknij \u201eOblicz wynik\u201d.';\n    document.getElementById('rx-jak-result-note').innerHTML = 'Modu\u0142 bezpiecze\u0144stwa monitorowania inhibitor\u00f3w JAK: pokazuje brak oczywistych czerwonych flag, potrzeb\u0119 weryfikacji lub piln\u0105 flag\u0119 bezpiecze\u0144stwa.';\n  });\n})();\n<\/script>\n","protected":false},"excerpt":{"rendered":"<p>Monitorowanie leczenia innowacyjnego Celowane leki innowacyjne (inhibitory kinaz janusowych \/ JAK) \u2014 Tofacytynib, Barycytynib, Upadacytynib, Filgotynib Interaktywny modu\u0142 do oceny bezpiecze\u0144stwa rozpocz\u0119cia lub kontynuacji leczenia inhibitorami JAK w reumatologii. Uwzgl\u0119dnia morfologi\u0119, nerki, w\u0105trob\u0119, lipidy, TB, HBV, infekcje, p\u00f3\u0142pasiec, ryzyko zakrzepowo-zatorowe i sercowo-naczyniowe. 1. Etap terapii i lek Wybierz lek oraz moment oceny bezpiecze\u0144stwa. Lek TofacytynibBarycytynibUpadacytynibFilgotynib&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"_kadence_starter_templates_imported_post":false,"_kad_post_transparent":"","_kad_post_title":"","_kad_post_layout":"","_kad_post_sidebar_id":"","_kad_post_content_style":"","_kad_post_vertical_padding":"","_kad_post_feature":"","_kad_post_feature_position":"","_kad_post_header":false,"_kad_post_footer":false,"_kad_post_classname":"","footnotes":""},"class_list":["post-450","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/rheumanext.pl\/pl\/wp-json\/wp\/v2\/pages\/450","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/rheumanext.pl\/pl\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/rheumanext.pl\/pl\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/rheumanext.pl\/pl\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/rheumanext.pl\/pl\/wp-json\/wp\/v2\/comments?post=450"}],"version-history":[{"count":4,"href":"https:\/\/rheumanext.pl\/pl\/wp-json\/wp\/v2\/pages\/450\/revisions"}],"predecessor-version":[{"id":1227,"href":"https:\/\/rheumanext.pl\/pl\/wp-json\/wp\/v2\/pages\/450\/revisions\/1227"}],"wp:attachment":[{"href":"https:\/\/rheumanext.pl\/pl\/wp-json\/wp\/v2\/media?parent=450"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}